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Common Cycling Injuries

Since the 1800s when bicycles first made their appearance, cycling has become popular for commuting, recreation, exercise, and sport. Studies estimate that large numbers of these cyclists experience physical problems: 48 percent in their necks, 42 percent in their knees, 36 percent in the groin and buttocks, 31 percent in their hands, and 30 percent in the back. No matter why they use a bicycle, young people can follow some basic safety principles to avoid common cycling injuries.

WHAT ARE THE MOST COMMON CYCLING INJURIES AND HOW CAN THEY BE PREVENTED?

Knee Pain

The knee is the most common site for overuse injuries in cycling. Patellofemoral syndrome (cyclist’s knee), patella and quandriceps tendinitis, medial plica syndrome, and iliotibial band friction syndrome are a few of the more common knee overuse injuries. The first four injuries mentioned involve pain around the kneecap, while the last condition results in outer knee pain. Shoe implants, wedges beneath the shoes, and cleat positions may help prevent some overuse injuries.

Head Injuries

One of the most common injuries suffered by cyclists is a head injury, which can be anything from a cut on the cheek to traumatic brain injury. Wearing a helmet may reduce the risk for head injury by 85 percent. The majority of states have no laws governing the use of helmets while riding a bicycle, but helmets are readily available for purchase and typically low in cost.

Neck/Back Pain

Cyclists most likely experience pain in the neck when they stay in one riding position for too long. An easy way to avoid this pain is by doing shoulder shrugs and neck stretches that help relieve neck tension. Improper form also leads to injuries. If the handlebars are too low, cyclists may have to round their backs, thus putting strain on the neck and back. Tight hamstrings and/or hip flexor muscles can also cause cyclists to round or arch the back, which causes the neck to hyperextend. Stretching these muscles on a regular basis will create flexibility and make it easier to maintain proper form. Changing the grip on the handlebars takes the stress off of over-used muscles and redistributes pressure to different nerves.

Wrist/Forearm Pain or Numbness

Cyclists should ride with their elbows slightly bent (never with their arms locked or straight). When they hit bumps in the road, bent elbows will act as shock absorbers. This is also where changing hand positions will help reduce pain or numbness. Two common wrist overuse injuries, Cyclist’s Palsy and Carpal Tunnel Syndrome, can be prevented by alternating the pressure from the inside to the outsides of the palms and making sure wrists do not drop below the handlebars. In addition, padded gloves and stretching the hands and wrists before riding will help.

Urogenital Problems

One common complaint from male riders who spend a lot of time riding is pudendal neuropathy, a numbness or pain in the genital or rectal area. It is typically caused by compression of the blood supply to the genital region. A wider seat, one with padding, a seat with part of the seat removed, changing the tilt of the seat, or using padded cycling shorts will all help relieve pressure.

Foot Numbness and Tingling

Foot numbness and tingling are common complaints, and shoes that are too tight or narrow are often the cause. In addition, foot numbness can be due to exertional compartment syndrome. This arises from increased pressure in the lower leg and resulting compression of nerves. The diagnosis is made by pressure measurements and is treated with surgical release.

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Flexor Tendon Injuries

A deep cut on the palm side of your fingers, hand, wrist, or forearm can damage your flexor tendons, which are the tissues that help control movement in your hand. A flexor tendon injury can make it impossible to bend your fingers or thumb.

Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This causes parts of the body (such as a finger) to move.

The flexor tendons allow you to bend your fingers.

The muscles that move the fingers and thumb are located in the forearm. Long tendons extend from these muscles through the wrist and attach to the small bones of the fingers and thumb.

The tendons on the top of the hand straighten the fingers. These are known as extensor tendons. The tendons on the palm side bend the fingers. These are known as the flexor tendons.

When you bend or straighten your finger, the flexor tendons slide through snug tunnels, called tendon sheaths, that keep the tendons in place next to the bones.

A torn or cut tendon in the forearm, at the wrist, in the palm, or along the finger will make it impossible to bend one or more joints in a finger.

Because flexor tendons are very close to the surface of the skin, a deep cut will most likely hit a flexor tendon. In these cases, the tendon is often cut into two pieces.

Like a rubber band, tendons are under tension as they connect the muscle to the bone. If a tendon is torn or cut, the ends of the tendon will pull far apart, making it impossible for the tendon to heal on its own.

Because the nerves to the fingers are also very close to the tendons, a cut may damage them, as well. This will result in numbness on one or both sides of the finger. If blood vessels are also cut, the finger may have no blood supply. This requires immediate surgery.

