Orthopedic Treatment For Carpal Tunnel Syndrome

by Administrator 24. April 2017 11:36

Carpal Tunnel Syndrome or median nerve entrapment is a condition that affects the functionality of hand. Median nerve passes from the forearm to the hand via a small passage known as carpal tunnel. It is responsible for providing sensation to the palm, thumb and three fingers of the hand. Any pressure upon the nerve may lead to this condition and cause the hand to function improperly.


  • Hereditary - Some people may have anatomic differences in the shape of their carpal tunnel leading to this condition. The trait can be running in various generations.  
  • Overuse Of Hand Muscles - Repeated use of hand and wrist may lead to inflammation of the tendons which puts pressure on the nerves.
  • Hand’s positions – Continuous flexion and extension of the wrist muscles may compress the median nerve.
  • Pregnancy – Hormonal changes during this period may be responsible for Carpal Tunnel Syndrome.
  • Medical Conditions – Certain conditions like Arthritis, thyroid imbalance, Diabetes may also be responsible for the dysfunction of wrist.


  • Pain radiating towards the forearm.
  • Numbness and tingling sensation in thumb, index, middle and ring fingers.
  • Weakness in the hands.
  • Difficulty in gripping objects.
  • Stiffness in the fingers, specifically in the morning.


  • Physical Examination – The doctor may apply pressure with hand or a finger at the position of the nerve and check whether the patient feeling any numbness or not. He may also look for any kind of atrophy at the base of the thumb and fingers.
  • Imaging Tests – To have a clearer picture of the condition and to eliminate the possibility of other disorders, the doctor may recommend certain imaging tests.
  • Electrophysiological Tests – These diagnostic tests include nerve conduction studies and electromyography. They let the doctor know about how well is the median nerve working and responding to the normal stimuli.
  • X-rays – If a patient has limited wrist motion, the doctor may recommend an X-ray test. I will allow the doctor to view all the bony structures of the hand.
  • MRI (Magnetic Resonance Imaging) - This test may be suggested by the doctor to visualize the surrounding tissues, ligaments and tendons.

Treatment –

Non-Surgical Treatment

  • The orthopedic doctor may ask the patients to wear braces or splints, so that the affected area could be immobilized for some time. This may help to remove the pressure from the nerve.
  • Anti-inflammatory medication may be suggested by the doctors to reduce swelling and discomfort.
  • Modification in activities that lead to worsening of pain may also be suggested.
  • Exercise that may help to restore the mobility of wrist may also be recommend by the doctors. E.g. Nerve gliding exercises.

Surgical Treatment

  • Open Carpal Tunnel Release – In this procedure the orthopedic surgeon may make a small incision in patient’s wrist and cut the ligament forming the root of carpal tunnel. This may widen the tunnel and reduce pressure on the median nerve.
  • Endoscopy - The orthopedic surgeon may make one or two small incisions over the wrist and insert a small camera called endoscope into the affected area. After visualizing the extent of damage the surgeon may transversally divide the carpal tunnel and broaden it to reduce pressure from the nerve.

For complete treatment and diagnosis of Carpal Tunnel Syndrome, contact Dr. Knoll. To request an appointment with the hand and wrist specialist, call at (972) 985 – 1072.

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Wrist Arthritis: Causes, Symptoms And Treatment

by Administrator 27. March 2017 10:05

Wrist is a complex joint, it is made up of two bones from the arm (radius and ulna ) and eight carpal bones. Cartilage tissue present between these bones is responsible for their smooth and gliding movement. Growing age and many other factors may deteriorate these cartilages and lead to severe inflammation in the joints. This condition is referred to as Wrist Arthritis. With its progression, the wrist bones start to rub against each other leading to irreparable damage.  It is commonly observed in elderly people.

Causes -

  • Previous wrist injuries
  • Conditions like Rheumatoid Arthritis, Osteoarthritis

Symptoms -

  • Constant pain
  • Swelling
  • Difficulty in gripping objects
  • Stiff wrist in the morning

Diagnosis -

The wrist doctor may begin by conducting a thorough physical examination of the wrist. He may try to bend and rotate it to see the range of motion. For a complete diagnosis and better understanding of the condition, the doctor may recommend certain imaging tests like X-ray and MRI Scans.

