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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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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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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Sprained Wrist: Causes, Symptoms, Prevention And Treatment

by Administrator 23. March 2015 07:05

Wrist sprain is a common condition that results due to stretching, wear and tear, and injury to ligaments in the wrist. The sprain ranges from mild to severe depending upon the damage to the ligaments. It is a common injury among players who play boxing, hockey, volleyball, basketball, wrestling, weightlifting, etc. and occurs due to repeated use of the wrist joint and twisting movements.


Wrist sprain can occur during day-to-day activities or during sports and other recreational activities. Some causes of wrist sprain include

  • Fall onto an outstretched hand
  • Falling on a hard surface while playing sports such as snowboarding, skateboarding, cycling, etc
  • Lifting heavy objects
  • Weak or inflexible tendons or ligaments
  • Repeated strain due to overuse

Many other factors often lead to wrist sprain and these include poor conditioning, fatigue, slippery surface, improper warm up etc.


  • Swelling
  • Pain at the time of injury
  • Bruising
  • Discoloration of the skin
  • Tenderness
  • A popping sound
  • Stiffness
  • Inability to move the joint


When the patient visits the orthopedic doctor he will physically examine the wrist and enquire about previous injuries and medical history. He will review your symptoms and recommend certain imaging tests that will help in confirming the sprain. These tests include X-rays, CT scan, MRI and Arthrogram.


If the sprain is mild, it can be treated with resting the joint for one or two days, applying ice pack to the swelled area for 20 minutes, compressing the swelling with an elastic bandage and elevating the injured wrist above the level of the heart. The patient can get relief with non-steroidal anti-inflammatory medicines. By immobilizing the wrist, the patient can treat the sprain without any surgery. To avoid the stiffness due to immobilization, the physician often recommends some stretching exercises.

In case of severe sprains, the ligament has to be reconnected to the bone surgically. The wrist doctor will decide whether the patient needs surgery. After surgery, the patient has to undergo a period of rehabilitation, which helps the patient recover the strength and motion to the joint.


As the wrist sprain occurs mainly due to falling on the wrist; therefore, to avoid the sprain, one should be careful while walking on wet or slippery surface. Sportspersons should use wrist guard splints or protective tape, which offers support to the wrist and prevents bending of the wrist.

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Wrist Pain: Orthopedic Treatment In Plano, TX

by Administrator 21. November 2014 05:43

Wrist pain has become a very common problem and is often caused due to fractures or sprains due to repetitive activities.  However, the condition can also be a result of chronic health problems such as Carpal Tunnel Syndrome or Osteoarthritis. Thus, it is critical to make an accurate diagnosis of the causes of wrist pain so that it can be treated effectively.


  • Sudden blows: Wrist pain is often the result of an injury due to falling on an outspread hand. This may lead to strains, sprains or fractures of the hand and wrist.
  • Repetitive stress: Activities involving repetitive movements of the writs can also be a cause of pain. These may include playing tennis or driving long distances.
  • Arthritis of the wrist: The wrist joint is most commonly affected by two types of Arthritis, including Osteoarthritis and Rheumatoid Arthritis. These conditions can cause inflammation or pain in the muscles and tissues of the wrist.
  • Other medical conditions: Certain other medical problems like Ganglion Cysts, Carpal Tunnel Syndrome, De Quervain’s Tendonitis, Kienbock’s Disease can also cause wrist pain.


To make a diagnosis of the cause, the hand and wrist doctor in Plano, TX will conduct a thorough physical examination to check your wrist for signs like swelling, tenderness, bruising or deformity. You may also be recommended to undergo certain imaging tests like X-rays or CT scans to analyze the extent of damage caused to the wrist.


Depending upon the underlying cause of your wrist pain, the orthopedic doctor may recommend the following treatment options:

  • Rest and activity modification: The first step in the treatment for wrist pain is to provide ample rest to the joint and let the swelling to subside. Indulging in activities that put stress on the wrist should also be avoided till the condition gets treated completely.
  • Ice or heat application: Applying ice packs or heat pads are also an effective treatment method for wrist pain. These help the release compression from the wrist nerves and, thus, provide relief from pain. 
  • Anti-inflammatory medications: Certain over the counter non-steroidal medications may also be prescribed by the orthopedic doctor to ease the pain and tenderness in the wrist.
  • Wrist support: If the wrist pain is due to a fracture or injury, wearing a cast or splint can help to provide support and boost recovery.