Occasionally, flexor tendons may be partially cut or torn. With a partial tendon tear, it may still be possible to bend your finger, but not completely. These types of tears can be difficult to diagnose.

Causes of Flexor Tendon Injuries

In addition to cuts on the arm, hand, or fingers, certain sports activities can cause flexor tendon injuries. These injuries often occur in football, wrestling, and rugby. “Jersey finger” is one of the most common of these sports injuries. It can happen when one player grabs another’s jersey and a finger (usually the ring finger) gets caught and pulled. The tendon is pulled off the bone. In sports that require a lot of arm and hand strength, such as rock climbing, tendons and/or their sheaths can also be stretched or torn.

Certain health conditions (rheumatoid arthritis, for example) weaken the flexor tendons and make them more likely to tear. This can happen without warning or injury — a person may simply notice that his or her finger no longer bends, but cannot recall how it could have happened.

Symptoms of Flexor Tendon Injuries

The most common signs of a flexor tendon injury include:

  • An open injury, such as a cut, on the palm side of your hand, often where the skin folds as the finger bends
  • An inability to bend one or more joints of your finger
  • Pain when your finger is bent
  • Tenderness along your finger on the palm side of your hand
  • Numbness in your fingertip

Doctor Examination

It is important to see a doctor whenever the fingers are injured. This is especially true if your finger is jammed and you cannot bend or straighten your fingertip.

First Aid

When you have a serious cut to your hand or fingers, apply ice immediately. Tightly wrap your hand with a clean cloth or bandage to slow down the bleeding. Elevate your hand by keeping it lifted above your heart. See a doctor as soon as possible.

Your doctor may first clean and treat any wounds that are not deep. You may need a tetanus shot or antibiotics to prevent infection.

Physical Examination

These standard examination tests help your doctor determine if a tendon or nerve has been injured.

During the examination, your doctor will ask you to bend and straighten your fingers. To test your finger strength, your doctor may have you try to bend your injured finger while he or she holds the other fingers down flat. To determine whether any nerves or blood vessels have been injured, your doctor may test your hand for sensation and blood flow to the fingers.

Additional Tests

Your doctor may also order an x-ray to see if there is any damage to the bone.

Treatment of Flexor Tendon Injuries

Your hand may be placed in a splint for protection prior to surgery.

After examining your hand, your doctor may place your hand in a splint for protection.

Tendons cannot heal unless the ends are touching, which does not occur with a complete tear. In most cases, a cut or torn tendon must be repaired by a doctor. This requires surgery.

Surgery is usually performed within 7 to 10 days after an injury. In general, the sooner surgery is performed, the better recovery will be.

If your injury is restricting blood flow to your hand or finger, your doctor will schedule an immediate surgery.

Surgical Procedure

Because tendons tear in different ways — such as straight across, at an angle, or pulled right off of the bone — there are many different methods for your surgeon to repair them. All the methods for repair, however, involve special sutures, which are stitches.

Surgery is usually performed on an outpatient basis (you may go home the day of surgery). Your doctor will apply a dressing and splint after the surgery. Many doctors use a plastic type of splint to protect the repair. Your fingers and wrist will be placed in a bent position to keep tension off the repair.

After surgery, a splint is applied to limit movement and help the tendon heal.

Recovery from Surgery

It can take up to 2 months before the repair heals and your hand is strong enough to use without protection. It may take another month or so before your hand can be used with any force.

Soon after surgery, you will begin physical therapy. Specific exercises will help you gradually regain motion and function. Stiffness after surgery is common, but it usually responds to therapy.

Splint wear and proper exercise, exactly as prescribed by your therapist, are as important to recovery as the surgery itself.

Treatment for Partial Tears

Recent evidence suggests that partially torn tendons do not require surgery for good results. The same splinting and exercise programs that are used for surgery patients can be very effective for patients with partial tears, but with no surgery necessary.

This nonsurgical treatment option is appropriate only after the doctor has explored the wound to accurately assess the extent of the injury.

Long-Term Outcomes

Over the last several decades, advanced research and experience in the treatment of flexor tendon injuries have resulted in improved patient outcomes. Flexor tendon injuries, however, can be very challenging to treat.

Despite extensive therapy, some patients have long-term stiffness after flexor tendon injuries. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion.

Overall, flexor tendon surgery results in good return of function and high patient satisfaction.

