Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Methodist Bone & Joint Center

Our Services - Hand and Wrist Conditions

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition affecting the median nerve, which passes from the thumb and forefingers to the wrist. This nerve runs through a space known as the carpal tunnel. When the tunnel is damaged or strained - usually through overuse and repetitive daily motions - it compresses the nerve, causing pain in the palm and fingers. Treatment for carpal tunnel syndrome may involve a splint on the hand to help prevent wrist movement and decrease the compression of the nerves inside the tunnel. Anti-inflammatory medications will help to reduce swelling and pain. In some cases, your doctor may use surgery to relieve the pressure within the carpal tunnel.

deQuervain's Tendonitis

DeQuervain’s tendonitis is an inflammation of tendons around the wrist, causing pain and swelling near the bottom of the thumb and in the forearm. Using a splint upon the wrist is preferred to treat this form of tendonitis, since it will prevent movement and relieve stress upon the tendons. A brace may be worn, however, if you aren’t able to refrain from the activities that caused the condition. As with other types of tendonitis, medications and physical therapy are also effective treatments.

Wrist Synovitis

Synovial membrane is a type of tissue that lines the cavities of joints. When this tissue becomes inflamed, it is known as synovitis. Patients with rheumatoid arthritis (a systemic condition affecting joints, organs and other tissues) are at a higher risk for developing inflammation in the synovial membrane.
A combination of surgery and physical therapy can treat wrist synovitis. The surgery (called a synovectomy) removes the damaged tissue, and new tissue grows in its place. Physical therapy will help you regain a full range of motion after surgery.

Focal Hand Dystonia

Also known as writer’s cramp, focal dystonia in the hand causes unwanted muscle contractions and lack of control over hand and wrist movements. Musicians and writers are especially prone to hand dystonia, as it is worsened by repetitive motions of the fingers. To date, the most effective treatment for focal dystonia is botulinum toxin (Botox) injections, which relax the muscles and prevent spasms.

Guyon's Canal Syndrome

Guyon’s canal syndrome is a condition similar to carpal tunnel syndrome, but involves the ulnar nerve (which provides sensation to the pinky and a portion of the ring finger). This nerve also helps give the hand the ability to grasp objects. Patients with Guyon’s canal syndrome often have uncomfortable sensations of pins and needles in the fingers. This condition is usually simple to treat, however, with medications, a brace, and other therapies.

Hypothenar Hammer Syndrome (HHS)

Hypothenar hammer syndrome (HHS) occurs when there is not enough blood flow to the fingers, causing them to become numb and limiting their movement. Repetitive grinding or twisting movements using the palm of the hand – particularly the fleshy edge, known as the hypothenar eminence – cause this condition by damaging the ulnar artery, which supplies blood to the fingers. If the condition is severe enough, some patients may show discoloration in the fingers and will be sensitive to colder temperatures.
A brace can help to keep the wrist straight and provide some padding for the palm, preventing damage to fragile blood vessels. However, the best treatment is to refrain from the activities that are causing the problems.

Trigger Finger

Trigger finger is characterized by a 'catching' movement of a finger when it is extended. The finger will become locked in this position until the tendon forces itself to straighten, making a clicking noise as it pops into place. Those who are frequently gripping tools or instruments (such as musicians or construction workers) can develop this condition.
The most effective treatment for trigger finger is to keep the tendon at a rest position, especially after strenuous activity. In serious cases, the condition may require minor, outpatient surgery.

Distal Radioulnar Joint (DRUJ) Injury

The distal radioulnar joint (DRUJ) allows the wrist to rotate. Arthritis and injury to this joint can cause inflammation (tendonitis) in the DRUJ and the surrounding tendons in the wrist. Treatment will depend upon the cause of the inflammation, but may include a combination of physical therapy, a cast, and medication. Surgery may be an option for patients with advanced cases of tendonitis.

Triangular Fibrocartilage Complex (TFCC) Tears

The triangular fibrocartilage complex (TFCC) is a set of cartilage and ligaments found on the outer side of the wrist. TFCC injuries are usually caused by falling directly upon an outstretched hand, making them more common in tackling or close-contact sports like football or basketball, but tears can also result from overuse or strain.
A tear in this fragile complex will cause an inability to rotate your wrist without great pain. Your doctor may prescribe the RICE (rest, ice, compression, elevation) method to bring down swelling from a TFCC tear, along with a cast, medication and physical therapy.

Wrist Sprain

Wrist sprains are common after falls, because of the natural instinct to “catch” oneself and land on the hands during the fall. If you injure your wrist, you should immediately employ the RICE (rest, ice, compression, elevate) method to keep swelling and pain at a minimum and seek medical attention.
Wrist sprains can also stretch and tear the ligaments around the wrist joint, making it prone to further injury. Surgery and physical rehabilitation may be necessary to restore and strengthen the ligament.

Ganglion Cysts

Ganglion cysts are small sacs of fluid that can develop within the ligaments surrounding the wrist joint. While most of these cysts are harmless and may not interfere with everyday activities, large and painful cysts require medical treatment. Large cysts may also put pressure on the nerves within the hand, causing problems with movement and sensation. Your physician may drain the cyst to reduce its size and pressure, or may surgically remove the problem cyst.

Osteoarthritis

The breakdown of cartilage in a joint and its neighboring bone is known as osteoarthritis. Over time, osteoarthritis can cause symptoms such as joint pain, stiffness, limited movement, numbness and weakness. Overuse (or underuse) of the hips, knees, fingers, feet and spine can contribute to this condition. Exercise, physical therapy, medication and/or surgery may be used to treat osteoarthritis.

Metacarpal Fractures

The metacarpal bones are located at the base of the fingers inside the palm of the hand. Fractures to these bones typically occur because of sudden force to the area (as with a punch or a blow). After a metacarpal fracture, your doctor will use a splint to keep the hand immobile to prevent further damage or misalignment while the bones are healing. If the bones heal incorrectly, this could increase your risk of arthritis or other long-term conditions.

Triquetral Fractures

Triquetral fractures occur when the ulna bone (connecting the hand and wrist) becomes separated from the carpal bones (located at the bottom of the palm). It can be caused by falling on an outstretched hand, by receiving a hard blow to the hand, or anything that applies sudden, extreme force onto the palm. As with other fractures, a cast and/or splint will be needed to aid healing. Your recovery may take up to three months, depending upon the severity of the injury.

Thumb Dislocation & Fracture

Most injuries to the thumb occur between the joints, especially near the wrist at the base of thumb. Most fractures are so severe that moving or using the thumb is nearly impossible. A misshapen appearance and a loss of sensation are not uncommon after a thumb injury.
If the bone is fractured, but it is still in place, a splint will be sufficient to treat the fracture. If the bone fragments have been displaced (completely separated), your surgeon will use screws and/or wire along with a cast to keep the pieces in place during your recovery.