For complete diagnosis and treatment of wrist pain in Plano, TX, visit Dr. Knoll. To schedule an appointment with the wrist doctor, you can call at (972) 985-1072.

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Orthopedic Treatment For Wrist Sprains

by Administrator 21. August 2014 08:32

Wrist sprain is one of the most common sports injuries and can occur to anyone. The wrist is made of a number of bones, ligaments and muscles. The ligaments in the wrist connect the hand with the forearm and stretching or tearing of these ligaments results in a wrist sprain. Falling from a height, outstretched hand or repeated stress can damage the ligaments and cause sprain. The risk is increased if the tissues in the wrist are already weak or damaged. Depending upon the extent of damage to the ligaments, the severity of the sprain can range from mild, moderate to severe.


Some of the causes of a wrist sprain are as follows

  • Work or sports activity related repeated motion of wrist
  • Various sports activities
  • Loose joints
  • Poor balance and coordination


A wrist sprains causes discomfort and is accompanied by the following symptoms

  • Pain
  • Swelling
  • Redness around the wrist
  • Tenderness
  • Bruising
  • Wrist deformity
  • Inability to move the wrist


For proper treatment of the condition it is essential to properly diagnose that the injury is a sprain and not a fracture. An orthopedic doctor should be consulted immediately so that he can physically examine the wrist and take details regarding the medical history of the patient and determine the cause of the problem. The doctor may also recommend some imaging tests like X- Ray, MRI or a CT scan to check the stability of the joint and to know the severity of the injury.


Depending upon the type and severity of sprain in the wrist an orthopedic surgeon may offer different treatments including non-surgical and surgical methods.

Non-surgical methods

For treating the wrist pain, the physicians recommend patients to take rest and advise to avoid movement of the wrist. The doctor may even suggest using ice therapy to gain relief from the swelling and pain. Physicians also recommend compression bandages that help in reducing swelling along with anti- inflammatory drugs.

Surgical Methods

If the non-surgical treatments fail to have an effect on the sprain, the orthopedic surgeons may suggest surgery as a last resort. During surgery, the surgeon repairs and reconnects the torn ligaments and the surgery is followed by a rehabilitation period to restore movement in the wrist. The patient is often recommended physiotherapy to recover and gain strength in the wrist.

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Orthopedic Treatment For Cubital Tunnel Syndrome

by Administrator 21. April 2014 08:58

Cubital Tunnel Syndrome is an extremely painful condition of the arm caused by overuse of the elbow joint. In this condition the ulnar nerve gets stressed, compresses or swollen near the elbow area. It causes pain, discomfort, numbness and loss of mobility. Apart from heavy use of the elbow joint, Cubital Tunnel Syndrome can also occur as a result of impact damage to the Cubital Tunnel near the elbow.


Cubital Tunnel Syndrome is most often causes by repetitive motion. The ulnar nerve actually stretches and flexes quite a bit when the elbow joint is bent. Too much of repetitive bending of the elbow can cause strain on the nerve and form the beginnings of Cubital Tunnel Syndrome. Situations where there is a constant pressure on the elbow joint can also be a major cause for this condition. Finally, Cubital Tunnel Syndrome can also be caused by impact damage resulting from accidents and falls.


One of the main symptoms that manifest when people have Cubital Tunnel Syndrome is a numbness of the hand. The first stages of the condition result in considerable numbness on the internal areas of the hand like the ring finger or the little fingers and underlying areas on the palm. The numbness can gradually give way to extreme pain particularly when the elbow joint is moved or bent.

Diagnosis and Treatment

Cubital Tunnel Syndrome can be diagnosed with the help of a detailed physical examination and some special tests. The standard test which is used to detect this condition is called the nerve conduction velocity test which measures the speed at which impulses are transmitted along the length of the nerve. This can sometimes be coupled with an electromyogram test for accurate diagnosis.

In less severe cases non-surgical treatment might be all that is needed. It is recommended to stop the activity that might cause the condition to worsen and to give your arm adequate rest. Anti-inflammatory drugs can be used for pain management. Your wrist doctor might prescribe the use of a brace or support to relieve pressure from the elbow joint. Working with a physical therapist and getting targeted exercise and rest can also prove crucial in this line of treatment.

With more serious cases of Cubital Tunnel Syndrome, surgery might prove to be the only option. There are different procedures which can be used to relieve the pressure from the ulnar nerve through surgery. The most commonly used technique involves surgical transposition of the ulnar nerve followed by post-operative rehabilitation.

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