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Hand and Wrist Injuries

Hand and wrist injuries are common following a fall onto an outstretched hand or in individuals involved in ball and contact sports or upper limb weight bearing sports (such as gymnastics). Patients suffering from hand and wrist pain are often seen in physiotherapy practice. Pain may be caused by local structures within or around the wrist or hand or occasionally, may be referred from other sources (such as the neck, upper back, shoulder or elbow).

One common clinical presentation is the patient suffering from sudden onset wrist pain typically as a result of a fall onto an outstretched hand, the cause of which is often torn ligaments or connective tissue around the wrist, such as a Sprained Wrist or occasionally a fracture such as a Radius Fracture or Scaphoid Fracture. In patients who experience finger trauma in ball or contact sports, a Sprained Finger or Thumb is often the result.

Gradual onset hand and wrist pain often develops as a result of overuse particularly in gripping activities such as racquet sports or manual work such as carpentry. One of the more common overuse wrist injuries is Wrist Tendonitis which involves gradual degeneration and inflammation of one or more wrist tendons. In those patients with associated neck, upper back, shoulder, elbow or forearm pain, Referred Pain (frequently from the neck, upper back, shoulder or elbow) is often the cause of symptoms. In older patients with gradual onset wrist pain associated with generalised wrist stiffness, Wrist Arthritis may be the source of symptoms. There are numerous other causes of hand and wrist pain, some of which present suddenly due to a specific incident, others which develop gradually over time.

Below are some of the more common causes of hand and wrist pain with a brief description of each condition to aid hand and wrist pain diagnosis. Conditions have been organised according to sudden or gradual onset and common or less common conditions for ease of use.

Metacarpal Fracture

A break in one of the metacarpal bones of the hand usually due to a punch, a direct blow to the back of the hand or a fall onto an outstretched hand. Associated with severe pain in the hand that may radiate into the wrist or fingers, in addition to swelling, tenderness on firmly touching the affected region of the bone, markedly reduced hand function and sometimes bony deformity.

Find out what may be causing your hand or wrist pain:

Sudden Onset Hand and Wrist Pain

Common Injuries

Sprained Wrist

Tearing of connective tissue and / or ligaments of the wrist joint typically as a result of a fall onto an outstretched hand causing the wrist to stretch excessively. Associated with pain in the wrist that may increase when firmly touching the affected region of the wrist joint, restricted wrist joint mobility and often swelling.

Sprained Finger

Tearing of connective tissue and / or ligaments holding the bones of the finger together typically following excessive stretching of the joint in one direction. Associated with pain on firmly touching the affected joint, restricted joint mobility and often swelling.

Sprained Thumb

Tearing of connective tissue and / or ligaments holding the bones of the thumb together typically following excessive stretching of the joint in one direction. Associated with pain on firmly touching the affected joint, restricted joint mobility and often swelling.

Radius Fracture

A break in the radius bone near the wrist usually due to a fall onto an outstretched hand. Associated with severe pain usually located on the thumb side of the wrist that may radiate into the thumb, hand or forearm, in addition to swelling, tenderness on firmly touching the affected region of the bone, markedly reduced wrist function and sometimes bony deformity.

Scaphoid Fracture

A break in one of the wrist bones located on the thumb side of the wrist (scaphoid) usually due to a fall onto an outstretched hand. Associated with severe pain at the time of injury that may settle to an ache, usually located on the thumb side of the wrist. Swelling, tenderness on firmly touching the affected region of the bone and markedly reduced wrist function are also present.

Phalanx Fracture

A break in one of the small bones of the finger (phalanges) usually due to a traumatic direct blow to the finger such as during ball or contact sports. Associated with severe pain in the affected finger, swelling, tenderness on firmly touching the affected region of the bone, markedly reduced finger function and sometimes bony deformity.

Wrist impingement / impaction syndromes

Pain in the wrist due to compression or pinching of structures within the wrist joint usually during a traumatic end of range wrist movement (e.g. a fall onto an outstretched hand), typically with the wrist in extension and in combination with weight bearing forces through the affected wrist (such as during gymnastics). Symptoms may increase on firmly touching the affected region of the wrist and on certain wrist movements.

TFCC Tear

Damage to cartilage tissue located on the little finger side of the wrist joint usually due to excessive compression forces often in association with twisting or side bending forces through the wrist such as a fall onto an outstretched hand, or during gymnastics, racquet sports or manual work such as using a hammer. Pain is usually located on the little finger side of the wrist and can occasionally radiate into the forearm or hand. There is usually tenderness on firmly touching the affected tissue and often swelling. Reduced grip strength may also be present. In some cases a clicking or catching sensation may be experienced during certain wrist movements.

