What Hand and Upper Extremity Care Covers
The hand and wrist pack 27 bones, dozens of gliding tendons and three major nerves into a space with no room to spare. Stiffness that would be a nuisance in a thigh is disabling in a thumb, which is why the examination, imaging and rehabilitation here differ from general orthopedics.
People come to GoldPlayPot.com for hands that go numb at 2 a.m., fingers that lock in a fist, thumbs that give out on a jar lid, and wrists broken in a fall on an icy step. Some leave with an orthosis and exercises; some need an operation inside a week. Most of the clinical work is deciding honestly which.
- Carpal tunnel syndrome and other nerve compressions, including cubital tunnel at the elbow
- Trigger finger, de Quervain tenosynovitis and other tendon sheath problems
- Thumb-base (CMC) arthritis and arthritis of the finger joints
- Distal radius, scaphoid and finger fractures
- Ganglion cysts, Dupuytren contracture, and tendon or nerve lacerations
- Elbow tendon problems, including tennis elbow that has not settled with load management
Carpal Tunnel Syndrome: What the Exam Is Looking For
Carpal tunnel syndrome is pressure on the median nerve where it passes under a tough band of tissue at the base of the palm. The classic account is numbness and tingling in the thumb, index, middle and half of the ring finger that wakes people in the early hours and eases when they shake the hand out. Driving, holding a phone and reading in bed provoke it, because each parks the wrist in a bent position.
The consultation is more than a symptom checklist. We test sensation finger by finger, measure thenar strength at the base of the thumb, and use provocative tests such as sustained wrist flexion and pressure over the tunnel. When the picture is unclear, or a neck problem could be mimicking it, nerve conduction studies grade how hard the nerve is struggling.
When a splint and time are genuinely enough
Early, intermittent symptoms respond well to a neutral wrist orthosis worn at night, which stops the wrist folding during sleep, plus a review of tools and workstation and nerve gliding exercises from a hand therapist. A corticosteroid injection often settles symptoms for months, and a hand that responds well to injection usually responds well to release.
When waiting starts costing nerve
Three findings change the conversation: numbness that has become constant, visible wasting of the thenar muscle at the thumb base, and dropping cups or coins because pinch has weakened. Those point to nerve fibers being lost rather than irritated, and recovery after release becomes slower and less complete. We then recommend prompt decompression instead of more splinting. Sensation usually improves; a muscle that has already wasted may never fully rebuild, which is why timing matters.
Endoscopic and Open Carpal Tunnel Release
Both operations do the same thing: divide the transverse carpal ligament completely so the roof of the tunnel opens and pressure on the nerve drops. The difference is the route. Open release uses a short incision in the palm and gives a direct view of the ligament and the nerve beneath it. Endoscopic release works through one or two small portals with a camera.
Published comparisons point the same direction. Endoscopic release tends to bring a slightly faster return to work and less scar tenderness in the first few weeks; by six to twelve months, grip strength and symptom scores are broadly comparable. We favor open release for unusual anatomy, a failed previous release, or when another procedure is planned at the same sitting. Either way the honest caveat is the same: release usually stops the problem progressing and ends the night waking for most people, but it does not promise a hand that feels 25 again.
- An outpatient procedure, usually under local anesthetic with light sedation
- No cast, so fingers move immediately and light self-care resumes within days
- Pillar pain, a tenderness on either side of the scar, is common and settles over three to six months
Trigger Finger and Thumb-Base Arthritis
These two fill a large share of the hand clinic, and both have a clear ladder of treatment that starts well below the operating room.
Trigger finger
A thickened tendon and a tight pulley at the base of the finger stop sliding smoothly, so the digit catches, clicks or locks into a fist. One corticosteroid injection at the pulley resolves it for most people, though relief is less durable in diabetes or when several digits are involved. A finger that locks and will not passively straighten deserves earlier treatment, because a middle joint held bent for weeks stiffens that way. Surgical release is a short outpatient procedure, and the finger moves the same day.
Thumb-base (CMC) arthritis
Pain at the base of the thumb when turning a key or opening a jar is usually wear at the trapeziometacarpal joint, and it becomes far more common after age 50. A hand-based thumb orthosis, joint protection coaching and strengthening of the muscles that stabilize the thumb often reduce pain enough to postpone surgery for years; injections help for months. When everyday pinch fails despite that, trapeziectomy, which removes the small arthritic wrist bone with or without ligament reconstruction, relieves pain for most patients. Grip and pinch take three to six months to settle, and heavy pinch may not return fully.
Distal Radius Fractures: Displacement Is Not a Wait-and-See Problem
A wrist broken in a fall on an outstretched hand is the most common fracture of the upper limb, and what happens next depends on where the bone is sitting. We measure radial height, the tilt of the joint surface and any step in the cartilage on the first radiographs, adding a CT scan when the fracture enters the joint.
