Alternative
treatment for CT and CTS
Q: What do you do when standard
operations for carpal tunnel and cubital tunnel
syndrome simply do not work?
Pregnancy
and the Hands
Q: I am in my third
trimester of an uncomplicated pregnancy. I have
been waking up several times each night with my
hands feeling like they have no circulation. Is
this a problem with my nerves or blood vessels?
Q:
Is there a treatment to relieve the symptoms of
pregnancy related CTS?
Q:
Is surgery ever required for CTS during the pregnancy?
Q:
I was relieved when my numbness and tingling resolved
after delivery, but I have now developed pain
and swelling at the thumb side of my wrist. These
new symptoms make lifting my baby difficult. Is
this also CTS?
Wrist
Fractures
Oh the weather outside is frightful...especially
when you consider that sneaky patch of ice hidden
under the snow on the sidewalk, or that deceiving
little soft spot on the ski slope. With winter
weather comes the threat of falls, and falls increase
the amount of wrist fractures that occur as a
result of outstretched hands trying to brace these
falls.
To get a better understanding
of wrist fractures, their levels of severity and
the treatments associated with them, we turn to
Dr. Lawrence H. Schneider, co-founder of the Hand
Center and an expert in the field of injuries
to the hand and wrist.
Q: What
is the most common type of fracture to the wrist?
Q: If the wrist is broken
in place, how long can I expect to wear a cast?
Q: Does a fracture that requires
manipulative treatment need fixation with some
kind of surgical device such as metal pins, plates
or screws?
Q: How long will it take
for a fracture to heal with or without surgery?
Q: Will I need to undergo
frequent X-ray treatments?
Alternative
treatment for CT and CTS
Q: What do you do when standard
operations for carpal tunnel and cubital tunnel
syndrome simply do not work?
A: Carpal tunnel and cubital
tunnel syndromes are two of the most common upper
extremity ailments. In these conditions, compression
or entrapment of the median or ulnar nerve cause
the hallmark symptoms of pain and numbness in
the arm, hand, and digits. These syndromes usually
respond well to treatment, but some patients continue
to experience symptoms after surgery. In difficult
cases, patients may undergo revision surgery that
duplicates the first operation. Unfortunately,
re-operation of this kind often fails to improve
on the initial surgery, and patients remain symptomatic.
Patients with persistent symptoms after surgery
may also undergo endless physical therapy sessions
without any real benefit. When repeat surgery
and therapy fails, patients may hear the harsh
words that the surgeon has nothing more to offer,
and they must live with their discomfort.
To deal with this difficult and often relentless
problem, a new surgical approach has been developed.
This new procedure involves re-exploration of
the failed surgical site and correction of any
nerve compression. A section of vein is then wrapped
around the damaged nerve. The added padding from
the vein wrap protects and insulates the nerve
from compression and other external forces that
could cause scarring of the nerve. The type of
therapy and duration of recovery from the saphenous
vein wrap procedure is similar to that of simple
nerve compression. The results of patients undergoing
this new procedure are very promising. I am personally
able to report a success rate of 80% in a preliminary
series of patients having undergone repeat operations
with the vein wrap procedure.
After this new procedure, patients consistently
report fewer symptoms and better function compared
to their preoperative states. Many patients report
the ability to return to normal activity for the
first time since the beginning of their original
nerve compression symptoms. We are encouraged
by these early results and will continue to study
the effectiveness of saphenous vein wrapping.
It is our hope that this procedure will provide
relief to patients who historically have had little
hope of recovery. For more information about this
procedure, please feel free to contact the Philadelphia
Hand Center, P.C.
Pregnancy
and the Hands
Q:
I am in my third trimester of an uncomplicated
pregnancy. I have been waking up several times
each night with my hands feeling like they have
no circulation. Is this a problem with my nerves
or blood vessels?
A: Your symptoms are due to
carpal tunnel syndrome (CTS). The normal fluid
retention which occurs in the last trimester of
pregnancy causes compression of the median nerve
as it passes thru the carpal tunnel at your wrist.
As you curl up at night to sleep and bend your
wrist, you cause additional pressure on the nerve.
This results in the symptoms of numbness, tingling,
pain, and “no circulation” which cause
you to awake and shake your hand.
Q:
Is there a treatment to relieve the symptoms of
pregnancy related CTS?
A: The good news is that in
the vast majority of women the symptoms disappear
once the baby is delivered. The bad news is that
it frequently reoccurs with subsequent pregnancies.
The simplest treatment is to wear a wrist splint
when you sleep. This stops you from bending your
wrist. It is often all that is needed to stop
night symptoms. If your symptoms do not improve
with a splint, or are constant during the day,
a cortisone injection into the carpal tunnel is
recommended. The cortisone will relieve inflammation
of the nerve and surrounding tissues providing
good relief of your symptoms. Check with your
obstetrician if there are any reasons why you
would not be a candidate for an injection prior
to receiving one.
Q:
Is surgery ever required for CTS during the pregnancy?
A: On rare occasions in severe
cases surgery to release the carpal tunnel and
relieve nerve pressure is required. Surgery is
only performed when splints and injections do
not provide relief of symptoms or when there is
evidence that irreversible damage is occurring
to the nerve. Surgery is performed under local
anesthesia. This places you and your baby under
less risk than general anesthesia. Your obstetrician
should be consulted prior to carpal tunnel surgery
to determine if fetal monitoring is required during
and after surgery.
Q:
I was relieved when my numbness and tingling resolved
after delivery, but I have now developed pain
and swelling at the thumb side of my wrist. These
new symptoms make lifting my baby difficult. Is
this also CTS?
A: Your new symptoms are due
to DeQuervain’s Tenosynovitis. This is an
inflammation of the tendons that move the thumb.
These tendons run thru a tunnel on the thumb side
of the wrist. As they swell they rub in the tunnel
and cause pain. Any activity which requires use
of your thumb such as lifting your baby, opening
a jar, or holding a bottle will be painful. This
condition is treated initially with a splint which
supports the thumb and wrist. If this does not
provide sufficient relief of symptoms, then a
cortisone injection is placed around the inflammed
tendons. On occasion the tunnel must be surgically
released to relieve symptoms. You can also use
oral antiinflammatory medication like ibuprofen
if you are not breast feeding.
Wrist Fractures
Q:
What is the most common type of fracture to the
wrist?
A: The fracture of a distal
radius is the most common fracture of the wrist.
The distal end of the radius bone, which is one
of the two long bones in the forearm, can break
at the wrist after a fall when the victim lands
on an outstretched hand.
Q:
If the wrist is broken in place, how long can
I expect to wear a cast?
A: One should expect to wear
a cast for a period of 6-8 weeks to allow for
sufficient healing.
Q:
Does a fracture that requires manipulative treatment
need fixation with some kind of surgical device
such as metal pins, plates or screws?
A: Not necessarily, but this
should only be determined through evaluation from
an experienced physician and will depend on the
nature of the displacement as well as if the fracture
has occurred in several places. Keep in mind that,
as is the case with all ailments, recovery time
will vary for each individual as factors such
as the general condition, activity level, age,
attitude and overall expectations of the patient
all play critical roles in the healing process.
Q:
How long will it take for a fracture to heal with
or without surgery?
A: The recovery time for most
fractures of the wrist is usually a period of
6-8 weeks.
Q:
Will I need to undergo frequent X-ray treatments?
A: In most cases, the fracture
is X-rayed once, soon after it is put in place
and then once a week for a period of two weeks.
After that, additional x-rays are needed less
frequently until the fracture is fully healed.