Dislocated Finger

Tearing of connective tissue surrounding one of the finger joints with subsequent displacement and separation of the bones forming the joint so the joint surfaces are no longer situated next to each other (i.e. the finger often appears deformed). Typically occurs as a result of a traumatic impact to the finger such as during ball sports and causes severe pain in the finger, a feeling of the finger ‘popping out’, deformity of the finger joint and sometimes pins and needles or numbness.

Referred Pain

Pain referred into the wrist or hand from another source such as the neck, upper back, shoulder or elbow frequently associated with symptoms above the wrist and hand (such as in the neck, upper back, shoulder, arm, elbow or forearm). Typically associated with pain on firmly touching the region responsible for the referred pain and / or loss of movement in that region. Sometimes in association with pins and needles or numbness in the affected arm or hand.

Less Common Injuries

Hamate Fracture

A break in one of the small wrist bones located on the little finger side of the wrist usually following hitting the ground during a golf swing, swinging a tennis racquet, baseball bat or playing volleyball or due to a fall onto an outstretched hand. Associated with severe pain at the time of injury that may settle to an ache, usually located on the little finger side of the wrist / hand, on the palm side of the hand. Swelling and tenderness on firmly touching the affected bone are also typically present.

Lunate Fracture

A break in one of the small wrist bones located approximately in the middle of the wrist usually following a fall onto an outstretched hand. Associated with severe wrist pain at the time of injury that may settle to an ache and can occasionally radiate into the hand or forearm. Swelling and tenderness on firmly touching the affected bone are also typically present.

Distal Radio-Ulnar Joint Sprain

Tearing of connective tissue and / or ligaments of the joint located between the ends of the forearm bones just before the wrist typically as a result of a fall onto an outstretched hand, often in combination with twisting of the wrist and forearm. Associated with pain in the wrist that may increase when firmly touching the affected region of the joint, restricted wrist joint mobility (particularly rotation of the wrist) and often swelling.

Carpal Dislocation

Tearing of connective tissue joining adjacent small bones of the wrist with subsequent displacement and separation of the affected bones forming the joint so the joint surfaces are no longer situated next to each other. Typically occurs as a result of severe trauma such as a fall onto an outstretched hand and causes severe wrist pain, deformity of the wrist, pain on firmly touching the affected joint and sometimes pins and needles or numbness.

Kienbock’s disease

Gradual bony tissue death to one of the small bones located approximately in the middle of the wrist secondary to a loss of its blood supply. Typically occurs as a result of trauma to the wrist (such as a fall onto the outstretched hand). Usually associated with chronic pain located on the front or back of the wrist that increases on firmly touching the lunate bone and often reduced wrist range of movement. Pain may also increase during weight bearing activity through the wrist and general use of the hand. Most common in those aged in their twenties.

Finger Tendon Ruptures

Complete tearing of one or more finger tendons, typically following a traumatic incident such as a direct impact to the finger during ball or contact sports. Associated with pain and swelling in the finger that may radiate into the hand, significant weakness of the affected finger and often deformity of the finger (e.g. a bent finger) that typically cannot be straightened by using the affected finger alone. Pain may also increase on firmly touching the affected tendon at the level of the finger.

Ulnar Artery Aneurysm or Thrombosis

Damage to the ulnar artery located on the little finger side of the palm of the hand at the level of the hamate bone resulting in dilation of the artery and / or the formation of a blood clot. Typically occurs following trauma or repeated impact to this part of the hand (e.g. using this part of the hand as a hammer, or during a karate chop in martial arts). May result in pain, discolouration, numbness, coolness, pins and needles or numbness in one or more fingers and sometimes the little finger side of the palm of the hand. Occasionally, swelling or a mass on the little finger side of the palm of the hand at the level of the hamate bone may also be present.

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Common Causes of Numbness in the Hands

Many individuals experience occasional numbness in extremities due to posture and positioning while sitting or lying down. This type of numbness is typically the human body’s normal reaction to exerting weight and force on to certain nerves and areas of the body.

Ongoing, chronic, or debilitating numbness, however, is often caused by an underlying condition. The seriousness and risks associated with the numbness vary greatly depending upon the part of the body that is affected by the numbness and the underlying condition which is causing the symptom.

