Hand, wrist and elbow conditions may affect bones, muscles, tendons or the surrounding nerves. The orthopedic specialists at Virginia Mason Franciscan Health treat a wide variety of these conditions, including carpal tunnel syndrome and Dupuytren's contracture. Learn more about these two common conditions and how our specialists can help.
Carpal tunnel syndrome (CTS) occurs when the median nerve that runs from the forearm into the palm side of the hand is compressed as it passes through the narrow carpal tunnel in the wrist.
People with carpal tunnel syndrome may experience any one or all of the following symptoms:
A neurologic test conducted by a doctor or neurologist aids in diagnosing the condition.
Studies have shown that use of a computer keyboard and mouse does not lead to, nor does it raise the risk of developing, carpal tunnel syndrome.
A medical history, physical exam and a neurologic exam with a doctor or neurologist will help confirm or rule out carpal tunnel syndrome. Several neurologic tests are available to help in the diagnosis, including:
Both conservative (nonsurgical) and surgical treatments are available for CTS, depending upon its severity. In mild cases, nonsurgical management is recommended first and includes a modification of activities with excessive vibration, repetitive motion, forceful gripping or excessive flexion and extension of the wrist. Wearing a wrist splint or brace during the day and at night can help keep the wrist straight and take pressure off the carpal tunnel. If symptoms are mild, steroid injections can be effective in treating carpal tunnel syndrome in the short term.
Surgery for CTS is an outpatient procedure done under local anesthesia in which the transverse carpal ligament of the wrist is divided. This creates more room in the carpal tunnel and relieves pressure on the median nerve.
Surgery to "release" the transverse carpal ligament that crosses the wrist resolves the problem in most cases. Recurrence is less than 5 percent.
Dupuytren's contracture is painless fibrous tissue formation under the skin on the palm of the hand and at the base of the fingers. The condition begins as lumps of painless tissue that are often mistaken for callouses. Over time thick bands of tissue can form, pulling the fingers down toward the palm.
The condition is hereditary but occasionally develops in individuals without any family history. Dupuytren's contracture is seen most often in people of Northern European and Scandinavian ancestry. It's not associated with occupation and doesn’t result from trauma. Its prevalence is approximately 10 times more frequent in men than in women.
It's likely, particularly if there is a family history of Dupuytren's.
In its advanced stages, Dupuytren's contracture is quickly assessed and diagnosed by a doctor. In its earlier bumpy phase, it's frequently confused with callouses.
Surgery used to be the only method to treat the contractures. Now a new technique is available that avoids the risks of surgery and shortens rehabilitation time. A specialized enzyme that will dissolve in one to three days (XIAFLEX®) is precisely placed into the hand by a trained specialist during an office visit. During a second visit a few days later, the finger is numbed and straightened. For most people, this manipulation will result in a near full correction. Specially trained hand therapists will then make a splint to help keep the fingers straight, and the patient will start a self-supervised course of therapeutic exercises.
Virginia Mason Franciscan Health’s board-certified hand surgeons have been specially trained and have extensive experience in safety and effectively administering XIAFLEX.
The injection only removes the tissue causing the contracture. The diseased tissue on either side of that location remains. Early studies show that injections done in the palm result in a recurrence rate of 50 percent at three years. Injections into fingers have a 62 percent recurrence rate. The good news is that many of the recurrences can be reinjected. Surgery has a 50 percent recurrence rate at five years.
Dupuytren's contracture is named after a French surgeon, Baron Guillaume Dupuytren (1777-1835) who put his name on the condition. The name is pronounced do-pee-truns.
If you cannot put your hand flat on a table top, it is time to see a hand surgeon. The standard recommendation is to consider surgery when the contractures approach 30 degrees, since that is when the disease starts to interfere with hand function.
For more information about treatment for Dupuytren's contracture, contact Virginia Mason's hand surgery team at 206-341-3000.
Our Orthopedics and Sports Medicine specialists are ready to treat your hand, wrist or elbow condition and get you back to doing the activities you love. Schedule an appointment today.