Hand and Upper Extremity
If you're experiencing pain in your hand, wrist, elbow or shoulder, even everyday tasks like brushing your teeth can be difficult.
Our team of specialists includes board-certified orthopedists who have also received advanced fellowship training and are dedicated to the care of the broad range of conditions that may cause pain in your hands or upper extremities.
- Injuries to the hand, wrist, forearm, elbow and shoulder
- Fractures and tendon injuries to the hand and upper extremity
- Sports-related injuries, including those to pitchers and other throwing athletes
- Chronic or degenerative conditions, such as arthritis, bursitis or tendonitis
- Carpal tunnel syndrome
- Trigger finger
- Common wear and tear conditions brought on by aging or overuse
We offer the most advanced surgical techniques, including highly complex reconstructive procedures, such as joint replacements in the elbow and shoulder and microsurgical nerve reconstructions. We also provide nonsurgical treatments.
Our expert and experienced hand therapists greatly improve recovery of both nonsurgical and postsurgical patients. Our hand therapists hold advanced certifications and have many years of experience treating a variety of common and complex hand conditions.
Munns, Stephen MDOrthopedicsLocations:
- Indian Creek Campus Medical Office Building
- Sports Medicine and Performance Center
- 10730 Nall Ave., Suite 200
- Overland Park, KS 66211
Randall, Jeffrey MDOrthopedicsLocations:
- Sports Medicine and Performance Center
- 4910 Corporate Centre Drive
- Suites 110 and 150
- Lawrence, KS 66047
Toby, E Bruce MDOrthopedicsLocations:
- Orthopedics and Medical Pavilion
- 2000 Olathe Blvd.
- Kansas City, KS 66160
What you need to know about carpal tunnel syndrome
Carpal tunnel syndrome may be common, but it can be misunderstood. What is carpal tunnel syndrome?
Carpal tunnel syndrome is the most common compressive neuropathy in the upper extremity. It's a compression of the median nerve, which is one of the major nerves that runs through the hand. It's located in the wrist and it becomes compressed. The condition occurs in about 1 in every 25 people.
What are some of the symptoms of carpal tunnel syndrome?
The most common reason people come to see me is they start to have numbness and tingling in the first 3 fingers of their hand – usually their thumb, index and long finger. It's usually in its mild form when it starts, with intermittent numbness and tingling. Patients may feel it when they're speaking on their cellphone or driving their car. Or they could be waking up at night, feeling like they have to shake their hand out in order to get feeling back in it. That's typically what brings people in.
As the compression becomes more significant, usually over a long period of time, the symptoms become more frequent. And sometimes, the numbness and tingling can be there constantly, which is quite bothersome. The last stage involves the wasting away of some of the muscles in the hand because the nerve has been compressed for such a long period of time.
Can you live with carpal tunnel syndrome?
Carpal tunnel syndrome can be a major factor affecting someone's quality of life. People may feel as though they're dropping things or they may feel their hand is weak because they don't know how hard to squeeze something when they're picking it up.
Additionally, waking up several times per night because your hands are buzzing or tingling can really affect your quality of life.
That's certainly part of the decision-making process that we discuss – how much is this affecting your life, your work and your sleep. This might lead us down one treatment path or another.
What are treatment options for carpal tunnel syndrome?
Treatment options depend on how severe the level of compression is and how severe clinical symptoms are. Typically, for mild carpal tunnel syndrome – which means there is intermittent numbness and tingling – we can simply start off with a night brace. The night brace can be quite effective as it keeps the wrist in a neutral position. It also prevents any compression of the nerve at night. Sometimes that allows a fairly long, symptom-free period.
As we get into the mild to moderate symptoms, which means the numbness and tingling is becoming more frequent and more bothersome, an injection of corticosteroid effectively alleviates symptoms. This can sometimes last for quite a long period of time and give good relief.
As we get into the moderate to severe range, which means people are having numbness and tingling consistently and there's concern about weakness in the hand, surgical release tends to be the best option. By relieving the compression of the nerve, we prevent any further numbness, tingling or permanent symptoms that may occur and damage the nerve.
How successful is carpal tunnel release?
The success of this treatment is excellent. Most people are satisfied with the results of carpal tunnel release, especially those who have had significant night symptoms. I've seen many post-op patients who are so excited they're back to sleeping throught the night without difficulty.
The happiest patients tend to be those who come and see us when they still have mild to moderate symptoms. As you get into more severe nerve compressions over a longer period, the numbness and tingling may not resolve completely or some of the weakness may not resolve completely. Those patients are always happy to have relief from nerve damage and can be quite happy with the use of their hand.
Carpal tunnel syndrome is pretty common – can't you be treated anywhere? Why come to The University of Kansas Health System?
Not everyone who thinks they may have carpal tunnel syndrome actually has carpal tunnel syndrome. It may be a nerve compression in the neck or anywhere along the back down into the hand. We have a great team with a wide range of experience in both routine and complex nerve compression conditions. We receive many referrals, so we have seen some complex cases when it comes to peripheral nerve injuries.
We also have a great team in neurology who helps us evaluate and refer to different types of studies to help us sort out the particularly difficult cases.
What are peripheral injuries?
Usually when we talk about the central nervous system, we talk about the brain and spinal cord. Together, of course, they connect to a number of nerves that travel down through the arms and give us the feeling and function of the hand and the feet. Anywhere there is a nerve injury, this is called the peripheral nervous system that goes out into the arms and legs.
One of the things we do quite well is evaluate for other areas of compression or injury of these peripheral nerves.
Why is The University of Kansas Health System so good at orthopedic hand and upper extremity care?
We're a major referral center from all over the states of Kansas and Missouri – and often beyond that. We see a number of the most complex, traumatic and posttraumatic cases. We do a lot of secondary reconstructions – meaning people who have possibly had surgery in other places or their function isn't quite what they had expected it to be after their initial injury.
There may be some new emerging things that we can do involving tendon transfers or nerve transfers to try to restore function where, otherwise, function may be lacking.