Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a condition caused by increased pressure on the median nerve as it passes through a narrow passageway in the wrist called the carpal tunnel. This pressure leads to numbness, tingling, and pain in the thumb, index, middle, and ring fingers. It is one of the most common hand conditions, affecting approximately 3% of women and 2% of men, with peak prevalence in women over age 55.

What are the symptoms of carpal tunnel syndrome?

The hallmark symptom is nighttime hand numbness or tingling that improves when you shake your hands. As the condition progresses, you may experience daytime numbness, weak grip strength, difficulty with fine motor tasks like buttoning a shirt, and in advanced cases, visible wasting of the muscles at the base of the thumb (thenar atrophy).

What causes carpal tunnel syndrome?

CTS can be associated with repetitive hand and wrist activities (especially forceful, repetitive motions), pregnancy, diabetes, hypothyroidism, inflammatory arthritis, wrist fractures, and other medical conditions. In many cases, no single cause is identified.

How is carpal tunnel syndrome treated without surgery?

First-line treatment includes nighttime wrist splinting in a neutral position and avoiding activities that provoke symptoms. Corticosteroid injections can provide temporary relief. Hand therapy exercises, including nerve gliding techniques, may also improve symptoms.

When is carpal tunnel surgery recommended?

Surgery is recommended when conservative treatments fail to relieve symptoms after approximately 6 weeks, or when there are signs of advanced nerve damage such as constant numbness, hand weakness, or thenar muscle atrophy. Your hand surgeon will discuss whether electrodiagnostic testing (nerve conduction studies) is needed to guide the decision.

What does carpal tunnel surgery involve?

Carpal tunnel release involves cutting the transverse carpal ligament to relieve pressure on the median nerve. It can be performed as an open procedure through a small incision in the palm, or endoscopically through one or two smaller incisions. Both techniques are highly effective.

How long is recovery after carpal tunnel surgery?

Most patients return to self-care activities within 4 to 5 days. Return to desk work typically occurs within 1 to 2 weeks, while return to light manual work averages about 2 to 3 weeks. Heavy manual labor may require 4 to 6 weeks. Overall, the average return to work is approximately 3 weeks, though this varies based on your occupation and individual healing.

—

Trigger Finger

What is trigger finger?

Trigger finger (stenosing tenosynovitis) occurs when the tendon sheath in a finger becomes inflamed and narrowed, causing the finger to catch, snap, or lock when you bend it. It is common in people who perform repetitive gripping activities and is more prevalent in women aged 40 to 60.

What does trigger finger feel like?

You may notice a clicking or popping sensation when bending or straightening the affected finger, stiffness (especially in the morning), a tender nodule at the base of the finger in the palm, and in severe cases, the finger may lock in a bent position and require you to manually straighten it.

How is trigger finger treated?

First-line treatment is a corticosteroid injection into the tendon sheath, which resolves symptoms in many patients. Splinting and activity modification may also help. If symptoms recur after injection, surgical release is recommended. For patients with insulin-dependent diabetes, surgery may be considered as a first-line option because steroid injections are less effective in this population.

What does trigger finger surgery involve?

Trigger finger release is a brief outpatient procedure that involves cutting the A1 pulley — the tight band of tissue that is restricting the tendon’s movement. It can be performed as an open or percutaneous (needle-based) procedure, both with excellent success rates (over 94%) and very low complication rates.

How long does it take to recover from trigger finger surgery?

Most patients experience immediate relief of the triggering sensation. Pain typically resolves within about 11 days, and stiffness within about 12 days. Most patients achieve full symptom relief within 6 weeks. Some patients, particularly those with longstanding symptoms or pre-existing joint stiffness, may take longer to fully recover.

—

De Quervain’s Tenosynovitis

What is de Quervain’s tenosynovitis?

De Quervain’s tenosynovitis is inflammation of the tendons on the thumb side of the wrist. It causes pain when you turn your wrist, grip objects, or make a fist. It is sometimes called “mommy thumb” because it is common in new parents and during pregnancy, and has also been linked to heavy smartphone use.

