Dr. Herb Von Schroeder, Orthopaedic Surgeon, Toronto, ON

Medical Director, Hand and Wrist Specialty Program, Altum Health, Associate Professor, Division of Plastic and Orthopaedic Surgery, University of Toronto, Associate Professor, Department of Surgery, University of Toronto A recognized expert in the field of hand and wrist injuries, Dr. von Schroeder is the Medical Director of the WSIB Hand and Wrist Specialty Program, an Associate Professor in the Divisions of Plastic and Orthopaedic Surgery, Department of Surgery, University of Toronto and a Research Scientist at the Faculty of Dentistry. With over 22 years experience, Dr. von Schroder also holds the Certificate for Added Qualification in Hand Surgery. In 1982, Dr. von Schroeder completed a Bachelor of Science (Honours) followed by a MD in 1986, both at University of British Columbia. His research fellowships took place at the University of California, San Diego and at the University of Toronto in skeletal and cell research. Dr. von Schroeder finished his residency in Orthopaedic Surgery at the University of Toronto, and became a Fellow of the Royal College of Surgeons (Canada) in 1996. In 1996 and 1997, Dr. von Schroeder completed two clinical fellowships at Sunnybrook Health Sciences Centre, Toronto, and C.M. Kleinert Institute for Hand and Microsurgery, Louisville, KY., obtaining highly specialized training in hand, wrist and microsurgery. Dr. von Schroeder has particular clinical interest in reconstructive wrist surgery for carpal instability, scaphoid fracture surgery, scaphoid pseudarthrosis reconstruction, vascularized bone graft procedures in the wrist, small joint arthroplasty in the hand and wrist arthroscopy. Carpal tunnel syndrome. Carpal tunnel syndrome is one of the most common conditions of the hand and it causes numbness and tingling in the hand, and especially the fingertips. It sometimes causes pain. The condition occurs when one of the major nerves to the hand called the median nerve is squeezed or compressed as it travels through its tunnel into the palm. It's this tunnel that's called the carpal tunnel. It's just two centimeters wide and four centimeters long. The tunnel is formed by the wrist bones on one side and by a thick ligament on the other side called the transverse retinacular ligament. More on this later. In addition to the median nerve within the carpal tunnel, the space is shared with nine flexor tendons to the digits. There are two tendons for every finger and only one to the thumb. The flexor tendons are structures that cause your fingers to bend or flex into the fist position. Carpal tunnel syndrome occurs when the median nerve traveling through the tunnel gets compressed. So the next question is why does this happen? The most common cases of carpal tunnel syndrome are caused by a whole combination of factors, including aging. A common and important factor is simply the size of the tunnel, and this may be hereditary. So that is the carpal tunnel has an anatomically smaller shape in some patients, and so there's less space for the nerve. Heavy or repetitive use of the hand, such as with heavy lifting of objects, especially when vibration is incurred, can lead to swelling of those flexor tendons to further decrease the space in the tunnel. Repetitive activity usually needs to be prolonged for this compression and the symptoms to occur. Doing activities that involve extreme flexion or extension for prolonged periods of time can also increase the pressure on the nerve, but light repetitive use of the fingers is not likely a cause of carpal tunnel syndrome. Your body's hormone changes, such as those that occur with pregnancy, can also cause swelling and lead to carpal tunnel syndrome. And finally, there are several health conditions such as diabetes, rheumatoid arthritis, or thyroid gland imbalance that are also conditions that are associated with carpal tunnel syndrome. These health conditions are, however, less common causes of the syndrome. Symptoms. What are the major symptoms of carpal tunnel syndrome? The most common symptoms of this syndrome are numbness and tingling, primarily of the thumb and the index and the long finger, and part of the ring finger. The small finger is rarely affected, as the nerve that carries the feeling to the small finger is not the median nerve. Feeling to the small finger is carried by the ulnar nerve, also known as the "funny bone". If patients have numbness primarily in the small finger, then one must reconsider the diagnosis of carpal tunnel syndrome. Patients may also have burning and pain in the median nerve distribution of the hand, and that pain or tingling may travel up the forearm towards the shoulder. Weakness and clumsiness of the hand may make it difficult to perform fine movements