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Douglas Sammer, M.D. Answers Questions On Carpal tunnel, Dupuytren’s contracture, and arthritis

Douglas Sammer, M.D. Answers Questions On: Carpal tunnel, Dupuytren’s contracture, and arthritis

What are the latest treatment options for common issues, such as carpal tunnel syndrome?

Carpal tunnel can now be treated in a minimally invasive way. It may not be appropriate for all patients, but some are candidates for either a mini-incision or an endoscopic carpal tunnel release. We use a very small incision, insert a camera into the carpal tunnel, and then do the nerve release that way.

It substantially reduces discomfort after surgery, and patients are able to return to work and activities sooner than with other types of carpal tunnel surgical procedures.  

Are there nonsurgical options for carpal tunnel syndrome?

If patients present early enough and their symptoms are mild, we first try to treat carpal tunnel without surgery.

The most effective treatment is to wear a wrist brace or splint at night. It keeps the wrist in a neutral position and prevents flexing or extending the wrist. Studies have shown that extended or flexed wrist positions put a lot of pressure on the nerve.

Wearing a splint at night can reduce the symptoms, and in some cases, patients don’t need surgery at all.

What are the latest treatment options for Dupuytren’s contracture?

Dupuytren’s contracture is an inherited disorder, where nodules and cords form in the hand and result in contractures, or stiff bent fingers. Historically, we have treated this condition with surgery, but now there are less-invasive options. One is to use an injectable enzyme called collagenase to dissolve the cords causing finger contractures.

Are there nonsurgical options for arthritis in the hand?

Patients with arthritis in the hand have trouble with everyday activities like turning a key or a doorknob, or opening a jar. Although the effects are temporary, steroid injections are an effective treatment for arthritis. And again, splints can help rest the joints when there are flare-ups.

You do a lot of research on distal radius fractures in the elderly. Besides osteoporosis, what are the other risk factors for that? How can aging patients try to avoid those kinds of problems?

Distal radius fractures tend to happen in two populations: young males and elderly women. In young males, it’s typically a high-energy, high-impact injury, like one sustained in a car accident or a fall from a roof. In older patients, it can result from a fall from standing height.

Elderly patients often have distal radius fractures before a hip fracture, so it can be a warning sign that more severe systemic problems are coming. Those patients are more likely to have hip fractures in the next few years.

Distal radial fractures are more common in elderly females because they are prone to have osteoporosis. Patients should visit their primary care physician for early detection and treatment of osteoporosis because they are at risk for other fragility fractures.

What can hand surgery patients look forward to in the future?

As time goes on, incisions are getting smaller, and surgery is becoming less invasive. We’ll be able to do more things with small incisions, cameras, and medications rather than with large-scale operations.

We’ll also be using more nonoperative treatment, like therapy, as a primary treatment and as an adjunct after surgery. That often works as well or better in many scenarios.