Dr. David Alvarez: Hand Injuries and Treatments

Dr. David Alvarez: Hand Injuries and Treatments

In a recent interview for the TOC Ortho Minute segment on The Greg Tish Show on RealTalk 93.3, Dr. Alvarez discussed how our hands are affected by how we routinely use them throughout the day and at night, including carpal tunnel syndrome and trigger finger.

In the modern age of constant computer use, carpal tunnel syndrome is one of the most common things TOC treats. But it’s one of the most misunderstood issues as well. 

Dr. Alvarez said, ” Many people think carpal tunnel syndrome is wrist pain of some sort, but it’s not so much wrist pain, and it doesn’t just happen because of computer use.”

As Alvarez continued to explain, pain during typing isn’t what most people initially complain about. “Typically, what happens, or what people start complaining about or noticing, is that their thumb, index, and middle finger are numb, and it wakes them up at night.”

This numbness causes people to have “progressive difficulties like picking up items or not feeling things like their buttons when they’re not looking at them,” said Alvarez.

And Dr. Alvarez explained that this numbness occurs because of the “median nerve…that runs up and down the arm, and through certain points in their trajectory, they get really narrow.” And since the wrist is one of the narrow points, “as we get older and our ligaments get less stretchy, and they start putting a little bit more and more pressure on those nerves.”

And the pressure on the nerve doesn’t happen when you might think. Dr. Alvarez explained that it’s common since many people “sleep in a little fetal position…but that’s a high-pressure position for that nerve.” 

Fortunately, carpal tunnel syndrome doesn’t have to require surgery to treat it. 

As Alvarez revealed, one of the simplest ways to help heal is by wearing a wrist brace at night to prevent the wrist from bending in a position that would apply pressure on the nerve. Alvarez then warned that “if the symptoms continue to get worse, then you should see either your primary care doctor or local orthopedist or neurosurgeon because not all things that tingle are carpal tunnel.”

For example, Dr. Alvarez noted that the tingle might mean you “have peripheral neuropathy, which is where your nerves don’t work well, and that could be because of things like diabetes or thyroid disease.”

Additionally, Alvarez said that some people experience numbness in more than just their thumb and index finger. He explained that the cause of this might be “cubital tunnel syndrome,” which goes through the pinky and is what he described as “the lesser-known cousin” to carpal tunnel syndrome.

And before attempting surgery, Alvarez explained that the doctors “might do things like corticosteroid injections to try decrease inflammation in your wrist and see if, by decreasing inflammation, you increase space available for the nerve.”

But if that doesn’t work, Alvarez says surgery will most likely be used “to try and improve the space available for the nerve to prevent permanent nerve damage.”

Another common issue in the hands is trigger finger. Alvarez described the condition as when you “make a tight fist and then when you go to open them, of your fingers doesn’t open.” 

And Dr. Alvarez revealed that even though most people refer to fixing it as “popping it back in place,” the issue really lies in the tendon, not the joint. Alvarez noted that the condition is hard to explain, but essentially, there are rings the tendons go through, and “whenever you get any type of irritation in the tendon, the tendon swells. The part of that tendon has a hard time making it through.” Dr. Alvarez explained that you could either make the tendons smaller through anti-inflammatory treatment or you can make the rings bigger through surgery

The good news is that Alvarez said it doesn’t always hurt, but “most of the time it either stays the same or it gradually progresses and starts getting worse.” Dr. Alvarez finished by saying that “if it’s making you miserable, we can fix it.”

Dr. David Alvarez joined TOC in 2018, specializing in the hand and upper extremities. He is in practice at TOC’s Capital Medical Boulevard clinic. Originally from South Florida, and attended Florida State University for training, undergrad, and medical school. Dr. Alvarez also attended LSU Shreveport for orthopedics, and I did his hand fellowship at the University of Mississippi.

TOC – Experts in Orthopedic Care serving North Florida and South Georgia with eight locations. TeamTOC.com.

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