such as buttoning clothes. Dropping objects as a result of this loss of sensation is a common symptom. This could also be due to the hand getting weaker as a result of the syndrome. In most cases, symptoms of carpal tunnel syndrome begin gradually. There's rarely any specific injury to account for the onset of symptoms, although an acute injury can sometimes precipitate the problem. Nighttime symptoms are very common. The reason for this is the flexor tendons tend to swell at nighttime when the digits are not moved. Resolution of the symptoms usually involve shaking the hand or moving of the fingers. This causes the local [inaudible 00:04:00] to decrease and the numbness to resolve. Symptoms often occur when holding something for long periods of time with the wrist in the bent position, either forwards or backwards, such as when using a phone or when driving or when reading a book. This can also occur during sleep, when most people are unaware of the bent position of their wrist. So how is carpal tunnel syndrome treated? For most people, the syndrome will worsen over time without some form of treatment. The flexor tendons will naturally increase in size as people age. Although nonsurgical treatment can often slow the progress of symptoms, it will rarely stop it completely. Firstly, wearing a brace or a splint at nighttime will keep you from bending your wrist while you sleep. Keeping your wrist in the straight position reduces the pressure on the nerve in the carpal tunnel. The splint does not have to be tight since the whole goal is simply to stop you from bending. Wearing a splint during the daytime can also be helpful to avoid extreme positions of wrist flexion or extension. Modification of your job or your recreational activities may also slow the progress of the syndrome. Anti-inflammatories may help relieve some of the pain and inflammation, and cortisone injection into the carpal tunnel can act as a powerful anti-inflammatory and temporarily relieve symptoms. All of these treatments will rarely lead to a permanent resolution of the symptoms. The surgical procedure performed for carpal tunnel syndrome is called carpal tunnel release. The decision whether to have the surgery is based on the severity of the symptoms. When the symptoms of carpal tunnel syndrome occur on a daily basis and the non-surgical management options have failed, it's usually recommended that surgery be performed. Ideally, the surgery should be performed when the numbness is intermittent and before there is any constant numbness in the hands. The surgery is usually very effective. The result from the surgery is usually the same, regardless of how frequent or severe the symptoms are as long as the sensation to the finger returns to normal between the episodes of numbness and tingling. But if there are constant sensory changes in the hand, there may be permanent damage to the median nerve that cannot be improved through the surgical decompression. Surgery involves releasing the pressure within the carpal tunnel by cutting the transverse carpal ligament or the transverse retinacular ligament. This is usually done through a small incision directly over the ligament. Most surgeries are done in ambulatory care setting using local anesthetic, just like at the dentist. The surgical procedure usually takes less than 15 minutes. The wound can be closed with dissolving or non-dissolving sutures and a light stressing supply. The pain after the surgery is typically not bad at all. The combination of Tylenol and an anti-inflammatory such as Advil or Naproxen is usually sufficient. Most patients don't require narcotic pills after the surgery. Light washing of the wound is usually allowed at two to three days after the surgery, and patients are asked to avoid soaking the wound or exposing it to any dirty environments for at least 10 to 14 days after surgery. It's important to aggressively move your fingers after the surgery to help reduce the swelling and prevent the stiffness. Heavier activities may be painful, but these are permitted. Most patients are able to resume light activities within three weeks and heavier activities within six weeks. Resolution of intermittent symptoms and numbness is usually very rapid. You may notice an improvement in the nighttime numbness and tingling as soon as the first night after the surgery, but if patients have some degree of constant numbness in their hand prior to the surgery, this may not completely resolve over time. The surgical site can sometimes remain tender for several months. There will be a localized area of hardness around the surgical site that usually gets worse for the first few weeks. The hardness will subside in the following months. Deep massage of the area is recommended after about two