How is de Quervain’s tenosynovitis diagnosed?

Your hand surgeon will perform a physical examination including the Finkelstein test, which involves making a fist with the thumb tucked inside and bending the wrist toward the pinky side. Reproduction of pain along the thumb side of the wrist is a strong indicator of this condition.

What are the treatment options for de Quervain’s tenosynovitis?

Treatment begins with activity modification, thumb splinting, and anti-inflammatory medications. Corticosteroid injection into the tendon sheath is highly effective. If symptoms persist beyond 6 weeks of conservative treatment, surgical release of the tendon compartment may be recommended.

—

Thumb Arthritis (Basal Joint Arthritis)

What is thumb basal joint arthritis?

Thumb carpometacarpal (CMC) joint arthritis, also called basal joint arthritis, is wear-and-tear arthritis at the base of the thumb where it meets the wrist. It is one of the most common forms of hand arthritis and is a leading reason for referral to a hand surgeon, with referrals nearly tripling over the past two decades.

What are the symptoms of thumb arthritis?

Symptoms include pain at the base of the thumb during pinching, gripping, or twisting motions (such as opening jars or turning keys), swelling and tenderness at the thumb base, decreased grip and pinch strength, and in advanced cases, a visible bony bump at the joint.

How is thumb arthritis treated?

Initial treatment includes splinting, anti-inflammatory medications, activity modification, and corticosteroid injections. When conservative measures no longer provide adequate relief, surgical options include joint reconstruction, fusion, or removal of the arthritic bone with tendon reconstruction.

—

Dupuytren’s Contracture

What is Dupuytren’s contracture?

Dupuytren’s contracture is a condition in which thick, scar-like cords form beneath the skin of the palm, gradually pulling one or more fingers into a bent position. It is more common in men over age 50 and in people of northern European descent. Smoking and manual labor are associated risk factors.

When should Dupuytren’s contracture be treated?

Treatment is generally recommended when the contracture reaches approximately 30 degrees at the knuckle joint, or when it begins to interfere with daily hand function — for example, difficulty placing the hand flat on a table, wearing gloves, or shaking hands.

What are the treatment options for Dupuytren’s contracture?

Three main treatment options exist:

– Needle aponeurotomy (fasciotomy): A minimally invasive office procedure where a needle is used to break the cord. Recovery is quick, but recurrence rates are higher.

– Collagenase injection (Xiaflex): An enzyme is injected into the cord to weaken it, followed by a manipulation procedure a few days later to straighten the finger. This is an FDA-approved, office-based treatment.

– Limited fasciectomy (surgery): The cord is surgically removed through an incision. This provides the most durable correction with the lowest recurrence rates, though recovery takes longer.

Recent clinical trials show that all three treatments are similarly effective at 3 months, but surgery provides the best long-term results at 2 years.

—

Ganglion Cysts

What is a ganglion cyst?

A ganglion cyst is a noncancerous, fluid-filled lump that most commonly develops on the back or front of the wrist, though it can also appear on fingers or at the base of fingers. Ganglion cysts are the most common soft-tissue mass in the hand and wrist.

Are ganglion cysts dangerous?

No. Ganglion cysts are benign and are not cancerous. However, they can cause discomfort, pain, or weakness if they press on nearby nerves or interfere with joint movement.

Do ganglion cysts need to be treated?

Not always. Many ganglion cysts resolve on their own — over 50% may disappear without treatment. If a cyst is painful, limits activity, or is cosmetically bothersome, treatment options include aspiration (draining the fluid with a needle) or surgical excision. Surgical removal has a success rate of over 90%, while aspiration has a higher recurrence rate (over 50% may return within a year).

—

Hand Fractures

How do I know if my hand is broken?

Signs of a hand fracture include significant pain, swelling, bruising, difficulty moving the finger, and visible deformity. If you suspect a fracture, seek prompt evaluation — X-rays can confirm the diagnosis.

Do all hand fractures need surgery?

