Frequently Asked Questions

The technical term is stenosing tenosynovitis. This occurs when a tendon (which is what moves the finger or thumb) is swollen and it cannot slide through the tight tunnel which keeps the tendon next to the bone. At times the tendon may even have a knot in it. When this knot is forced into the tunnel or out of it, the finger will trigger. Every time the finger triggers it swells more and the process worsens. Though the problem is in the palm at the level of the creases, it can feel as though it is in the finger itself.

Most times the cause is unknown but it can be associated with rheumatoid arthritis and diabetes.

A trigger finger can start as discomfort at the base of the thumb or the finger but not yet start to trigger.

The goal is to stop the locking and the pain. In the early period, a splint at night can be worn to prevent locking at night and thereby decrease swelling in the tendon. Anti-inflammatory medicine (Advil) can be taken to decrease the swelling also. Often times a cortisone shot is used to control the swelling. Only two shots of cortisone are given and are separated by one month. This prevents weakening of the tendon which can then result in rupture.

Surgery works very well to stop the locking and get rid of the pain. Under local anesthesia (novacaine) a cut is made in the palm and the tight tunnel is cut. Then you are asked to make a fist to show that there is no more triggering. You are moving your hand the same day and have to limit the lifting for the first week. Flexion contracture can develop in some patients, especially diabetics. Therapy can be utilized to resolve this but at times it is permanent.

It is an irritation of the tendons of the thumb side of the wrist. Two of the tendons that move the thumb are swollen and cannot slide through their tunnel normally. It can be gradual in onset or can come from a traumatic episode.

Though it can happen in anyone, it is associated with overuse and is oftentimes seen in new mothers (from lifting the baby).

A history of pain and swelling, sometimes a lump, on the thumb side of the wrist is usually a giveaway. On examination, tenderness over the tendons and pain with deviation of the wrist away from the thumb while the thumb is clasped (Finkelstein's test) are positive signs of the problem.

Conservative treatments start with anti-inflammatory medication (Motrin) and splinting that includes the thumb. Some patients will find it difficult to work with this splint on. Cortisone shots in the area will help to relieve the inflammation and get rid of the problem possibly forever.

Under local anesthesia the tight tunnel is release to make more room for the tendons. The biggest risk of the surgery is injury to a nerve in the area of the tunnel. This can cause chronic pain and number and is difficult to treat. It happens less than 1-percent of the time.

Most patients get better in less than 6 weeks but some take up to 6 months for full recover. Some patients will require therapy.

CTS is pressure on the median nerve at the wrist causing numbness and tingling in the thumb, index, middle and ring fingers.

Swelling of the tendons at the wrist, fractures and arthritis are some known causes of the condition. It is also associated with thyroid conditions, diabetes and rheumatoid arthritis. Some pregnant women will get CTS from fluid retention. In these cases the symptoms will cease after childbirth. In many cases the cause is unknown.

Numbness and tingling or pain in the thumb, index, middle and ring fingers are the classic signs of CTS. Most often, the symptoms are at night and can awaken people from sleep. Others report symptoms when they are driving a car or reading a newspaper. A careful history and exam will often uncover the diagnosis of CTS.

Nerve conductions studies (NCS) and electromyography (EMG) are tests that will document the severity of the CTS. These are ways to test the speed at which the nerve is transmitting impulses across the wrist and also to tell if the muscles of the thumb are being affected.

Splints at night to stop wrist flexion are a mainstay of treatment. In some patients anti-inflammatory (Advil, etc.) medicines are used with success. Therapy is another option to try to allow the nerve and the tendons in the carpal tunnel to glide better. Cortisone shots can be effective if the symptoms are intermittent and present for less than one year.

Those with persistent numbness and tingling, wasting of the thumb muscles or a positive EMG to show these muscles are affected and those who are fed up with the symptoms and have failed other treatments should consider surgery.

Under local anesthesia (novacaine) with a light sedation currently in a hospital setting the transverse carpal ligament is released. This tight band of tissue is exposed through a cut in the palm. The patient goes home the same day and is encouraged to move their fingers but should not do any heavy lifting until advised by the surgeon.

The symptoms at night usually go away the first night. Return of sensation to the fingertips can take several months. In severe cases the sensation will not return because the CTS has led to permanent nerve damage. If there is wasting of the thumb muscles, this will not reverse after the operation. Far and away, most patients that get CTS surgery will never have a return of the symptoms. There is a small percentage of patients that will get recurrent CTS and an even smaller number that will not get better from the surgery.

Oftentimes people are disappointed with CTS because they are expecting too much from the surgery. The operation is designed to fix a nerve problem. It will not treat associated arthritis, tendonitis or conditions that are not caused by compression. The most reliable symptom treated is the waking up from sleep. If patients understand this before surgery they will not be disappointed with the operation.