Treatment -

Non-Surgical Treatment -

  • Modification in routine activities – Depending upon the severity of the condition, the doctor may ask patients to bring certain changes in their daily routine and avoid activities that cause pain.
  • Immobilization - In order to provide support and reduce stress on the wrist, the doctor may ask the patients to wear wrist splints.
  • Medication – Painkillers and anti-inflammatory medicines may also be prescribed by the doctor to alleviate affliction and swelling.
  • Rehabilitation Exercise -  Certain muscle strengthening exercises to increase the range of motion and restore the functionality of wrist.

Surgical Treatment -

In case no relief is experienced with conservative treatment, the orthopedic surgeon may recommend a surgery. Based upon patient's symptoms any one of the following surgeries can be conducted -

  • Proximal Row Carpectomy - In this procedure, the orthopedic surgeon may remove first row of carpal bones. This moves radius and ulna close to other bones leading to the formation of a new hinge joint which reduces pain and friction.
  • Fusion – If pain occurs only on moving the wrist, the orthopedic surgeon may suggest a fusion surgery. In this, he may remove the damaged cartilage and then use pins, screws and metal plates to hold the bones together. This allows the bones to fuse together and stop from rubbing against each other.
  • Arthroplasty (Total Wrist Replacement) – In most severe cases, the orthopedic surgeon may recommend complete replacement of the wrist joint. In this procedure, he may remove all the damaged bones as well as cartilage tissue and replace them with artificial metal or plastic joints.

If you are looking for an effective treatment of Wrist Arthritis, contact, Dr. Knoll. She is a board certified, hand and wrist specialist serving the patients in Frisco, TX. To schedule an appointment with the hand surgeon, you can call at (214) 618 – 5502.

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Triangular Fibrocartilage Complex Tear: Orthopedic Plano

by Administrator 26. October 2016 08:15

The Triangular Fibrocartilage Complex (TFCC) Tear is a complex structure between the ends of the small carpal bones and the ulna (in the wrist). It provides stability to the forearm bones (radius and ulna). When this structure gets injured or torn, it results in Triangular Fibrocartilage Complex (TFCC) Tear.

There are two main types of TFCC Tears:

  • Type 1 Tears: These are called Traumatic tears and occur due to excessive use of hand or force applied.
  • Type 2 Tears: Wear and tear of cartilage takes place with the progression of the age.


  • Degenerative changes.
  • Power drill injuries.
  • Fall on an outstretched hand
  • Excessive use of badminton racquet or a cricket bat.


  • Pain in the ulna which increases by performing any physical activity
  • Swelling in the wrist
  • Weakness
  • Clicking sound produced while moving the wrist
  • Low hand grip


An orthopedic doctor may conduct physical examination of the wrist and analyze the symptoms experienced by the patient. An X-ray test may be conducted to check for any fracture or dislocation in the wrist. The doctor may even recommend an MRI test which may help to visualize the enlarged image of the injury. Wrist arthrography may also be performed to determine the severity of the condition.


Non-Surgical Treatment Options

  • Splint: The doctor may recommend wearing a splint to immobilize the joint and promote healing. The wrist may be immobilized for 4-6 weeks depending on the extent of damage.
  • Medication: Anti-inflammatory medications may be prescribed by the doctor to reduce swelling. Cortisone injections may be administered in case of severe pain.  
  • Physical Therapy:  Certain exercises may be suggested by the doctor to provide strength and flexibility to the wrist joint. These exercises may also help to improve the range of motion of the wrist joint.
  • Rest: Adequate rest must be provided to the affected area. Activities that strain the wrist joint must be avoided.

Surgical Treatment

If non-surgical treatment fails to provide relief, a surgery may be recommended. The doctor may make small incisions to clean the torn edges and remove damaged tissues in the wrist joint. Tears can also be repaired through sutures.


TFCC tear can take a long time to recover, ranging from 8 to 12 weeks.