While numbness has been reported in nearly all parts of the human body, the hands are among the most common body parts associated with numbness, tingling, and sensations of “pins and needles”. Numerous conditions have the ability to cause numbness in the hands, though the most common include:

B12 Deficiency

Vitamin B12 plays a vital role in the overall function and health of the human body. Due to this fact, it is no surprise that a lack of B12 can cause problems such as numbness and tingling in the hands.

Individuals which do not consume Vitamin B12 through their diets (commonly those practicing vegetarian and vegan diets) are the most at risk for developing symptoms of B12 deficiency.

Peripheral Neuropathy

Commonly resulting from injury, infection, metabolic issues, hereditary conditions, and exposure to assorted toxins, peripheral neuropathy is an umbrella term for conditions affecting nerve function. These conditions often cause impairment of nerve function in the hands and feet, which may cause numbness, tingling, sensations, and weakness.

Type 2 Diabetes

Generally known as adult-onset diabetes, type 2 diabetes affects the human body’s process of metabolizing sugar, creating a resistance of the regulatory hormone known as insulin.

Among the many symptoms which type 2 diabetes is known to cause are numbness, tingling, pain, and sensations in the hands.

Alcoholism

Surprising to many, the long term effects of the abuse of alcohol are known to cause many seemingly strange conditions in the human body, such as nerve damage, which in turn has the ability to cause numbness in the hands and feet.

Carpal Tunnel Syndrome

A condition affecting hundreds of thousands of Americans each year, carpal tunnel syndrome is often associated with various hand symptoms, including numbness and tingling.

While those performing repetitive movements of the hands on a daily basis are more likely to suffer from carpal tunnel syndrome, this condition is not always necessarily caused by movements of the hands.

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Carpal Tunnel Syndrome

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What is carpal tunnel syndrome?

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What are the symptoms of carpal tunnel syndrome?

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

What are the causes of carpal tunnel syndrome?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. Carpal tunnel syndrome is also associated with pregnancy and diseases such as diabetes, thyroid disease, or rheumatoid arthritis.  In some cases no cause can be identified.

There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer’s cramp – a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity – is not a symptom of carpal tunnel syndrome.

Who is at risk of developing carpal tunnel syndrome?

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel.

How is carpal tunnel syndrome diagnosed?

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient’s complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.

Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments

Drugs – In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics (“water pills”) can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor’s prescription.) Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

Exercise – Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Alternative therapies – Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

Surgery

Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post-operative pain and a minimal scar.  It generally allows individuals to resume some normal activities in a short period of time.

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

How can carpal tunnel syndrome be prevented?

At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

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Hand, Finger and Wrist Injuries

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.

Finger, hand, or wrist injuries most commonly occur during:

  • Sports or recreational activities.
  • Work-related tasks.
  • Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
  • Accidental falls.
  • Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury.

In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, or a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

  • Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See a picture of a bruise (contusion) .
  • Injuries to ligaments. See a picture of a torn thumb ligament  as in skier’s thumb.
  • Injuries to tendons, such as mallet finger.
  • Injuries to joints (sprains).
  • Pulled muscles (strains).
  • Broken bones (fractures), such as a wrist fracture .
  • Dislocations.
  • Crushing injury, which can lead to compartment syndrome.

Overuse injuries

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by “overdoing” an activity or repeating the same activity. Overuse injuries include the following:

  • Carpal tunnel syndrome is caused by pressure on a nerve (median nerve ) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. See a picture of carpal tunnel syndrome .
  • Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
  • De Quervain’s disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed. See a picture of de Quervain’s disease .

Treatment

Treatment for a finger, hand, or wrist injury may include first aid measures; medicine; “buddy-taping” for support; application of a brace, splint, or cast; physical therapy; and in some cases, surgery. Treatment depends on:

  • The location, type, and severity of the injury.
  • How long ago the injury occurred.
  • Your age, health condition, and activities (such as work, sports, or hobbies).

Stop the pain and get your hand checked. Call +65 6471 2744 (24 Hours) or SMS to +65 9235 7641

Carpal Tunnel Syndrome

Do you often feel numbness or tingling in your hand, especially at night? Maybe you experience clumsiness in handling objects and sometimes you feel a pain that goes up the arm to as high as the shoulder. These may be the symptoms of carpal tunnel syndrome

The median nerve travels from the forearm into your hand through a “tunnel” in your wrist. Wrist bones form the bottom and sides of this tunnel and a strong band of connective tissue called aligament covers the top of the tunnel. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium, which may enlarge and swell under some circumstances. If the swelling is sufficient it may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain described above.

