Texas Hill Country Orthopaedics and Sports Medicine, P.A.
813 S Milam St
Fredericksburg, TX 78624
To Schedule An Appointment
Call 830-997-4043
Expert Hand and Elbow Care
Carpal Tunnel Syndrome
Mini-incision Carpal Tunnel Release
Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. It happens when the median nerve, which is one of the main nerves in your hand, gets squeezed or pressed as it passes through your wrist.
For most people, carpal tunnel syndrome gets worse over time. If it is not treated, it can cause lasting damage to the hand, including loss of feeling in the fingers and weakness. That is why it is important to find and treat the condition early.
Early symptoms can often be helped with simple treatments, such as:
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Wearing a wrist brace while sleeping
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Doing exercises to help the nerve move freely
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Avoiding activities that make your symptoms worse
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Getting a steroid shot in the wrist to reduce swelling and pressure on the nerve
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.
The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size.
The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck; these roots then come together to form a single nerve in the arm.
The median nerve travels down the upper arm, across the elbow, and into the forearm, then passes through the carpal tunnel at the wrist on its way to the hand and fingers. It separates into several smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger, and half of the ring finger (the thumb side).
Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the tissue surrounding the flexor tendons (known as synovium) swells, putting pressure on the median nerve and reducing its blood supply.
This abnormal pressure on the nerve can result in numbness, tingling, pain, and weakness in the hand.
Texas Hill Country Orthopaedics Surgeons are trained to treat carpal tunnel syndrome with advnaced, minimal-incision techniques. Call for an appointment today!
Trigger Finger
Trigger finger, also called stenosing tenosynovitis, is a condition affecting tendons in your fingers or thumbs that prevents them from bending normally. It causes a sensation of catching, locking, or "triggering" of the finger or thumb when you try to bend or straighten them. It can also cause pain and stiffness.
Surgery may be needed if:
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Your trigger finger symptoms are severe or do not get better with other treatments.
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Your finger is stuck in a bent position and cannot be straightened
The surgical procedure for trigger finger is called a trigger finger release.
Trigger Finger Release
Trigger finger release is an outpatient procedure, meaning you come in and go home the same day. Before the procedure, the area is numbed with a shot. You can be awake or lightly sedated.
Your doctor will make a small cut in your palm or use the tip of a needle to open up the A1 pulley. This gives the tendon more room to move freely. Opening the A1 pulley does not hurt hand function as long as the other pulleys are left in place.
Occasionally, your doctor will need to remove part of a tendon if opening the A1 pulley does not resolve the triggering. This is more likely in patients who have had triggering for a long time.
Thumb Pain/Arthritis
Arthritis is a condition where the cartilage inside a joint breaks down or wears down over time. In the thumb, the most common site for arthritis to develop is the joint at the base of the thumb — also known as the thumb carpometacarpal (CMC) joint.
Although there are several types of arthritis, the one that most often affects the base of the thumb is osteoarthritis (degenerative, or wear-and-tear, arthritis).
Thumb CMC arthritis happens when the cartilage inside the joint wears down over time. When the cartilage wears down, the bones begin to rub together, causing pain. Some things can make you more likely to get this condition:
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Being female: Women are 2 to 3 times more likely to get this condition
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Being over the age of 50: With time, there is wear and tear on the joint that breaks down the cartilage
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Having a family member with the same condition
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Being overweight
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Having a past injury to the thumb or wrist
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Having "loose" joints
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Doing jobs or activities that involve a lot of gripping, pinching, or heavy lifting
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Smoking
Thumb CMC arthritis can be managed without surgery in many cases. Options include:
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Ice. Applying ice to the joint for 5 to 15 minutes several times a day can help with pain and swelling.
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Activity modification. To reduce pain of the thumb, avoid both activities that make symptoms worse and using tools and equipment.
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Splinting. A splint that supports the base of the thumb can reduce pain during activities or overnight.
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Exercises. Gentle exercises can improve the range of motion and strengthen the muscles of the thumb. These can be done with a hand therapist.
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Medications. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help with pain. A topical NSAID gel (such as diclofenac) applied directly to the joint is another option and may have fewer side effects than oral medications.
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Injections. A steroid shot directly into the joint is an option. While the injection can provide relief in some people, the effect may wear off over time. There are also risks, which your doctor will discuss with you.
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Awareness. Some patients are reassured by knowing that this condition is not dangerous. In many people, it may become less bothersome over time with or without any specific treatment, and they are able to change their activities to work around any hand problems.
If nonsurgical treatment is no longer effective, surgery is an option. The operation can be performed on an outpatient basis, meaning you go home the same day.
There are several procedures available. The Texas Hill Country Ortho Team is well-versed on the latest technology and techniques to treat thumb arthritis.