Dr. Knoll is a hand surgeon in Frisco, TX providing effective treatment for Triangular Fibrocartilage Complex (TFCC) Tear. To schedule an appointment, you can call at (214) 618 - 5502.

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Kienbock’s Disease: Orthopedic Treatment In Frisco

by Administrator 25. April 2016 10:47

The wrist is made up of eight carpal bones-one of which is the lunate bone. Any damage or loss of blood supply to this bone is termed as Kienbock’s Disease. Also known as Lunatomalacia or Avascular Necrosis of the Lunate, the condition is characterized by severe pain, swelling and difficulty in wrist movement. In severe stages, it may affect the adjacent bones within the wrist joint. It can be categorized into four stages:

  • Stage 1 – At this stage, there may be a disruption in blood supply to the lunate. However, an X-ray may not show any signs of damage.
  • Stage 2 – The bone may become hard and dense, a condition known as Sclerosis. X-ray results may reveal the damage caused to the bone. 
  • Stage 3 – In this, the affected bone may begin to collapse and break into several pieces, causing the surrounding bones to dislocate.
  • Stage 4 – The lunate is completely collapsed during this stage and the other wrist bones may also weaken, leading to the development of Arthritis.


  • Loss of arterial supply to the lunate
  • Damage to the venous drainage of the lunate
  • Short length of the adjoining ulnar bone
  • Trauma to the wrist, such as during a car accident
  • Repetitive stress
  • Medical conditions such as Sickel Cell Anemia, Gout, Cerebral Palsy, Lupus etc.


  • Swollen wrist
  • Pain
  • Stiffness
  • Clicking sound in the wrist
  • Weakening grip strength
  • Tenderness to touch
  • Restricted range of motion, particularly during upward movement of the wrist


  • The doctor may recommend wearing a brace or splint to restrict the movement of the wrist.
  • Giving complete rest to the wrist and avoiding any movements that may trigger pain.
  • Anti-inflammatory medications may be prescribed to ease pain and reduce swelling.

Patients with Stage 4 Kienbock’s Disease may require surgery. The wrist specialist may recommend any of the following procedures:

  • Revascularization: This involves removing a portion of a bone along with the blood vessels and inserting into the lunate to augment or restore blood supply.
  • Joint Leveling: It may be performed if there is a difference in lengths of the forearm bones. The surgeon may either insert a bone graft to increase the length or remove a section of the bone to shorten it. 
  • Fusion: Joining the surrounding wrist bones, either partially or completely, may help to decrease pressure on the lunate.
  • Arthroplasty: In this procedure, the lunate is replaced with an artificial implant to help the patient find relief from the symptoms.


  • Avoid trauma to the wrist
  • Seek proper and timely of the wrist conditions that may cause Kienbock’s Disease, such as Septic Emboli or Sickle Cell Disease.

Dr. Knoll is a Frisco, TX based hand and wrist surgeon providing comprehensive treatment for Kienbock’s Disease. To schedule an appointment, you can call at (214) 618 – 5502.

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Scapholunate Ligament Tear: Causes, Symptoms And Treatment

by Administrator 23. November 2015 08:39

The wrist is a complex joint comprising of three bones:

  • Radius: The big bone of the forearm on the thumb side.
  • Ulna: The small bone of the forearm on the finger side.
  • Carpal Bones: There are eight carpal bones namely- scaphoid, lunate, triquetrum, pisiform, hamate, capitates, trapezoid and trapezium.

Scaphoid is a small bone located near the thumb. Lunate is a small crescent shaped bone present in the center of the wrist, right next to the scaphoid. Scapholunate ligament holds both these bones together and allows them to move in tandem. When this ligament is injured, it is known as a Scapholunate Ligament Tear. The condition may cause a gap between the two bones, hence, causing them to move away from each other, disrupting proper movement and giving rise to pain.


Scapholunate Ligament Tear is commonly seen in athletes involved in contact sports or racquet sports which require maximum wrist movement. Sudden fall or impact on the wrist may cause the ligament to tear away.


  • Pain in the wrist, mainly near the thumb.
  • Mild to severe swelling.
  • Bruising or redness around the wrist area.
  • The grip of the wrist may weaken.
  • There may be slight snapping or popping sensation in the wrist.


