Importance
Carpal tunnel syndrome, trigger finger, de Quervain’s tenosynovitis, and arthritis of the basilar (carpometacarpal) joint of the thumb can be associated with significant disability.
Observations
1. Carpal tunnel syndrome
Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and index, middle, and radial ring fingers and by weakness in thumb opposition when severe. It is more common in women and people who are obese, diabetic, and who work in occupations that involve the use of keyboards, computer mice, heavy machinery, or vibrating hand tools.
The Durkan physical examination maneuver, which involves firm digital pressure through the carpal tunnel to reproduce symptoms, has a sensitivity of 64% and a specificity of 83% for carpal tunnel syndrome.
People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing , which has a sensitivity of approximately over 80% and a specificity of 95% for carpal tunnel syndrome.
Splints or steroid injections may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment.
2. Trigger finger (stenosing tenosynovitis)
Trigger finger , which involves abnormal resistance to gentle flexion and extension ("activation") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population.
Steroid injection is the first-line therapy, but is less effective in people with insulin-dependent diabetes.
People with diabetes and those with recurrent symptoms may benefit from early surgical release.
3. De Quervain’s tenosynovitis
De Quervain’s tenosynovitis , which involves inflammation of the extensor tendons of the wrist, is more common in women than men.
People who use cell phones frequently are at higher risk.
The median age of onset is 40 to 59 years.
Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization.
People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment.
4. Arthritis of the carpometacarpal joint of the thumb
Arthritis of the carpometacarpal joint of the thumb affects approximately 33% of postmenopausal women, based on radiographic evidence of carpometacarpal arthritis.
Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, injection of steroids and analgesics) relieve pain but do not alter disease progression.
Surgery may be appropriate for patients who do not respond to conservative treatments based on radiographic evidence of carpometacarpal arthritis . Approximately 20% of patients require treatment for pain and disability.
Conclusions and relevance
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