Frequently Asked Questions

Your first visit will start with a focused history and physical examination of your hand, wrist or elbow. Dr. Dimachkieh will ask questions regarding the onset of symptoms and the details of your specific complaint. We will routinely perform x-rays in the office, which Dr. Dimachkieh will review with you in person. After making a diagnosis, we may order further tests (e.g. nerve conduction studies, advanced imaging such as CT scan or MRI, etc) and discuss conservative treatment options such as occupational/physical therapy, whether surgery may help, expected recovery and next steps – all in language that is easy to understand.

Carpal tunnel syndrome typically causes numbness, tingling, and/or a burning sensation in the thumb, index finger, middle finger and half of the ring finger — classically worse at night or with activities like holding a phone or driving. Some people have hand weakness or trouble with fine motor skills such as buttoning a button on a shirt collar. Diagnosis is usually made with a combination of history and physical examination. Oftentimes, we confirm the diagnosis of carpal tunnel syndrome with nerve conduction studies (performed by a neurologist) or a steroid injection. Many patients improve with splints, activity modification, steroid injections, or surgery if conservative management fails.

Trigger fingers occur when the tendon that flexes the finger down into a fist catches as it slides through a constrictive structure called the A1 pulley, causing a mechanical sensation in the finger usually felt as a pop, click or even lock. Symptoms are usually worse at night-time or first thing in the morning. Early-onset cases often respond to rest, splinting, anti-inflammatory medications, or a steroid injection. If these don’t help, a simple outpatient procedure in the operating room can release the pulley that’s catching the tendon and typically restore full finger function. This surgery can be done with the patient wide-awake or under anesthesia, depending on patient preference.

Dr. Dimachkieh believes in conservative management whenever there is a chance that a condition may be resolved and function fully restored without operative treatment. However, there are certain cases when surgery is the only option to fully restore function to pre-injury levels. The treatment plan for each patient is custom-tailored to each patient’s individual needs and goals. Examples of when surgery may be indicated include when:

• Nonoperative care (splints, medications, injections, therapy) hasn’t relieved symptoms, and those symptoms affect daily life and/or work.
• There’s long-standing nerve compression (e.g., in carpal tunnel) that risks permanent nerve damage, resulting in progressive weakness or permanent numbness and tingling.
• A fracture (broken bone) is displaced or unstable and won’t heal properly without restoration of anatomic alignment.
• Surgery may be a necessity for certain conditions such as tendon or nerve lacerations.

We’ll always discuss all options, risks, and realistic recovery expectations before recommending surgery.

Treatment depends on the specific bone that is broken, how widely the fracture is displaced, and your activity needs. Options include:

• Splinting or casting for stable fractures.
• Closed reduction (manipulation) and casting for some minimally-displaced fractures.
• Surgical fixation for unstable fractures or those that involve the joint (intra-articular fractures)

General healing timelines are as follows:

• Finger fractures: 4-6 weeks to heal enough for most daily activities, with an additional 6 weeks to regain range of motion and strength.
• Wrist fractures: 6–8 weeks for bone healing, but 3-4 months to rebuild strength and motion.
• Elbow fractures: variable — often 6–8 weeks for bone healing; stiffness is common and may require therapy. Even after the bone heals, regaining range of motion and strength often continues for several months.

• Carpal tunnel release: Most patients have rapid improvement of numbness and tingling over days to weeks, although there is no guarantee symptoms will 100% resolve. The wound heals in 7-10 days. Return to light activities happens quickly, within a few days of surgery. Full return of strength usually takes 8-10 weeks.
• Trigger finger surgery: Most patients get quick improvement in locking; wound heals in 1–2 weeks. Some swelling or stiffness may take several weeks to resolve.
• Fracture fixation: Immobilization period varies (usually 2–8 weeks), followed by gradual motion and strengthening with therapy. Full functional recovery can be several months depending on the fracture. Dr. Dimachkieh will provide specific activity restrictions, dressing instructions and a personalized rehab plan after surgery.

Oftentimes, yes — therapy speeds recovery of motion, reduces stiffness, and helps restore strength and fine motor skills. For some simple procedures, you may not need formal therapy, but you’ll get a home exercise program to do on your own. For more complex procedures such as fractures and tendon/nerve repairs, formal therapy is commonly recommended and sometimes essential to a good outcome.

Post-operative pain is usually controlled with a combination of short-term oral pain medicines (NSAIDs and/or acetaminophen and, if needed, a short course of stronger prescription medication), icing, elevation, and early motion as allowed. Dr. Dimachkieh will tailor a pain-management plan specific to your needs and minimize opioid use whenever possible. It is important to note that some pain is always expected after surgery and our team wants the pain to be at a manageable level. Dr. Dimachkieh often recommends a regional nerve block, done by the anesthesiologist at the time of surgery, which provides excellent reduction or even elimination of pain in the immediate postoperative period, when pain levels are typically at their worst.

Dr. Dimachkieh performs both endoscopic and open carpal tunnel releases.

In most cases, Dr. Dimachkieh recommends an endoscopic release when the patient is comfortable having surgery under general anesthesia. This technique uses a small camera and a tiny incision in the wrist crease to release the ligament pressing on the median nerve in the central portion of the palm. Patients typically have less soreness in the first few weeks and an earlier return to normal activities than with the open release technique.

For patients who prefer to stay wide-awake with only local anesthesia, Dr. Dimachkieh performs an open carpal tunnel release. This is done through a slightly larger (but still small) incision in the mid-portion of the palm while the hand is numbed — no IV or sedation is needed.

Both techniques have the same long-term results, and the choice depends on your comfort level and preferences. Dr. Dimachkieh will discuss both options together so you can decide which approach best fits your needs.