There are many structures in the wrist and hand that can cause pain. The pain from all these various structures van be very similar but their treatments may be quite different.
Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome is a condition well known to almost everyone. It represents a compression or relative tightness of one of the nerves of the hand called the median nerve as it passes through a “tunnel” as it crosses the wrist to the palm. The compression of this nerve at this level can lead to inflammation that can cause pain, numbness, and stiffness in the hands and fingers.
The median nerve or “carpal tunnel nerve” provides motor muscle function to only the muscle of the thumb, allowing the thumb to pinch the little finger with power and strength. The nerve’s primary function is a sensation on the palm side of the hand to the thumb, index, long finger, and also commonly half of the ring finger, but only rarely to the fifth finger. The diagnosis is usually made clinically, by a physical examination.
In a mild case, the treatment is usually relatively simple, consisting of resting the wrist in a slightly extended position, splinting the wrist again in a slightly extended position, and using anti-inflammatory medications to decrease swelling.
If you are pregnant however, this condition is as a result of your pregnancy and in most cases will resolve shortly after delivery.
Other Tunnel Problems
Tendonitis is an inflammation of a tendon. Pain in the thumb is most likely related to a group of tendons that extend and/or spread open the thumb that also passes through a tunnel. This tunnel keeps these tendons both in their functional proper alignment, and also keeps them from bow-stringing inefficiently. This inflammation and irritation can cause pain and localized swelling, limiting their function.
Ganglions
This is a herniation of either the lining of a joint or of the synovial lining sheath of a tendon. It is usually caused by an over-production of synovial joint fluid that has the usual function of nourishing the joint or a tendon. It can also result from an injury where the tissue has been torn recently or in the past and has weakened the lining sheath.
Arthritis
Arthritis is basically a “wear and tear” phenomenon. These wear and tears can cause micro fractures in the area of the joint that is called degenerative arthritis. The joint of the thumb is one of the most mobile joints in the body. Degenerative arthritis is more found in the mobile joints and therefore common at the base of the thumb. Other arthritic conditions include rheumatoid or systemic arthritis, which will require specific and often specialty diagnosis and treatment.
DR. JADALI’S APPROACH TO CARPAL TUNNEL IS TO PREVENT SURGERIES AS MUCH AS POSSIBLE. CONSERVATIVE MANAGEMENT OF THE PROBLEM THAT RANGES FROM APPROPRIATE BRACING THAT HE USUALLY MANUALLY ADJUSTS FOR EACH PATIENT TO NERVE BLOCKS, JOINT AND TENDON SHEATH INJECTIONS THAT DR. JADALI PERFORMS UNDER ULTRASOUND GUIDANCE TO MINIMIZE THE PAIN AND MEDICATIONS USED.