No. The majority of hand fractures heal well with conservative treatment such as splinting or casting. Surgery may be needed when fractures involve the joint surface, have significant displacement (more than 4 mm) or angulation (more than 15 degrees), involve multiple fingers, or are accompanied by tendon, nerve, or blood vessel injuries.

—

General Questions

When should I see a hand surgeon?

Consider seeing a hand surgeon if you experience persistent hand or wrist pain lasting more than a few weeks, numbness or tingling in your fingers, a finger that catches or locks, difficulty gripping objects, a visible lump or mass, a hand injury with swelling or deformity, or progressive difficulty using your hand for daily activities.

What is a hand surgeon?

A hand surgeon is a physician with specialized training in conditions of the hand, wrist, and forearm. Hand surgeons may be trained in orthopedic surgery, plastic surgery, or general surgery, and have completed additional fellowship training focused specifically on the hand and upper extremity.

Will I be awake during hand surgery?

Many hand and wrist procedures are performed under local or regional anesthesia (numbing the hand and arm), often with light sedation. This means you are comfortable but do not require general anesthesia in most cases. Your surgeon will discuss the best anesthesia option for your specific procedure.

Hand Therapy and Occupational Therapy After Surgery

What is hand therapy and will I need it after surgery?

Hand therapy is a specialized form of rehabilitation provided by occupational therapists or physical therapists who are trained in treating conditions of the hand, wrist, and forearm. Depending on your procedure, your hand surgeon may prescribe a course of hand therapy to help you regain motion, strength, and function. Research shows that occupational therapy significantly improves motor function, muscle strength, and pain after hand injuries and surgery. Compliance with your therapy program is one of the strongest predictors of a successful recovery.

What does a hand therapy session involve?

A typical hand therapy session may include range-of-motion exercises, nerve gliding techniques, grip and pinch strengthening, scar massage and desensitization, custom splint fabrication or adjustment, and functional activity training. Your therapist will design a program tailored to your specific surgery and recovery goals.

How many hand therapy sessions will I need?

The number of sessions depends on the type of surgery performed and your individual progress. Some patients may need only a few visits for instruction on a home exercise program, while more complex surgeries — such as tendon repairs or joint reconstructions — may require several weeks of supervised therapy.

—

Pain Management After Hand Surgery

How is pain managed after hand surgery?

Modern pain management after hand surgery focuses on a multimodal approach that minimizes the need for opioid medications. For many common hand procedures — including carpal tunnel release, trigger finger release, and ganglion cyst removal — clinical research has shown that a combination of over-the-counter acetaminophen (Tylenol) and ibuprofen (Advil/Motrin) provides pain relief equivalent to opioid-containing medications, with significantly fewer side effects. Your surgeon may also recommend ice therapy (cryotherapy), elevation, and in some cases a medication called gabapentin to further reduce discomfort.

Will I need opioid pain medication after hand surgery?

In many cases, no. The American Academy of Orthopaedic Surgeons (AAOS) recommends opioid-minimizing, multimodal pain strategies as the standard of care for musculoskeletal surgery. For soft tissue hand procedures, studies show that non-opioid regimens provide equivalent pain control with only a 3% side effect rate, compared to 23% with opioid-containing regimens. If opioids are prescribed, they are typically needed for only a few days.

How long will I have pain after surgery?

Most patients experience the greatest discomfort in the first 2 to 3 days after surgery, with significant improvement by the end of the first week. For common procedures like trigger finger release, the median time to pain resolution is approximately 11 days. Your surgeon will provide specific expectations based on your procedure.

—

Swelling Management

Why is my hand swollen after surgery and how long will it last?

Swelling is a normal part of the healing process after any hand surgery. It typically peaks in the first 48 to 72 hours and gradually improves over the following weeks. Some mild swelling may persist for several months, particularly after more extensive procedures. Controlling swelling is important because excess fluid in the hand can limit finger motion and slow your recovery.

What can I do to reduce swelling after hand surgery?

The most effective strategies for reducing postoperative swelling include:

– Elevation: Keep your hand elevated above the level of your heart as much as possible during the first 48 to 72 hours and whenever you are resting.

