Hand, Wrist, and Elbow

• Carpal tunnel syndrome (median nerve compression at the wrist)

  • Symptoms: numbness, tingling, nocturnal hand pain, weakness with gripping.

  • Diagnosis and care: focused clinical exam including Tinel/Phalen signs, nerve conduction testing when indicated, conservative measures (wrist splinting, activity modification, corticosteroid injection), and surgical release when necessary to restore hand function and relieve nerve compression.

• Cubital tunnel syndrome (ulnar nerve compression at the elbow)

  • Symptoms: numbness or tingling in the ring and small finger, weakness with grip or finger coordination, pain at the inner elbow that can radiate down the forearm.

  • Diagnosis and care: targeted elbow examination, nerve conduction studies as appropriate, nonoperative options (activity modification, elbow pads, night splints, corticosteroid injection in selected cases), and surgical options including in-situ decompression or anterior transposition when symptoms persist or nerve function is declining.

• De Quervain’s tenosynovitis (abductor pollicis longus and extensor pollicis brevis tendon sheath inflammation at the radial wrist)

  • Symptoms: pain and swelling at the radial wrist, pain with thumb motion and gripping, positive Finkelstein test.

  • Diagnosis and care: clinical assessment and activity review, thumb spica splinting, anti-inflammatory medication, corticosteroid injection into the first dorsal compartment, and surgical release of the sheath for refractory cases.

• Trigger finger (stenosing tenosynovitis)

  • Symptoms: catching, locking, or painful clicking when bending or straightening a finger; tenderness at the A1 pulley.

  • Diagnosis and care: clinical examination, steroid injection into the pulley region for many patients, and limited surgical release for persistent mechanical locking or pain.

• Basal joint (thumb CMC) osteoarthritis

  • Symptoms: thumb base pain with pinching/grasping, reduced strength, and decreased function.

  • Diagnosis and care: clinical and radiographic evaluation, splinting, activity modification, NSAIDs, corticosteroid injections, and surgical options (e.g., trapeziectomy with or without ligament reconstruction/interposition) to restore pain-free function.

• Hand and wrist tendon injuries and tenosynovitis

  • Symptoms: pain, weakness, limited motion, and sometimes palpable gaps or triggering.

  • Diagnosis and care: clinical assessment, imaging when needed, immobilization or splinting, repair for complete tendon lacerations, and tendon debridement or reconstruction for chronic or complex tendon pathology.

• Elbow tendinopathies (lateral epicondylitis — “tennis elbow” and medial epicondylitis — “golfer’s elbow”)

  • Symptoms: localized pain worsened by repetitive wrist/forearm activities, reduced grip strength.

  • Diagnosis and care: focused examination, activity modification, physical therapy, bracing, anti-inflammatory measures, corticosteroid or biologic injections when appropriate, and surgical débridement or repair for refractory cases.