weeks. This will accelerate the scar softening and decrease the total tenderness. Grip and pinch strength usually returns about three to six months after surgery, although it may take longer in some people. Infection at the surgical site is rare. This is usually treated with a course of oral antibiotics. Increasing pain, redness and drainage can be signs of infection. Concerns should be raised with your surgeon or your family doctor if this were to occur. To summarize, carpal tunnel syndrome is the numbness and tingling of some of your fingertips due to tightening or compression of the nerve and its tunnel in the hand, and it's relieved by three things: a splint, a cortisone injection or surgery. Each treatment has different effectiveness. You'll decide on your treatment plan by talking with your doctor. Thank you. Herb Von Shroder: Thumb pain and osteoarthritis. Pain and inflammation and arthritis are common symptoms at the base of the thumb. These symptoms are associated with age and it's a type of ostearthritis that is worse with activity, such as gardening or anything that involves gripping, including racquet sports and golf. As well as things around the house, like opening jars or prolonged pinching and finer tasks. The joint at the base of the thumb is very mobile and the thumb is a critical part for all of your hand functions, and therefore becomes symptomatic. In addition to pain, and pain with use, the area gets sore and swollen and tender to touch. You may notice a redness or a warmth in the area, particularly with overuse. As well, the base of the thumb can become more prominent. You may notice some clicking. The treatment initially involves using a splint or a brace around the base of your thumb and wrist and sometimes across the wrist. The splints to braces are made of various materials depending on comfort and fit and an occupational therapist, or physiotherapist, or hand therapist, can fit you, or make a custom splint for you. Some patients use different splints for different activities. You'll notice an overall improvement in your function, since the splint immobilizes the painful joint. With the splint you may be able to get back to many of your regular activities. The next way to treat this is with oral or topical anti-inflammatories. Ibuprofen is commonly used, or sometimes a prescription anti-inflammatory is required. Tylenol can also be added as it works differently in your body to help with the pain. Keep in mind that the medications have side effects and you should talk to your doctor or your pharmacist about. Cortisone, or corticosteroid injections, are relatively safe and very effective for the arthritis at the base of your thumb. Many patients get so much relief, that they'll have additional injections in the future, or help keep your symptoms under control and to keep their activity level high. You may have more than one injection. The splinting, medications, and injections are all very helpful for many, but the arthritis could progress beyond the medical care, in which case surgery could be considered. Surgery for this joint involves taking out, or excising a part of the arthritis, and rebuilding the ligaments. The procedure is commonly done and can be very effective. Please see our related videos on medications, injections, and the roles of occupational physiotherapists as well as pharmacists and allied health partners, and our special video on surgery at the base of the thumb. Herb Von Schroeder: There's also called De Quervain's Syndrome, or De Quervain's tendonitis. Hi this is Herb Von Schroeder talking about De Quervain's tenosynovitis. And this is also called De Quervain's Syndrome or De Quervain's tendonitis. So what is this condition? De Quervain's tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. Also known as the radial side. The condition affects the tendons that move the thumb. So it's noticeable when trying to bend the thumb up and down from the straight hitchhikers position to the bent position across the palm in the direction of the small finger. So what causes De Quervain's tenosynovitis? This inflammation is caused by spontaneous swelling of the tunnel that carries the two tendons that go to the thumb. Although it can be caused by trauma, it's usually spontaneous and unrelated to an injury. It's more common in people in their fifth decade of life, but it also occurs in younger patients. Especially in mothers with a newborn child. A relatively minor injury can sometimes precipitate the condition. The symptoms are usually pain and swelling on the radial side of the wrist. And this is where the thumb's extensor tendons pass through a tight tunnel and change directions slightly. The pain may appear either gradually or suddenly. The pain is usually aggravated with use of