A wrist specialist will carefully examine the wrist joint through to diagnose exact cause and extent of damage caused to the ligament. Treatment options may include:

Non-Surgical Methods:

  • A splint or cast may be put around the joint to keep it stable and restrict mobility for a faster healing.
  • Anti-inflammatory medicines may be recommended to provide quick relief from swelling and pain.

Surgical Method:

Wrist Arthroscopy may be recommended if the ligament has suffered major damage. The procedure involves removing the damaged tissues from the ligament. In some cases, the ligament is realigned and the bones are held in place with the help of pins.

For complete diagnosis and treatment of Scapholunate Ligament Tear or any other hand/wrist conditon, visit Dr. Knoll in Plano, TX. To schedule an appointment with the hand doctor, you can call at (972) 985 – 1072 or 4031 West Plano Parkway Suite 100, Plano, Texas 75093.

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De Quervain’s Tendonitis: Orthopedic Carrollton

by Administrator 26. October 2015 14:07

De Quervain’s Tendonitis, also known as Washerwoman's Sprain is a medical condition which involves inflammation of the tendons around the base of the thumb. These tendons run through a tunnel made up of soft tissues which swells and narrows the tunnel. Swelling of the tendons may lead to pain while doing any hand or wrist movement.  People involved in activities that require repetitive hand and wrist movement have more chances to develop this condition.


  • Overuse of the thumb
  • High-impact blow to the thumb
  • Repetitive clutching
  • Rheumatoid Arthritis
  • Racquet sports
  • Activities such as gardening
  • Women can get it just after pregnancy


  • Pain along the back of the thumb
  • Pain that resonates from the thumb up to the forearm
  • Difficulty in moving the thumb
  • Hurting sensation, particularly when grasping things
  • Inflammation and pain side of the wrist


An orthopedic doctor may conduct Finkelstein test to confirm the presence of De Quervain. He may ask the patient to make a fist with thumb placed in his palm. While turning the wrist outwards, the tendons get pulled and stretched. If this test is painful then a patient suffers from this condition.


  • Splint: A doctor may advise to wear a splint to prevent thumb and wrist movement. All activities that worsen this condition have to be completely stopped.
  • Ice pack: Ice packs can be applied to the affected area at regular intervals as it may help in eliminating pain and swelling.
  • Medication: Anti-inflammatory medicines such as ibuprofen or naproxen, as prescribed by doctor, can be administered to reduce tenderness. Steroids can also be given if the pain is unbearable.
  • Avoiding strenuous activities: A doctor may suggest reducing the activities that cause pain and swelling as it may relieve the symptoms.
  • Corticosteroids: Corticosteroids injection may be recommended by a doctor to provide relief from pain and swelling.
  • Exercise: Certain exercises may be recommended by the doctor so as to strengthen the thumb and wrist. These help in the healing process by reducing pain and improving health of the patient.
  • Surgery: When a patient does not respond to non-surgical treatments, the doctor may recommend surgery.

If you are suffering from De Quervain’s Tendonits, consult Dr. Knoll. The orthopedic doctor specializes in treating a wide range of wrist and hand conditions. To schedule an appointment, call at (214) 618 -5502 or visit 5757 Warren Parkway Suite 180, Frisco, Texas 75034.

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Non-surgical Treatments For Carpal Tunnel Syndrome

by Administrator 23. September 2015 09:20

Carpal Tunnel Syndrome occurs when the median nerve gets compressed from where it passes through the carpal tunnel in the wrist joint. The condition can be caused due to repetitive movements of the wrist, health conditions such as Diabetes or Arthritis, deformity in joint structure, fluid retention during pregnancy etc. Carpal Tunnel Syndrome is symptomized by numbness, stiffness in fingers, pain in the forearm, difficulty in using the thumb, loss of range of motion of the wrist etc.

