Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today is Dr. Adam Jacoby. He's an Assistant Professor of Surgery and Plastic Surgery at Weill Cornell Medicine, and he's here to tell us about what patients should know about hand and upper extremity surgery. Dr. Jacoby, thank you so much for joining us today. I'd like you to tell us some of the common injuries, the most common injuries of the hand and the wrist that you see every day. And if there are some sports or professions that you see them in where they occur the most, tell us about those.

Dr. Adam Jacoby: Hi, Melanie. Thank you so much for having me. I'm happy to discuss hand and upper extremity surgery. I do see a lot of injuries, primarily in people who use their hands a lot. There are a lot of construction workers, manual laborers who injure their hands, particularly their nails and bones within their fingers, that's very, very common, as well as athletes who sprain their fingers or break their bones. So, professions such as boxing, playing hockey, those are very common things that we see with fractures of the bones and torn ligaments.

Melanie Cole, MS: Dr. Jacoby, I'd like you to speak about the risk factors. How do we get these? You just mentioned some sports and professions where we can, but there are also overuse injuries that cause problems to our wrists and our hands. We hear about people that text a lot getting carpal tunnel or working at a computer or something like that. So, can you tell us some risk factors that might predispose us to things that would subject our hands to injuries?

Dr. Adam Jacoby: Sure. Particularly with carpal tunnel and nerve compression syndromes, patients that have rheumatoid arthritis or inflammatory arthritis or diabetes are at higher risk for having those conditions. So, those are some of the big risk factors can put you at higher risk for carpal tunnel syndrome.

Melanie Cole, MS: Well, speak a little bit about that specific condition then. Tell us about carpal tunnel. And when you see it, it's probably pretty common, yes? Tell us a little bit about what it feels like. What are the symptoms? How do we know?

Dr. Adam Jacoby: Yeah. Carpal tunnel is probably the most common diagnosis I see in my office and people have numbness and the feeling of clumsiness in their first three fingers, so their thumb, their index and their middle finger, and sometimes they feel some weakness. And it's caused by entrapment of a nerve called the median nerve at the level of the wrist.

Melanie Cole, MS: Tell us about some of the others. You mentioned trigger finger tendonitis, another common one. How do we know the difference when you speak about carpal tunnel? How do we know the difference between that and tendonitis?

Dr. Adam Jacoby: So, carpal tunnel, you'll have what we describe as nerve-like pain, so it feels like your hand falls asleep, those numbness, tingling feelings. Tendonitis is more or less pain. In the finger, you can get something called trigger finger, where your finger locks down into your palm, and that's caused by swelling of the tendon in your hand.

Melanie Cole, MS: Wow. There are so many injuries of the hands and fingers that we don't even tend to think about now. When someone comes to you, Dr. Jacoby, what are some conservative measures that you'd try before considering surgery or injections? Speak about some of those non-surgical options, whether it's medications, physical therapy, ice, heat, what do you do?

Dr. Adam Jacoby: I think that's a great question. And fortunately, many of the conditions can be treated non-surgically, including tendonitis and nerve compressions like carpal tunnel syndrome. We work with our therapists who are wonderful here at Weill Cornell, and they can cure many of our patients of these issues, particularly with carpal tunnel syndrome and nerve compression of the ulnar nerve behind the elbow called cubital tunnel syndrome. They can work on exercises that provides mobility of the nerve, and they can also give splints that can prevent repetitive actions that can actually compress the nerve. That's one of the main treatment options we have before we give something like an injection.

Melanie Cole, MS: Before we get into injections, I'd like to focus a bit on splinting and you mentioned therapy and exercises. We think of bracing as a way to, as you said, prevent it from keep happening, prevent us from doing that movement. Does it then make the muscles weaker when you brace your wrist or hand? And also, tell us about ice versus heat. Do you ever use that as a modality?

Dr. Adam Jacoby: Yeah. The therapist I work with use both quite frequently. For nerve compression syndromes, particularly carpal tunnel, whenever you flex or bend your wrist down to your arm, you actually compress the nerve. So, splinting actually prevents you from compressing the nerve there, so extremely helpful. And it usually does not weaken the muscles because we usually try splinting only at night time.

Melanie Cole, MS: Thank you for answering that. A lot of people have questions about that. I'm an exercise physiologist and I've gotten these kinds of questions for years and thank you so much for clearing that up. Now, let's speak about injections and where they fit in to this picture of rehab and/or these conditions.

Dr. Adam Jacoby: Yeah. Injections are very, very helpful, especially for trigger finger and De Quervain tenosynovitis, which are two tendonitis conditions. And the literature shows that most of them can be completely cured with one or two injections. So, they're extremely helpful. For carpal tunnel syndrome, injections are less helpful, studies show that the same rate of people need surgery with or without injections.

Melanie Cole, MS: Then when does it become surgical, Dr. Jacoby?

Dr. Adam Jacoby: Patients who come in with severe weakness from nerve entrapment like carpal tunnel, that's immediately surgical because weakness can be irreversible. So, I do not give them a trial of splinting or physical or hand therapy. But patients who have tried hand therapy and who have maximized hand therapy without improvement, I'll also operate on those patients.

Melanie Cole, MS: What are some of those surgical options? What are they like for the patient and how soon can they get back to doing whatever it was they were doing?

Dr. Adam Jacoby: Yeah. There are two options for carpal tunnel, for example. The traditional open surgical technique, which is about 1-1/2-inch incision at the palm versus an endoscopic or using a camera technique, where the incision is about a third of that length, and the recovery is usually faster.

Melanie Cole, MS: Dr. Jacoby, we've heard the term ergonomics at work a lot in the last bunch of years. And we think of that for our necks and our lower backs, but there's also ergonomics for our hands and our wrists. And with all our kids, the way they've been texting and the way they use those thumbs, I can't do what my kids can do on their phone. I just can't move that fast. Are you seeing injuries in that way and can you give us any kind of good advice on ergonomics, prevention, anything when we see that and we see our kids with their thumbs moving a million miles an hour?

Dr. Adam Jacoby: Yeah. I actually have not seen a ton of texting-related overuse injuries, although I know my colleagues have. What I have seen a lot of, as you mentioned, are spine issues that result also in carpal tunnel syndrome. The nerves that come out of our spine also end in our hand and wrist. So if they're compressed in the spine from cervical spine disease, you can absolutely have a higher risk of having carpal tunnel syndrome. Your posture at work is extremely important to prevent hunching over.

Melanie Cole, MS: That's great advice. Do you have any final thoughts on hand and wrist injuries and what you would like listeners to take away from this podcast?

Dr. Adam Jacoby: Yeah, of course. I think this is a great field to be in because I can treat many of my patients without surgery. And many of them heal with appropriate splinting and conservative measures. But for those patients with fractures and bad injuries, they may often need surgery. So if you have really bad swelling, pain, numbness, tingling, always feel free to reach out to your local hand surgeon for help.

Melanie Cole, MS: Thank you so much, doctor, for joining us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts and Google Podcasts.

And for more health tips, please visit weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole. Thanks so much for joining us today.

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