– Ice therapy: Apply ice wrapped in a cloth to the surgical area for 15 to 20 minutes at a time, several times per day, during the first few days.

– Gentle finger motion: Unless your surgeon instructs otherwise, gently moving your uninvolved fingers helps pump fluid out of the hand.

– Compression: Your surgeon or hand therapist may provide a compression wrap or glove to help manage persistent swelling.

—

Scar Management

How do I care for my surgical scar?

Once your incision has fully closed and your sutures have been removed, scar management can begin. Effective scar care includes gentle scar massage (using circular and cross-friction techniques over the scar for 5 to 10 minutes, several times per day), application of silicone-based scar sheets or gel, and moisturizing the area. These techniques help soften the scar, prevent adhesions to underlying tendons, and improve the final appearance.

When can I start scar massage?

Scar massage typically begins once the wound is fully healed and sutures or staples have been removed — usually around 2 to 3 weeks after surgery. Your surgeon or hand therapist will let you know when it is safe to begin.

Will my scar be visible?

Hand surgeons place incisions along natural skin creases whenever possible to minimize scar visibility. Most surgical scars fade significantly over 6 to 12 months. Factors that affect scarring include your skin type, genetics, sun exposure, and how well you follow scar care instructions. Protecting your scar from direct sunlight with sunscreen or a bandage during the first year can help prevent darkening.

—

Splinting and Bracing

Will I need to wear a splint after surgery?

Many hand and wrist surgeries require a period of splinting to protect the repair and allow healing. The type and duration of splinting depend on your specific procedure. Some surgeries, such as tendon repairs, require strict splinting protocols, while others — like carpal tunnel release — may require only a light dressing or soft wrap.

How long do I need to wear my splint?

Splint duration varies by procedure:

– Carpal tunnel release: A soft dressing or light splint for 1 to 2 weeks.

– Trigger finger release: A soft dressing for a few days; splinting is generally not required.

– Wrist fracture surgery: A splint or cast for 2 to 6 weeks, depending on the type of fixation.

– Tendon repair: A protective splint for 4 to 8 weeks, with a specific therapy protocol for controlled motion.

Your surgeon will provide specific instructions for your situation.

Can I remove my splint to shower?

In most cases, your splint should remain in place until your surgeon says it is safe to remove. Some splints are removable and your surgeon may allow you to take them off briefly for gentle hygiene, while others must stay on at all times. Ask your surgical team for specific guidance. Waterproof cast covers are available to help keep your splint dry during bathing.

—

Wound Care

How do I care for my incision after hand surgery?

Keep your dressing clean and dry for the first 48 hours unless your surgeon instructs otherwise. After the initial dressing is removed, gently clean the incision with mild soap and water as directed. Apply any prescribed ointment and a clean bandage. Avoid submerging your hand in water (no baths, pools, or hot tubs) until the incision is fully healed.

When can I get my hand wet after surgery?

Most surgeons allow brief showering with a waterproof covering within 1 to 2 days of surgery. The incision should not be soaked or submerged until it is fully closed and sutures have been removed, typically at 10 to 14 days. Your surgeon will give you specific instructions based on your procedure.

When will my stitches be removed?

Sutures are typically removed between 10 and 14 days after surgery during a follow-up office visit. Some procedures use absorbable sutures that dissolve on their own and do not require removal.

—

Return to Driving

When can I drive after hand or wrist surgery?

Return to driving depends on the procedure performed, which hand was operated on, and whether you drive an automatic or manual transmission vehicle. After common procedures like carpal tunnel release, many patients can safely resume driving within 1 to 2 weeks. After wrist fracture surgery with plate fixation, research shows most patients can safely return to driving within approximately 3 weeks, with pain being the primary limiting factor. Your surgeon will clear you to drive when you can safely grip the steering wheel and respond to emergency situations.

Is it safe to drive with a splint or cast on?

Driving with above-elbow immobilization (a long arm cast or splint) is generally considered unsafe and is not recommended. Driving with a short wrist splint may be acceptable in some situations, but you should always get clearance from your surgeon before driving with any immobilization device. Remember that your ability to control the vehicle in an emergency is the key safety consideration.