How is it diagnosed?

  • Numbness and tingling in the hands, especially when these symptoms occur at night and after use of the hands
  • Decreased feeling in your thumb, index, and long finger
  • The presence in your hand of an electric-like shock or tingling (like hitting your “funny bone”) when your doctor taps over the course of the median nerve at the wrist
  • The reproduction of your symptoms by holding your wrists in a bent down position for one minute

In some cases your doctor may recommend a special test called anerve conduction study. This test, done by a specialist, determines the severity of the pressure on the median nerve and may aid your orthopaedic surgeon in making a diagnosis and forming a treatment plan.

What causes it?
Anything that causes swelling, thickening or irritation of the synovial membrane around the tendons in the carpal tunnel can result in pressure on the median nerve.

Some common causes and associated conditions are:

  • Repetitive and forceful grasping with the hands
  • Repetitive bending of the wrist
  • Broken or dislocated bones in the wrist which produce swelling
  • Arthritis, especially the rheumatoid type
  • Thyroid gland imbalance
  • Sugar diabetes
  • Hormonal changes associated with menopause
  • Pregnancy

Although any of the above may be present, most cases have no known cause.

How is it treated?
Applying a brace or splint, which is usually worn at night and keeps your wrist from bending, may treat mild cases. Resting your wrist allows the swollen and inflamed synovial membranes to shrink; this relieves the pressure on the nerve. These swollen membranes may also be reduced in size by medications taken by mouth called non-steroidal anti-inflammatories. In more severe cases, your doctor may advise a cortisone injection into the carpal tunnel. This medicine spreads around the swollen synovial membranes surrounding the tendons and shrinks them, and in turn, relieves the pressure on the median nerve. The dosage of cortisone is small and when used in this manner it usually has no harmful side effects. The effectiveness of non-surgical treatment is often dependent on early diagnosis and treatment.

In those patients who do not gain relief from these non-surgical measures it ma be necessary to perform surgery. The site of the operation is made pain-free by local anesthesia injected either into the wrist and hand or higher up in the arm. The surgery itself is called a “release” – cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed in an outpatient facility and you are generally not required to stay over night.

Treatments
For mild cases, a splint or brace may be adequate. The usage of a splint or brace during the night could reduce the swelling, thereby reducing the pain. There are also oral medications that reduce the size of the swollen membranes.

For more severe cases, an anti-cortisone injection into the carpal tunnel may be the best solution. If none of these methods provide relief the next step would be surgery.

Surgical technique
The site of operation would be numbed by a local anesthesia either injected into the upper arm or the wrist by your anesthesiologist. Then the surgeon “releases” the tension in your wrist by cutting the top of the carpal tunnel to relieve the pressure.

Another method has proven to have a 99% success rate. We perform a flexor tenosynovectomy with a median neurolysis. This means that the surgery includes:

  • The removal of the flexor tenosynovium, which may be inflamed to cause discomfort for the patient.
  • The removal of the crushed median nerve trunk, which causes the numbness most patients with carpal tunnel syndrome complain about.
  • Either surgery technique can be done on an outpatient basis. No overnight hospital stay is required.

After surgery
Your symptoms may be relieved immediately or in a short period of time. Recovery period is about 10 days. Tenderness at the incision site may persist until healing is complete. Numbness may remain for a period of time. It may be several weeks before you can return to your normal level of physical activities.

You will be given hand exercises to do at home to help rebuild circulation, muscle strength and joint flexibility in your hand and wrist.

Stop the pain and get your hand checked. Call +65 6471 2744 (24 Hours) or Email to: info@boneclinic.com.sg

Carpal Tunnel Syndrome

Carpal tunnel syndrome is pressure on the median nerve – the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.

Causes

The median nerve provides feeling and movement to the “thumb side” of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.

Carpal tunnel syndrome is common in people who perform repetitive motions of the hand and wrist. Typing on a computer keyboard is probably the most common cause of carpal tunnel. Other causes include:

  • Sewing
  • Driving
  • Assembly line work
  • Painting
  • Writing
  • Use of tools (especially hand tools or tools that vibrate)
  • Sports such as racquetball or handball
  • Playing some musical instruments

The condition occurs most often in people 30 to 60 years old, and is more common in women than men.

