Health hotline: Doctors to answer questions on hand, wrist and elbow conditions and injuries

Published: Thursday, Sept. 6 2012 7:00 p.m. MDT

Jackie Schmidt, TOSH hand therapist, and Dr. Patrick Olson, TOSH orthopedic surgeon, pose for a portrait at TOSH, The Orthopedic Specialty Hospital, in Murray on Thursday, Sept. 6, 2012.

Kristin Murphy, Deseret News

SALT LAKE CITY — Contrary to popular belief, spending too much time at a computer keyboard doesn't necessarily lead to carpal tunnel syndrome.

The painful hand and wrist condition is common in middle-aged women, as well as for people with diabetes, hypothyroidism and those who are obese. But it isn't very prevalent in people who spend a lot of time hunched over a keyboard, said orthopedic surgeon Dr. Patrick Olson.

"We're just not seeing it in younger populations that tend to do more typing and spend more time on the computer," he said. The association of the condition to occupational exposure remains unclear.

Similarly, occupational hand therapist Jackie Schmidt said she has yet to see a case of tennis elbow that resulted from a patient playing too much tennis.

"It's not just stiffness in your elbow," she said. "That may be one symptom, but it develops from not getting good blood supply to one of the tendons there and that can be caused by a number of things."

The most common conditions to the upper extremities — in addition to carpal tunnel syndrome and tennis and golf elbow — include trigger fingers and basal joint arthritis, which become more painful as a person ages. But injuries that occur during various forms of activity and recreation can be just as debilitating if they're not treated properly.

To prevent having to see a therapist, Schmidt said a person needs "to maintain flexibility of the upper extremities, maintain strength and avoid any dumb mistakes, as well as use of good ergonomics."

"But you just can't help it sometimes," she said.

The more common hand injury of carpal tunnel syndrome is evidenced with pain felt in the hands at night — so much so that one has a hard time sleeping or often wakes up with numb or tingling extremities. Olson said it is caused by compression to the median nerve where it passes over bones at the front of the wrist.

That nerve is important, he said, as it gives sensation to the thumb, middle, index and half of the ring fingers, which can each become weakened by carpal tunnel syndrome.

Diagnosis can involve testing, and test results can quantify the degree of compression and indicate the severity of the condition.

The condition can be treated with minimally invasive splinting techniques to temporarily relieve pressure on the nerve, steroid injections that also provide temporary relief, and outpatient surgery to cut a ligament and permanently solve the problem.

While relief is often instant, "the sensory problems and weakness can take a longer time to come back," Olson said. "That's the one argument for not waiting to get it taken care of — there can be irreversible damage to the median nerve, causing permanent weakness to the hand."

Aerobic exercise, he said, is an investigational approach that is said to help a patient lose weight, resulting in improved symptoms. Results from exercise, however, have yet to be proven by research.

Olson said patients can also benefit from occupational therapy.

"We try to increase strength and use of the arm in a pain-free manner by using massage, stretching and various modalities (hot packs, medication patches and ultrasound) to decrease the pain," Schmidt said. "The object is to get patients back to their previous lifestyle, back to their highest level of function."

Olson and Schmidt also frequently treat basal joint arthritis, which Olson said is related more to age than to any other factor. It is a "grinding pain" at the base of the thumb that can be treated in ways similar to carpal tunnel syndrome.

He said a large percentage of individuals have the arthritic joints, but don't know it. "It is confusing that some people experience pain and others don't," Olson said.

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