Treatment for Carpal Tunnel Syndrome usually depends upon the severity and cause of the condition. Here are some of the non-surgical options usually recommended for the treatment of Carpal Tunnel Syndrome:

  • Wrist Splint: Providing support to the wrist with a splint or cast can assist in healing Carpal Tunnel Syndrome. The splint provides support to the wrist and holds it in a stable position. This protects the joint from any jerky movement that many further aggravate the condition. The patient may also be advised to wear the splint while sleeping to prevent nocturnal symptoms such as tingling and numbness.
  • Medication: The patient may be prescribed anti-inflammatory medication to offer relief from pain and swelling.
  • Injections: The orthopedic doctor may prescribe injections for patients experiencing severe pain. When administered directly into the carpal tunnel, injections help to eliminate swelling, which lowers the pressure on the median nerve.
  • Activity Modification: The patient may need to take a break from the job if it involves heavy use of the wrist. This can prevent the condition from worsening and promote a speedier recovery.
  • Ice Pack: The doctor may advise applying ice pack to the affected area. This can assist in reducing inflammation and offer relief to the wrist.
  • Rest: Avoiding activities that require repetitive movement or excessive use of the wrist can also be beneficial. The doctor may recommend giving complete rest to the affected wrist and refraining of any strenuous movements.
  • Physical Therapy: Once the pain and swelling subside, the orthopedic surgeon may refer the patient to a physical therapist. Performing light stretching and strengthening exercises, under proper supervision, can help to restore the range of motion of the wrist joint.

For comprehensive diagnosis and treatment of Carpal Tunnel Syndrome, visit Dr. Knoll. To schedule an appointment with the wrist doctor in Plano, TX, you can call at (972) 985 – 1072.

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Orthopedic Treatment For Writer's Cramp

by Administrator 16. July 2015 07:18

Writer’s Cramp, also known as Mogigraphia, is a condition that involves involuntary and sudden cramping of the intrinsic muscles of the hand. It is caused due to excessive writing and other repetitive tasks involving the hand. As it is a task-specific focal dystonia of the hand, the pain and symptoms are limited to the hand, and are caused due to specific tasks. It is not a common condition and is more prone to men.

The two basic types of Writer’s Cramp are:

  • Simple: When suffering with simple Writer’s Cramp, the person only faces difficulty with one specific task such as writing or typing.
  • Dystonic: In this condition the symptoms are present when the person performs any activity with the hand such as shaving, eating, washing or applying make-up.


  • Excessive muscular or motor activity
  • Using faulty writing technique
  • Excessive writing
  • Activities such as typing
  • Injury to the hand
  • Genetics
  • Ruptured Intervertebral Disc
  • Defective blood vessels
  • Tumors of the brain
  • Stroke


  • Pain contractions
  • Chronic sustained pain
  • Inability to write
  • Changes in handwriting
  • Difficulty in carrying out occupational tasks such as typing, writing, playing instruments, etc
  • Excessive abnormal movement of the elbow and wrist
  • Difficulty with coordination of the hand
  • Shaking or twitching of hand while writing
  • Deformity


In order to diagnose the condition the orthopedic surgeon may physically examine your hand. He may discuss the symptoms, nature of any injury and past medical history of the patient. The orthopedic doctor may recommend certain imaging test such as MRI, Electromyography, etc. to determine the extent of the condition.


The condition often resolves spontaneously but there are chances of recurrence if you return to repetitive tasks that led to the condition. The orthopedic surgeon may prescribe certain medicines to offer relief from the symptoms. The doctor can also recommend physiotherapy to regain flexibility and strength in the hand. The physiotherapist can help by offering an exercise program that helps the patient stretch the hands and avoid spasms. Surgery is also effective but is only prescribed in extreme cases. Release surgery is used to decompress the affected nerve in the wrist, hand or elbow. It is a minimal invasive surgery, which involves a short recovery time.

Making significant behavioral and ergonomic changes can prevent writer’s cramp. You should limit the working hours, take regular breaks, use alternate devices for transcription such as dictation, speech-to-text recognition software, etc. and change the way you grip a pen.

For complete diagnosis and treatment of Writer's Cramp, consult Dr. Knoll. To schedule an appointment with the hand surgeon, call at (214) 618-5502.

