Diseases, Disorders information

Treatment generally involves antiinflammatory drugs which often work quite well. Sometimes just modifying the shoes a little bit, getting some inserts. You can buy them in a drug store or sporting goods store. Sometimes a podiatrist can design an orthotics - or an orthopedic surgeon can design orthotics - that would help to relieve the strain of this plantar fascia. Corticosteroid injections can be useful. I don’t like to do them repeatedly, again because this structure has a tremendous amount of stress on it. So I’ll do it once, maybe twice. A lot of times that’s all you need. Sometimes patients do need ongoing antiinflammatory treatment if they continue to do what it is that caused the situation in the first place.
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Carpal tunnel syndrome is the most common thing that we see. The symptoms are pain and burning in the wrist and hands. Often it is not that well localized. Patients don’t read their neurology textbooks. They don’t know where the median nerve goes versus the ulnar nerve. Often they complain that the entire hand is numb. The pain may radiate up to the arm, even up into the neck if it is very severe and very acute. Paresthesia and numbness are classic. Symptoms are very prominent at night, especially if the patients just happen to fold their wrists in a certain position. They may actually wake up with their hand asleep and have to shake it out in order to get the feeling back into it. Also, clumsiness. They don’t have - even if they have normal sensation on exam - they don’t feel the dexterity is there in their hand. Physical findings; the Tinel’s sign. I find that that’s by far and away the best. You can do this with your finger, just like when you percuss or even with a reflex hammer over the carpal tunnel, which the best spot is over the area between the thenar.
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The hypothenar evidence marks the location of the carpal tunnel. If you tap there and the patient has pain, either radiating into their hands somewhere, their thenar evidence or their fingers, or up into their forearm, I consider that a positive sign. The Thalence is not quite as good. That’s where you bend the wrist, either flex it or extend it for the reverse Thalence and then let it sit there for awhile. I don’t find that is quite as useful. I don’t feel like wasting a minute, having them sit there if the Tinel’s sign is positive, that’s good enough for me. You may have abnormal sensory findings, occasionally weakness or even atrophy which is, in my experience, very unusual. Probably a hand surgeon or orthopedist see this a lot more. This just shows you the difference in nerve distribution, the median nerve is generally the first three-and-a-half fingers. Although it is very rare, I have had some patients say, “Why does the middle part of my finger feel strange and the outside of my finger feel normal?” I’ve had maybe twice that that’s happened, so most of the time they don’t differentiate it quite that precisely. You can see the ulnar nerve is the other part of the hands and also extends on to the dorsum, which the medial nerve does not affect the dorsum. That’s the radial nerve. This is one of the maybe two patients I’ve seen who had thenar atrophy. He had carpal tunnel syndrome for a long time and I just sent him right to the hand surgeon because that’s pretty serious when you get motor involvement.