Carpal Tunnel Syndrome (CTS)
CTS is a condition of pain, numbness, and weakness associated with compression of the median nerve located in the wrist. It is often caused by pressure from swollen tissues and tendons. Symptoms include numbness and tingling in the hands, pain at night generally relieved with shaking the hands, pain in daytime radiating up the forearm, elbow, or shoulder, and weakness in the hand causing difficulty gripping.
Trigger finger is a condition of the finger that causes the finger to lock down to the palm in a flexed position. Signs and symptoms of trigger finger may progress from mild to severe and include stiffness, particularly in the morning, popping or clicking sensation as you move your finger, tenderness or a bump (nodule) at the base of the affected finger, finger catching or locking in a bent position, which suddenly pops straight, and the finger may lock in a bent position from which you are unable to straighten. Trigger finger more commonly occurs in your dominant hand, and most often affects your thumb or your middle or ring finger. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.
A Dupuytren's contracture is different than a trigger finger. This is a condition that causes thickening and shortening of the connective tissue in the palm of the hand though it may occur in conjunction with trigger finger.
One of the most common types of tendon lining inflammation is DeQuervain's Syndrome, a painful inflammation of certain tendons of the thumb. The swollen tendons cause friction within the narrow tunnel or sheath through which they pass. The result is pain at the base of the thumb. Symptoms include pain along the back of the thumb, pain with movement of the thumb particularly grasping and pinching, swelling on side of wrist at base of the thumb, and pain with pressure applied to the base of the thumb.
Epicondylitis (lateral and medial)
Lateral epicondylitis is also referred to as tennis elbow and is the most common overuse injury of the elbow, observed up to 10 times more frequently than medial epicondylitis. Lateral epicondylitis is usually precipitated by repetitive extension of the wrist and is characterized by aching pain that is worsened with activity. The patient usually describes lateral elbow pain of gradual onset and the aching pain generally increases with activity. The patient may describe symptoms occurring during simple activities of daily living (ADL), such as picking up a cup of coffee or a gallon of milk. Pain may be present at night. Symptoms are typically only on one side.
Medial epicondylitis is an overuse injury affecting inside of the elbow. Medial Epicondylitis often is discussed in conjunction with lateral epicondylitis, which occurs much more frequently. It is characterized by pain over the medial epicondyle (elbow). Pain worsens with activities of bending and pronating the wrist. Patients may report discomfort even when simply shaking hands with someone. History of an acute injury may be reported (eg, taking a divot in golf, throwing a pitch in baseball, a hard serve in tennis). Up to 50% of patients complain of occasional or constant numbness and/or tingling sensation that radiates into their fourth and fifth fingers, suggesting involvement of the ulnar nerve.
Treatments for these disorders pre-operative and post-operative may include:
Stretching, strengthening, and nerve and tendon gliding exercises, coupled with pain and anti-inflammatory modalities including ultrasound, paraffin, soft tissue mobilization, fluidotherapy, friction/scar massage, joint mobilization, ROM, iontophoresis, cryotherapy, and electrical stimulation.