By Laura Adair MS, PT, CHT
Does your hand hurt? Have you noticed strange sensations, discomfort, and weakness occurring more often? Do you find yourself rubbing or shaking your hands to get them to feel normal? Most people have experienced pain, numbness or weakness in their hands at one time or another. As we grow older these symptoms can become more persistent and interfere with our daily lives. Since the symptoms often develop gradually many people are not sure when to seek medical advice. Many people are afraid that there is no solution for their pain except surgery and therefore avoid seeing a doctor . Fortunately, surgery is not the only treatment and many patients can relieve their symptoms with non-surgical intervention. This article will explain two of the more common diagnoses of hand pain and possible solutions for each.
Do you have numbness or tingling in your hand? Does it wake you up at night or do you wake in the morning with the hand feeling numb and you have to shake it in order to “wake it up?” Do you have pain or numbness with daily activities such as driving, buttoning or blow drying your hair? Does your hand feel weak or do you occasion- ally get sharp pains into your palm or up your arm? These are all common complaints of patients with Carpal Tunnel Syndrome (CTS).
The carpal tunnel is the area at the base of your hand and is formed by the carpal (wrist) bones at the base and a thick sheath of connective tissue (ligament) over the top. The median nerve and nine different tendons that control your fingers travel through this tunnel. Carpal Tunnel Syndrome occurs when the median nerve and tendons become compressed or squeezed at the tunnel. CTS is usually caused by a combination of factors. Age, heredity, hormonal changes, diabetes, thyroid conditions, trauma, and hand use can all contribute to the development of CTS.
Early diagnosis and treatment of CTS can help prevent permanent damage to the median nerve and can often avert surgical intervention. The doctor will perform a thorough examination of the neck, arm and wrist in order to eliminate other sources of pain. The doctor may per- form special tests to provoke the tingling or numbness in order to help localize the origin of the symptoms to the wrist. Often an x-ray is taken to assure no bony problems are present. Sometimes, it is necessary to have a neurologist evaluate and perform electrodiagnostic tests such as nerve velocity conduction test (NCV) or electromyography (EMG). These tests help clarify the level of severity of nerve compression or damage.
Just as early diagnosis is important, so is early treatment. Non-surgical treatments are often successful in controlling symptoms in the early stages of CTS. Wearing splints at night, a short course of anti-inflammatory medication(aspirin, ibuprofen, etc), activity modification and therapy can often alleviate early symptoms. The doctor may recommend a corticosteroid injection to help de- crease the inflammation in the carpal tunnel. If all these treatments fail to relieve your symptoms or if the doctor feels there is a risk of perm anent damage to the nerve and tendons, surgery may be necessary. Surgery is generally done on an outpatient basis and consists of a small incision at the wrist allowing the surgeon to release the ligament at the top of the tunnel. This relieves the pressure in the tunnel resolving the symptoms in the vast majority of patients within a couple of months.
But what if your wrist and thumb are sore but you don’t have the numbness and tingling? Have you developed aching or sharp pain at the base of your thumb over the years? Do your symptoms increase with activities such as knitting, opening jars, using tools, using a computer mouse, or turning a key in the lock? Does your hand feel weak or achy after use? Do you have increased pain when you rub where the thumb meets the wrist? These are complaints common to arthritis at the thumb carpometacarpal (CMC) joint.
CMC arthritis is basically a “wear and tear” arthritis that affects women more than men and usually starts after the age of 40. It is the most common form of arthritis in the hand. CMC arthritis is usually a result of aging, hormonal changes, injury or the stress of daily use of the hand.
As with CTS, early diagnosis and treatment can prevent/ delay progression of CMC arthritis. The doctor will perform a thorough examination of your hand to rule out other conditions (like CTS). This exam may include palpating the joint and compressing the joint. X-rays are important to assess the amount of joint damage that has occurred. This, along with the patient’s symptoms will help the doctor determine th e level of appropriate treatment.
Initial treatment usually consists of protective splinting either with a premade splint or one that is fabricated by a therapist. It is critical to have the thumb immobilized along with the wrist in order to rest the CMC joint. Anti -inflammatory medication, rest and activity modification are also important initial treatments to help decrease CMC arthritis symptoms. Some doctors may recommend hand therapy to help treat the initial symptoms. If these measures are not effective, or the evaluation indicates further intervention the doctor may recommend an injection. A corticosteroid injection is often quite effective in providing significant relief of pain for an extended period of time. While the injection may provide relief, splinting and activity modification re- main important to help delay further damage to the joint.
In a small percentage of patients symptoms may persist, reoccur and/or interfere with daily function to the point that surgery is the only solution. A referral to a surgical hand specialist is very important. Surgeries usually consist of removing the damaged joint and rebuilding the joint with other tendons from the wrist and hand. The surgery is performed on an outpatient basis and usually requires complete immobilization in a cast for 4 to 6 weeks followed by hand therapy for splinting and progressive exercises for several weeks after the cast is removed. The majority of patients who undergo surgery and rehabilitation have excellent pain relief and in- creased functional use of the hand.
These are just two of the many reasons your hands may hurt. It is important to seek appropriate medical advice to determine what is causing your pain. One of the most critical factors in avoiding surgery is to diagnose and treat the problem in its early stages. Hopefully, this information has reassured you that there are often conservative, non-surgical treatment s that can provide significant relief of pain and increased function. Your hands are too important to ignore!