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FirstHealth of the Carolinas
The hand and wrist By Dick Broom
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It takes a lot of bones and joints to make a tool as flexible and versatile as the human hand.

There are 14 bones in the fingers of each hand. Each finger has three bones except for the thumb, which has two. A joint between each bone allows the fingers to bend so that they can do everything from play the piano to grasp a golf club.

The fingers are connected to five bones in the hand that are connected to the eight bones that make up the wrist. These are called carpal bones, which is why the pinching of a nerve that runs through an archway of bones in the wrist is called carpal tunnel syndrome.

The carpal bones are connected to the two bones in the lower arm called the radius and ulna.

If the hand was nothing but bones and the skin that covers them, it would be useless. But there are dozens of muscles and tendons attached to the bones that allow the fingers, hand and wrist to move in all sorts of amazing ways.

A complex network of nerves controls these movements and gives us the sense of touch.

If you have never had carpal tunnel syndrome and you don’t know anyone who has, you are probably in the minority.

It is the most common problem of the wrist or hand that doctors see.

Carpal tunnel syndrome is pressure on the median nerve, which goes through a structure in the wrist called the carpal tunnel.

“The nerve goes into the fingers and feeds a combination of muscles,” says Mark Brenner, M.D., an orthopaedic surgeon with Pinehurst Surgical. “The nerve also has a sensory function, carrying the sensations of the thumb, index and middle fingers.”

If the carpal tunnel narrows, it can put pressure on the median nerve and cause numbness, tingling or pain in the fingers or hand.

Carpal tunnel syndrome can be caused by prolonged, repetitive motion—everything from typing to knitting to using tools that involve twisting the wrist. But there are many other causes, as well.

Mark Brenner, M.D.

“It can be associated with a metabolic problem such as diabetes or thyroid dysfunction,” says Dr. Brenner. “It also is common in pregnant women.”

Fluid retention associated with pregnancy makes women more likely to develop carpal tunnel syndrome.

The condition and its symptoms can often be relieved by avoiding activities that irritate the wrist, by wearing a splint at night to keep the wrist from bending and by taking anti-inflammatory medication. Some patients require surgery to widen the carpal tunnel and relieve the pressure on the nerve.

Another problem that hand and wrist specialists frequently see is called trigger finger, but it has nothing to do with firing a gun. It is a form of tendonitis in which a finger becomes stuck in the bent position. It is caused by a tightening of the sheath of tissue that surrounds the tendon in the finger.

“The tendon starts to catch on a pulley inside the palm when you try to straighten your finger,” Dr. Brenner says.

When the finger does straighten, it happens suddenly—often quite painfully—and with a popping sound, similar to that of a trigger being pulled.

Often, the finger remains bent only for a second or two. But in severe cases, it may become locked in that position.

Trigger finger is more common in women than in men and in people with diabetes. It can be caused by activities that involve tight gripping with the hand.

“It is often worse in the morning and can be worse with activity,” Dr. Brenner says.

Mild cases of trigger finger often respond to rest, finger exercises and splints that keep the finger extended. More severe cases may require injections of anti-inflammatory drugs or, ultimately, surgery.

Tendonitis also can occur in other parts of the hand and wrist. A tendon on the outer side of the wrist is particularly susceptible to inflammation, often caused by repetitive motion.

Of course, says Dr. Brenner, arthritis causes hand and wrist problems for a lot of people.

“The base of the thumb is probably the third most common place for osteoarthritis after the knee and the hip,” he says. “Because of the mechanics of the joint, it is subject to a lot of stress.”

In the Sandhills, where so many people play golf, a sport that puts considerable stress on the wrist, it isn’t surprising that orthopaedic specialists frequently find themselves treating golfers.

“We see a variety of wrist strains and ligament tears associated with golf,” Dr. Brenner says. “There is quite a bit of that in people of all ages.”

Ruth Gallagher plays tennis, spends quite a bit of time at the computer and does a lot of gardening. All of those activities can be hard on the wrists.

Several years ago, when she lived in Virginia, she began having numbness in the tips of the fingers of her right hand. Over time, it got worse and her fingers started to ache.

“I went to my doctor, but he didn’t know what it was,” she says. “I tried wearing a brace on my wrist to keep it straight, and that helped for a while. But as time went by, it wasn’t helping anymore.”

Gallagher continued to have numbness and pain in her fingers after moving to Southern Pines four years ago, but she decided she would just have to live with it. Then, last year, she went to a neurologist who performed a test to see how much feeling she had in her fingers.

The results indicated she had carpal tunnel syndrome. That’s when she went to see Mark Brenner, M.D., an orthopaedic surgeon with Pinehurst Surgical. He operated on her right wrist last September. Four months later, he performed the same procedure on her left wrist.

Playing tennis can be hard on the wrists, but Ruth Gallagher is back on the courts since surgery for carpal tunnel syndrome in both of her wrists.

“I would recommend it to anyone with carpal tunnel,” says Gallagher, who is 83. “It’s very quick surgery and, except for the shots they give you (local anesthesia), there’s hardly any pain. I’m very pleased with the results.”

Dr. Brenner operated on Gallagher’s left wrist Jan. 31, the same day he operated on Lydia Sturdevant’s left wrist.

Sturdevant says she inherited arthritis from her mother, and she thinks she inherited a predisposition for carpal tunnel syndrome from her, too.

“She would complain about how her hands got so hot when she went to bed at night, and I couldn’t understand what she was talking about,” Sturdevant says. “At the time, we had never heard of carpal tunnel.”

A few years ago, Sturdevant began having numbness in her fingers and intense heat in her hand after she went to bed. “The heat would go through my hand and sometimes up the arm to my elbow, and it would wake me up,” she says. “I thought, ‘Now I know what Mom was talking about.’ It can be almost excruciating when you have the numbness and your hand heats up and you can’t get comfortable.”

Sturdevant says she tried wearing braces on her wrists at night for a while, but she found them too cumbersome. “I had decided I would just have to live with it, but I finally couldn’t take it any longer,” she says. “I had to do something about it, so I went to Dr. Brenner and had the operation.”

Like Gallagher, Sturdevant was surprised that something that had bothered her so much for so long could be fixed so quickly.

“Once the procedure starts, it takes only about 10 minutes,” she says. “It’s over before you know it.”

And it gave her relief from the numbness and heat. “It feels good,” she says. “It just breaks my heart to think that my Mom went through this and nothing was ever done about it.”