—

Return to Work and Daily Activities

When can I return to work after hand surgery?

Return-to-work timelines depend on your procedure and the physical demands of your job:

– Desk or office work: Most patients return within 1 to 2 weeks after common procedures like carpal tunnel or trigger finger release.

– Light manual work: Typically 2 to 4 weeks, depending on the procedure.

– Heavy manual labor: May require 4 to 8 weeks or longer, particularly after fracture surgery, tendon repair, or joint reconstruction.

Your surgeon may provide a modified duty note to help you transition back to work safely.

When can I resume exercise and sports?

Light cardiovascular exercise (such as walking or stationary cycling) can often be resumed within the first week, as long as the surgical hand is protected. Upper body exercises and activities that load the hand — such as weightlifting, yoga, racquet sports, or golf — typically require 4 to 8 weeks or more, depending on the surgery. Contact sports may require even longer. Always get clearance from your surgeon before returning to athletic activities.

What activities should I avoid during recovery?

During the early recovery period, avoid heavy lifting, forceful gripping, pushing, pulling, and any activity that causes significant pain in the surgical hand. Avoid submerging the hand in water until the incision is healed. Specific activity restrictions will be outlined by your surgeon and hand therapist based on your procedure.

—

Warning Signs After Surgery

What are warning signs of a problem after hand surgery?

While complications after hand surgery are uncommon, it is important to know the signs that require prompt attention:

– Signs of infection: Increasing redness, warmth, or swelling around the incision; pus or cloudy drainage; red streaks extending from the wound; fever over 101°F (38.3°C).

– Signs of circulation problems: Fingers that become white, blue, or very pale; numbness or tingling that is new or worsening; fingers that feel cold and do not warm up with elevation.

– Excessive bleeding: Bleeding that soaks through the dressing and does not stop with gentle pressure and elevation.

– Worsening pain: Pain that suddenly increases after initially improving, or pain that is not controlled by your prescribed medications.

When should I call my surgeon or go to the emergency room?

Call your surgeon’s office if you notice any of the warning signs listed above, if you have questions about your medications, or if something does not feel right. Go to the emergency room if you experience severe uncontrolled bleeding, sudden loss of feeling or color in your fingers, signs of a severe allergic reaction, or a high fever with chills. Research shows that pain and wound concerns are the most common reasons patients visit the emergency room after hand surgery — and most of these visits result in reassurance and discharge home. When in doubt, call our office first, as we can often address your concern quickly over the phone or with a same-day visit.

—

Long-Term Recovery

How long until I have full use of my hand?

Full recovery varies by procedure. Many patients notice significant improvement within the first 4 to 6 weeks, but complete recovery — including return of full strength and resolution of all swelling — may take 3 to 6 months or longer. More complex surgeries, such as tendon repairs, joint reconstructions, or fracture fixation, may require up to a year for maximum recovery.

Will I regain full strength after hand surgery?

Most patients regain excellent hand function after surgery. Grip and pinch strength typically improve steadily over 3 to 6 months. Consistent participation in your hand therapy program and home exercises is the most important factor in achieving the best possible strength and function.

What factors affect my recovery?

Several factors can influence how quickly and completely you recover:

– Compliance with therapy: Following your hand therapy and home exercise program is the single most important factor in your recovery.

– Smoking: Smoking impairs wound healing and increases the risk of complications. Quitting before surgery can significantly improve your outcome.

– Diabetes: Uncontrolled blood sugar can slow healing and increase infection risk. Optimizing your blood sugar before and after surgery is important.

– Age and overall health: While age alone does not prevent a good outcome, overall health and nutrition play a role in healing.

– Severity of the condition: Patients who have surgery earlier in the course of a condition — before severe nerve damage, joint destruction, or tendon scarring has occurred — tend to have better outcomes.

—

Schedule Your Appointment

If you are recovering from a hand injury or considering hand surgery, the specialists at Raleigh Wrist are here to guide you through every step — from diagnosis through surgery and rehabilitation. Visit RaleighWrist.com or call our office to schedule a consultation today.