A number of medical problems are associated with carpal tunnel syndrome, including:

  • Bone fractures and arthritis of the wrist
  • Acromegaly
  • Diabetes
  • Alcoholism
  • Hypothyroidism
  • Kidney failure and dialysis
  • Menopause, premenstrual syndrome (PMS), and pregnancy
  • Infections
  • Obesity
  • Rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma

Symptoms

  • Numbness or tingling in the thumb and next two or three fingers of one or both hands
  • Numbness or tingling of the palm of the hand
  • Pain extending to the elbow
  • Pain in wrist or hand in one or both hands
  • Problems with fine finger movements (coordination) in one or both hands
  • Wasting away of the muscle under the thumb (in advanced or long-term cases)
  • Weak grip or difficulty carrying bags (a common complaint)
  • Weakness in one or both hands

Exams and Tests

During a physical examination, the doctor may find:

  • Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
  • Weak hand grip
  • Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel’s sign)
  • Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen’s test)

Tests may include:

  • Electromyography
  • Nerve conduction velocity
  • Wrist x-rays should be done to rule out other problems (such as wrist arthritis)

Treatment

You may try wearing a splint at night for several weeks. If this does not help, you may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot and cold compresses may also be recommended.

There are many changes you can make in the workplace to reduce the stress on your wrist:

  • Special devices include keyboards, different types of mouses, cushioned mouse pads, and keyboard drawers.
  • Someone should review the position you are in when performing your work activities. For example, make sure the keyboard is low enough so that your wrists aren’t bent upward while typing. Your doctor may suggest an occupational therapist.
  • You may also need to make changes in your work duties or recreational activities. Some of the jobs associated with carpal tunnel syndrome include those that involve typing and vibrating tools. Carpal tunnel syndrome has also been linked to professional musicians.

MEDICATIONS

Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms for a period of time.

SURGERY

Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and its severity.

Outlook (Prognosis)

Symptoms often improve with treatment, but more than 50% of cases eventually require surgery. Surgery is often successful, but full healing can take months.

Possible Complications

If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

  • You have symptoms of carpal tunnel syndrome
  • Your symptoms do not respond to regular treatment, such as rest and anti-inflammatory medications, or if there seems to be a loss of muscle mass in your fingers

Prevention

Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury.

Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.

Stop the pain and get your hand checked! Call us at +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg

Boutonniere Deformity

Boutonnière deformity is an injury to the tendons in your fingers that usually prevents the finger from fully straightening. The result is that the middle joint of the injured finger bends down, while the fingertip bends back. This is the characteristic shape of a boutonnière deformity. Unless this injury is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning.

Anatomy

There are several tendons in your fingers that work together to bend and straighten the finger. These tendons run along the side and top of the finger. The tendon on the top of the finger attaches to the middle bone of the finger (the central slip of tendon). When this tendon is injured, the finger is not able to be fully straightened.

Causes of Boutonniere Deformity

Boutonnière deformity is generally caused by a forceful blow to the bent finger.

It also can be caused by a cut on the top of the finger, which can sever the central slip from its attachment to the bone. The tear looks like a buttonhole (“boutonnière” in French). In some cases, the bone actually can pop through the opening.

Boutonnière deformities may also be caused by arthritis. About one third of all people with rheumatoid arthritis also have fingers with boutonnière deformities.

Symptoms of Boutonniere Deformity

Signs of boutonnière deformity can develop immediately following an injury to the finger or it may develop seven to 21 days later.

  • The finger at the middle joint cannot be straightened and the fingertip cannot be bent.
  • Swelling and pain on the top of the middle joint of the finger.
Boutonnière deformity must be treated early to help you retain the full range of motion in the finger.

Nonsurgical Options

Nonsurgical treatment is usually preferred.

  • Splints: A splint will be applied to the finger at the middle joint to straighten it. This keeps the ends of the tendon from separating as it heals. It is important to wear the splint for the recommended length of time-usually 6 weeks for a young patient and 3 weeks for an elderly patient. Following this period of immobilization, you may still have to wear the splint at night.
  • Exercises: Your physician may recommend stretching exercises to improve the strength and flexibility in the fingers.
  • Protection: If you participate in sports, you may have to wear protective splinting or taping for several weeks after the splint is removed.

People with boutonnière deformity caused by arthritis may be treated with oral medications or corticosteroid injections as well as splinting.

Surgical Options

While nonsurgical treatment of boutonnière deformity is preferred, surgery is an option in certain cases, such as when:

  • The deformity results from rheumatoid arthritis.
  • The tendon is severed.
  • A large bone fragment is displaced from its normal position.
  • The condition does not improve with splinting.