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Scaphoid Fracture Of The Wrist: Orthopedic Treatment In Plano

by Administrator 18. June 2015 05:17

The scaphoid, also known as the carpal navicular, is one of the eight small bones that make up the carpal bones in the wrist. A fracture in this bone is the most common kind of wrist fracture. It can be caused due to a sudden blow or abrupt landing on an outstretched hand. It can occur to anyone at any age but is most common in gymnasts and shot putters.


  • Falls: Falling on an outstretched hand can lead to a traumatic injury in the wrist. Falls can apply a great amount of pressure on the bones and may cause cracks in the scaphoid.
  • Repetitive stress: Overuse of the scaphoid bone while activities like writing, leaning on the wrist while sitting or standing can lead to straining of the muscles and harm the ligaments of the joint and also cause fractures.
  • Accidents: Severe traumas like motor cycle accidents car collisions can also cause injuries related to the wrist including Scaphoid Fracture.


  • Pain on the thumb side of the wrist
  • Swelling and tenderness
  • Bruises around the wrist
  • Difficulty in grabbing or holding objects
  • Reduced range of motion


The doctor inquires about the patient‘s medical history and how the injury occurred. He may physically examine the joint to look for symptoms like tenderness and swelling. Imaging tests like X-rays can also be suggested to determine the severity of the injury. Sometimes a Scaphoid Fracture may not be visible in X-ray. In such cases, the doctor may also order an MRI or a CT- scan.


  • Cast: The orthopedic doctor may suggest the patient to put the hand in a cast to restrict motion of the wrist. The cast may be worn for 9-12 weeks or as prescribed by the doctor to let the joint heal completely.
  • Medication: The doctor may also prescribe some anti-inflammatory medications which can help in minimizing pain and swelling in the joint. Calcium supplements can also be recommended to build bone strength and speed up the healing process.
  • Physical Therapy: The patient may be suggested to attend physical therapy sessions in order to build muscle strength and regain mobility in the joint. Physical therapy can also be helpful in reducing stiffness in the wrist.

An orthopedic doctor should be consulted as soon as possible for a Scaphoid Fracture or it can lead to severe health conditions like Arthritis.

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Mallet Finger: Orthopedic Treatment In Frisco, TX

by Administrator 20. May 2015 13:19

Mallet Finger, also known as baseball finger, is an injury to the outermost joint of the finger that is responsible for making the tip of the finger bend towards the palm. It is caused by damage to the tendon, causing severe pain and swelling. It is a common sports injury but can also occur due to minor accidents.


Mallet Finger generally occurs while playing sport activities involving a ball, like baseball or basketball. When the ball hits the tip of an outstretched finger the tendons of the outermost joint of the finger swell up, leading to Mallet Finger. It can also be caused when any hard object hits the finger or cut with a sharp object like a knife.

Risk Factors

People with less flexibility or concurrent sprains in their fingers and sportspersons involved in sports with a ball are prone to suffer from this condition.


  • Pain and swelling
  • Bent finger
  • Redness and numbness
  • Tenderness
  • Blood clots under nail
  • Inability to extend the finger
  • A popping sound at the time of injury


The orthopedic surgeon physically examines the injured finger to determine the extent of pain, redness and swelling. He may also diagnose the severity of the condition and the movement possible by bending the finger. The doctor may recommend an X-Ray to check if the injury involves any broken bones. Accordingly, he devises a treatment plan to treat the condition.


Non-surgical treatment:

  • Ice: Applying an ice pack can be advised to reduce swelling and pain.
  • Splints: Wearing a splint to keep the injured finger in a straight position can help to heal the injury. The doctor advises on the duration that the splint needs to be worn, as it depends on the severity of the condition.
  • Exercises: The doctor may also advise certain exercises to improve motion and resume flexibility in the finger.
  • Medication: The orthopedic surgeon can also recommend anti-inflammatory medications to reduce pain and swelling.

Surgical treatment:

In severe cases, if the non-surgical methods do not provide relief, the surgeon may recommend surgery. The surgical procedure is usually followed by physiotherapy and it is advised that you visit the orthopedic surgeon regularly for check ups.

If you have suffered a finger/fingertip injury, Dr. Knoll in Frisco, TX. To schedule an appointment with the wrist doctor, call at (214) 618 - 5502.

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