An undisplaced, stable fracture does well in a cast, with repeat films at one and two weeks to confirm it has not drifted. A displaced or unstable fracture is a different injury. Dorsal comminution, a joint surface step of more than about two millimeters, radial shortening and intra-articular patterns all predict that a cast alone will let the bone collapse into a position that stiffens the wrist, weakens grip and raises later arthritis risk. Those fractures are reduced and fixed without delay, usually with a volar locking plate, sometimes with pins or an external frame.
Fixing it early is not surgical enthusiasm. It is a shorter, cleaner operation than correcting a badly healed wrist months later, and it lets therapy start while the joint is still supple. We also watch the median nerve closely, because numbness that intensifies in the hours after a wrist fracture can need urgent decompression.
Hand Therapy Does Half of the Work
Surgery opens a window; therapy fills it. Our hand therapists fabricate orthoses on site, control swelling, restore tendon and nerve glide, desensitize scars and rebuild grip in measured steps. After a volar plate, most patients start gentle wrist motion within days instead of waiting out a cast, because stiffness, not the plate, usually spoils the result.
Therapists and surgeons at GoldPlayPot.com write in the same chart and review difficult hands together, so a plateau at week six is picked up in clinic rather than reported months later.
- Custom thermoplastic orthoses made and adjusted inside the same visit
- Swelling control, scar management and sensory re-education after nerve procedures
- Grip, pinch and range measured with a dynamometer and goniometer, not estimated by eye
- Job-specific conditioning before a return to work that depends on your hands
Returning to Work and to Ordinary Days
Timelines depend on the procedure and on the job, not on willpower. These are the ranges we quote at the outset and then revise at each review, rather than issuing one certificate on day one and hoping it fits.
- Carpal tunnel release: keyboard and desk work at roughly one to two weeks, light manual duties at two to four weeks, heavy gripping, vibrating tools and ladder work at six to eight weeks
- Trigger finger release: daily tasks straight away, office work usually within a week
- Thumb-base surgery: about six weeks in a protective orthosis, useful pinch from three months, gains continuing to a year
- Distal radius fixation: desk work near two weeks, driving once you can control the wheel unaided, manual trades commonly three to four months
Frequently asked questions
How do I know whether my numb hand is carpal tunnel or a neck problem?
Carpal tunnel numbness follows the median nerve, so it affects the thumb, index, middle and half the ring finger, is worst at night, and eases when you shake the hand out. Nerve irritation coming from the neck more often sends pain down the arm, changes with neck position, and can involve the little finger or a wider area. Examination plus nerve conduction studies separates them, and both can exist in the same arm at once.
Will a steroid injection cure carpal tunnel syndrome?
An injection relieves symptoms rather than curing the cause. Many people get several months of relief, some considerably longer, and a good response is a useful predictor that surgical release would also work well. Injections suit mild to moderate cases, pregnancy-related symptoms, or a patient who wants time to decide. They are not the right answer once the thenar muscle is wasting or the numbness has become constant, because nerve fibers are being lost while you wait.
Is endoscopic release better than open release?
Neither technique is better in every hand. Endoscopic release generally means less scar tenderness and a slightly quicker return to work in the early weeks, and by six to twelve months the two give comparable strength and symptom relief. Anatomy, previous surgery, and whether another procedure is planned at the same sitting usually decide it. We will tell you which one we recommend for your hand and the reasoning behind that choice before you consent.
Do all broken wrists need surgery?
No. A fracture sitting in good position and stable on repeat films is treated in a cast, with radiographs at one and two weeks to be certain it stays there. Surgery is recommended when the bone is displaced or unstable, meaning a step in the joint surface, shortening of the radius, or significant dorsal comminution, because those patterns tend to collapse further in a cast. Correcting a badly healed wrist later is a larger operation with a less predictable result.
Can splinting fix thumb-base arthritis?
Splinting will not rebuild worn cartilage, but a well-fitted hand-based thumb orthosis, joint protection technique and targeted strengthening reduce pain in most people and often delay surgery by years. Injections add months of relief. The decision to operate rests on function, meaning whether the thumb still manages the pinch your day requires, rather than on how severe the radiograph looks. Plenty of arthritic thumbs on film work perfectly well in daily life.
How soon should I be seen after a hand or wrist injury?
Within a few days for a suspected fracture, a finger that will not straighten, or a cut that stops a finger bending, so that nothing heals in the wrong position while you wait. Go to an emergency department immediately for an open fracture, a visible deformity, a dislocation, a hand that is cold, pale or numb, numbness that is rapidly worsening after an injury, or a hot, swollen finger with fever. Those are time-critical, and a clinic appointment is the wrong route.