Surgery can reduce pain and improve functioning, but it may not be able to fully correct the condition and make the finger look normal. If the boutonniere deformity remains untreated for more than 3 weeks, it becomes much more difficult to treat.

Diagnosis and Management of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common cause of motor and sensory symptoms in the hand. The complications that result can lead to limitations of activities of daily living and time away from work. This article summarizes the investigation and treatment of this disorder in light of the result from recent clinical trials.

Introduction

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and one of the most important causes of lost days at work. The incidence  is 139 per 100,000 person years for men and 506 for women.

The sex ratio varies from 2:1 in the UK to over 20:1 in South Korea. It is often present in both hands. Repetitive wrist movements, high-force hand grip and the use of vibrating tools have been associated with an increased prevalence. In many countries, CTS is recognized as a compensable occupational disease.

Anatomy and Pathophysiology

The medial cord of the brachial plexus from roots C8 and T1 from the motor supply of the median nerve while sensory fibres from the lateral aspect of the hand run in the lateral cord, from roots C5, C6 and C7. The terminal branches of the median nerve supply the thenar muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis) and the lateral two lumbricals. A number of anomalies are found in normal individuals at all levels of the nerve, e.g. the median and musculocutaneous nerve may be fused, the ulnar may supply all the thenar muscles and the median may supply the intrinsic muscles. These variations need to be considered during electrophysiological assessment. The floor and sides of the carpal tunnel are formed by the eight carpal bones. The tranverse carpal ligament forms the roof; it is attached to the hook of hamate and pisiform on the ulnar side and the scaphoid and trapezium on the radial side.

CTS is a sonsequence of compression of the median nerve within the carpal tunnel resulting in mechanical compression and local ischaemia. A rise in intracarpal canal pressure leads to reduced epineural blood flow and intrafascicular oedema. Histological examination of synovial biopsies shows a marked increase in fibroblast density, collagen fibre size and vascular proliferation compared with controls, changes that are similar to those seen after injury to other tissues. With time, changes in the myelin sheath and axonal injury are evident on nerve conduction testing. Over its long course, the median nerve becomes susceptible to compression at sites other than the carpal tunnel. In the pronator syndrome, the nerve is compressed by the pronator teres muscle, causing numbness in the hand and forearm tenderness. A proximal branch of the median nerve, the anterior interosseus nerve, may be compressed, producing weakness confined to the flexor pollicis longus, flexor digitorum profundus and pronator quadratus but without sensory loss.

Carpal Tunnel Syndrome

 Diagnosis

The clinical features in patients with electrophysiologically confirmed CTS are variable, but numbness over the lateral aspect of the hand is a typical feature of the syndrome, which may be more obvious during sustained grip, such as while reading a newspaper or driving. Initial symptoms may be intermittent but become more sustained as disease progresses. Awakening from sleep or symptoms upon awakening are common complaints. The majority of cases are idiopathic, but CTS is associated with conditions such as diabetes mellitus, renal dialysis, rheumatoid arthritis, thyroid dys-function, pregnancy and use of oral contraception.

Most CTS patients present with these classical symptoms but clinicians should be aware of atypical presenting feature.

A self-administered hand diagram has been devised to classify the level of centainty of the diagnosis into classic, probable, possible and unlikely; however, it was found to be unhelpful in the Asian population. Individuals with a high body mass index (BMI) of >29 are 2.5times more likely to develop CTS thatn those with a BMI <20.

Summary

For patients with CTS associated with other medical conditions such as hypothyroidism, treatment of the underlying disorder alone may resolve hand symptoms. Advise on avoiding activities that would exacerbate the disease should be given. Carpal Tunnel decompression is recommended at the outset for patients who have clinical or electrophysiological evidence of severe CTS and in those with symptoms of acute onset (e.g. post-traumatic). Splinting with or without steroid injection would be the first line treatment for patients with mild to moderate CTS, in view of the fact that a minority  would respond with first line treatment. Carpal tunnel release can be subsequently offered to those who do not respond to splinting and anti-inflammatory injection and to those who relapse. Failure to respond to carpal tunnel release is unusual; reasons include initial misdiagnosis, incomplete division of the flexor retinaculum, iatrogenic nerve branch injury and perineural fibrosis. Re-examination of the diagnosis and surgical re-exploration should be considered in these cases.