A Pain in the ...

… wrist, hand, foot or ankle can have a number of origins and treatments. We look at five common afflictions.

Injuries and damage to our extremities can make everyday life painful … at times insufferable. Three Oklahoma orthopedists describe common problems that people have with their wrists, hands, feet and ankles, and weigh in on treatments and solutions.

Wrist Sprains

Clayton Nelson, an orthopedic surgeon with the Oklahoma Sports Orthopedic Institute in central Oklahoma, says sprains occur when the wrist is flexed or extended beyond its normal position to cause injury to the ligaments.

“Being evaluated by your doctor and having X-rays taken are important to make sure there are no broken bones, dislocated joints or evidence of a full ligament tear,” he says. “Treatment generally consists of resting the injured wrist and using splints until symptoms improve. It can also be beneficial to use ice and anti-inflammatories to help with the swelling and pain.”

Carpal Tunnel Syndrome

This affliction is caused by the compression of the median nerve at the point where it travels through the carpal tunnel, a narrow passageway on the palm side of the wrist. Symptoms include numbness and tingling in the fingers.

Brian Chalkin, an orthopedic surgeon with the Orthopaedic Center of Tulsa, says while various treatments exist, most specialists recommend a splint to rest the wrist at night during sleep.

“This has a 50-percent success rate in treating the problem,” he says. “Ultimately, if conservative treatment fails, then surgical release of the carpal tunnel is recommended.”

Hand Tendinitis

“Tendinitis is inflammation or irritation of the tendon and is most commonly caused by an overuse injury,” Nelson says.

Any repetitive activity can cause overuse and result in the inflammation or thickening of the tendons, causing pain, swelling and restricted ranges of motion in the wrist and hand.

Tendinitis is typically addressed without surgery. Nelson says the most important treatment factor is limiting or eliminating the activity causing the condition.

“Modifying the work place environment or altering athletic techniques to reduce repetitive motions can help improve the swelling and pain experienced with tendinitis,” he says.

Other treatment options include anti-inflammatory medications, wearing braces or splints, and physical therapy.

Foot Stress Fractures

“Bones are living tissue and they can bend and deform under stress – if the bone bends too much or too forcefully, it will break or ‘fracture,’” says Bryan Hawkins, an orthopedic surgeon with Advanced Orthopedics of Oklahoma in Tulsa. “Treatment is simple. The foot is protected, often with a supportive shoe or removable boot, and comfortable activities are allowed, but repetitive, weight-bearing activities are stopped. Non-weight-bearing activities are permitted if they don’t cause undue pain.”

Arthritis in Hands and Ankles

“Treatment options for arthritis of the hands range from physiotherapy, specialized custom splints, topical or oral medications, anti-rheumatologic medications, and, as a last resort, surgical reconstructions or fusions of various joints,” Chalkin says. “Often times, there is no reason to suffer, and advanced treatments can offer patients great promise.”

Initial treatment of arthritis in the ankle includes medication and modifying activities to manage pain, Hawkins says. If the pain is too severe, surgical options include ankle fusion or ankle joint replacement. Fusion may sound limiting, but he says people can do many activities and walking appears normal in the majority of patients.

Ankle joint replacements preserve the motion of the ankle, but Hawkins says additional surgery may be needed because the replaced joint lasts 10-12 years. Additionally, activity is limited on ankle replacements because of the small size, as huge stresses are placed on the joint.

REBECCA FAST