When you think about it, there is very little we do without the use of our hands. In fact, we use our hands in just about every task we take on during the day. Our hands serve us well and sometimes suffer from overuse or injury, causing pain that interferes with our lives.
Dr. Erin Forest is a board-certified, fellowship-trained orthopaedic surgeon at Vero Orthopaedics who specializes in hand and upper extremity surgery. “I went into orthopaedics because I can make a big difference fairly quickly and it’s fun to see people who have a disability be able to bounce back. I decided to focus on the upper extremity from shoulder to fingertip because it was my way to be a full orthopaedic doctor and still be specialized and be the end of the line for most conditions,” she said.
One condition Dr. Forest sees is “trigger finger,” which is common in people whose work or hobbies require repetitive gripping actions. It’s a condition in which one finger gets stuck in a bent position. Your finger may bend or straighten with a snap, like a trigger being pulled and released.
“Trigger finger is caused by tendonitis or inflammation around the tendon,” she explained. “It happens when extra swelling around the tendon gets pulled down into the palm and the swelling tissue gets hung up on a tunnel that normally allows the tendon to glide and generate force.”
Trigger finger can affect any finger, including the thumb, and it can affect more than one finger at a time and may occur on both hands. Common symptoms include finger stiffness and swelling; a popping sensation as you move your finger; or your finger catching or locking in a bent position.
“Trigger finger is often times worse at night where the swollen tissue will get stuck on the edge of the tunnel when someone makes a fist or curls their hand up into a ball while they are sleeping,” Dr. Forest said. “And many times, there is pain related to trying to get the finger or thumb straightened out.”
Fortunately, trigger finger can often be remedied with noninvasive treatments such as nonsteroidal anti-inflammatory drugs, rest, stretching or splinting. If the symptoms are severe or if conservative treatments haven’t helped, your doctor may suggest a steroid injection near or into the tendon sheath to reduce inflammation and allow the tendon to glide freely again.
There is also a procedure called a percutaneous release where your doctor inserts a needle into the tissue around your affected tendon and moves it and your finger to break apart the constriction that’s blocking the smooth motion of the tendon. This simple procedure can be done in the doctor’s office.
In more severe cases your doctor may suggest surgery and will make a small incision near the base of your finger and cut open the constricted section of tendon sheath. This type of surgery would be done in an operating room.
“We leave the tendon alone for the most part and just release the tissue around it,” Dr. Forest said. “It’s a release and not a repair so there is not a lot of restrictions after the surgery. People are able to go back to using their hands the same day.”
Carpel tunnel is another common hand problem caused by repetitive motions on the median nerve. The carpel tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, it can cause tingling, numbness or weakness in the hand and arm.
“There’s a nerve that goes through a tunnel and tendons that bend all of the fingers,” Dr. Forest continued. “Anything that closes the space for the nerve causes the nerve to slow down and it takes longer for the signal to get back to the brain. With carpel tunnel it’s also common to have the symptoms worse at night because of the position that people are in when the wrist and fingers are both bent at the same time. The tendons and nerves get pushed up against the roof of the tunnel and cause pressure on the nerve.”
According to Mayo Clinic, carpal tunnel syndrome symptoms usually start gradually. You may notice tingling and numbness in your fingers or hand. Usually the thumb and index, middle and ring fingers are affected but not your little finger. You might feel a sensation like an electric shock in these fingers or that sensation may travel from your wrist up your arm. These symptoms occur suddenly and sporadically while holding the phone, reading the paper or during your slumber. Many people shake or stretch their hands to relieve the symptoms but over time they may become constant.
Carpel tunnel has been linked to operating vibrating equipment, prolonged computer uses and even bike riding, although there is no conclusive evidence that any particular activity is a direct risk for carpel tunnel. While there are no proven prevention strategies, you can minimize stress on your hands and wrists by gently stretching and bending the hands and wrists periodically.
If you are working on a computer, make sure your keyboard is at elbow height or slightly lower and your computer mouse is comfortable and doesn’t strain your wrist. If you use equipment that vibrates or requires you to exert force, take periodic breaks and relax your grip.
Treatment options for carpel tunnel syndrome include wrist splinting, medications and surgery.
Surgery may be performed with two different techniques. Endoscopic surgery is a procedure where the surgeon uses a telescope-like device or ultrasound to see the inside of your carpal tunnel and cut the ligament through one or two small incisions in your hand and wrist. During open surgery, the surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.
One thing Dr. Forest advises is to consult a doctor when these conditions start interfering with your everyday life. “Orthopaedics is looking at the whole body and what’s going with it. We operate. We give advice. We refer for therapy. We are, first of all, doctors, secondly surgeons, so if you are going to see an orthopaedic surgeon it doesn’t mean the next thing that’s going to happen is surgery. It’s fine to just go in and get some information.”
Dr. Erin Forest has been with Vero Orthopaedics for six years and now practices out their new state-of-the-art facility at 3955 Indian River Blvd., Vero Beach. She can be reached at 772-569-2330.