the thumb, especially when attempting to flex the thumb into the palm, or when trying to pull the thumb out straight. Pain can radiate up into the forearm and into the elbow region. Treatment for De Quervain's tenosynovitis should be firstly to modify the activities that cause the pain and using a splint from the thumb up across the wrist and into the forearm. The splint immobilizes the wrist and immobilizes the thumb to help with the inflammation. Anti-inflammatory medication such as Advil or Naproxen can be a benefit to help reduce the swelling and the pain. If the problem fails to resolve within a few weeks then a corticosteroid injection is often recommended. A corticosteroid injection is performed right at the tunnel that carries the tendons to the thumb. Improvement in the symptoms is usually felt between three to seven days following the injection. The relief usually continues to improve over six to eight weeks. The majority of patients who will receive a corticosteroid injection will have complete relief or near complete relief within about two months. Corticosteroid injections are very safe, but all medicines have side effects. Cortisone injections can cause transient deep pigmentation of the skin around the injection site. This can be particularly noticeable in patients with darker skin. Furthermore, the cortisone can cause thinning of the skin. Usually these issues do resolve with time, but on occasion the deep pigmentation and the thinning of the skin can be permanent. Unfortunately about one third of patients can have recurrence of their symptoms following corticosteroid injection, despite a period of improvement. A second corticosteroid injection can be recommended. Patients with diabetes or those with more advanced and chronic symptoms will likely have a higher rate of failure with a cortisone injection. If the symptoms don't improve with corticosteroids then surgery's generally the next step. Surgery involves opening of the tendon tunnel to the thumb. And it's usually done with a local anesthetic in an ambulatory care setting, much like going to the dentist. Although surgery is highly successful the recovery from surgery is slower than the recovery following a corticosteroid injection. It's common for patients to experience temporary numbness into the thumb and hand following the surgery. But this usually does resolve with time. The surgical incision is closed with either absorbable or non-absorbable sutures. After surgery there's a light dressing on the wound and this should stay in place for the first two to three days after surgery. At this point, the wound should be washed with soap and water. Patients are asked to avoid soaking and must keep it clean for the first 10 to 14 days after surgery. The surgical site can become a little bit harder over the first six weeks and deep massage and light dressings are typically encouraged. The scar reaction surgery is often more significant in the first six weeks after an intervention. Wound infections are rare but can occur. And are [inaudible 00:04:48] oral antibiotics. Persistent numbness in the fingers after surgery is usually caused by an injury to the radial nerve. This will usually not resolve with time, but it is a rare complication. So to summarize, De Quervain's tenosynovitis is pain and inflammation to the thumb tendons in their tunnel on the side of the wrist. It can be treated in three ways, a split from the thumb to the forearm, a cortisone injection, or surgery. And each treatment has different effectiveness. And you'll decide on your treatment plan by talking to your doctor.
( Dr. Herb Von Schroeder, Orthopaedic Surgeon, Toronto, ON) is in good standing with the College of Physicians and Surgeons.

If you are looking for local services or  treatment  in the office from a local  Orthopaedic Surgeon  or hospital from a Orthopaedic Surgeon, contact a provider such as ( Dr. Herb Von Schroeder ) to inquire if they are accepting patients or you need a referral.   Phone number to book an appointment (416) 603-5092 ( Dr. Herb Von Schroeder ) Is in good standing with the College of Physicians and Surgeons of Canda and the ( Dr. Herb Von Schroeder ) Is in good standing with the Orthopedic Association and the ( Dr. Herb Von Schroeder ) Is in good standing with the   Canadian Medical Association  

The speaker in the video may have no association with ( Dr. Herb Von Schroeder, Orthopaedic Surgeon Toronto, ON ). 
( Dr. Herb Von Schroeder, Orthopaedic Surgeon Toronto, ON ), may talk about some of the conditions and some of the treatment options shown on the videos. Always talk with your Orthopaedic Surgeon  about the information you learnt from the videos in regards to treatments and procedures the Orthopaedic Surgeon could  perform and if they would be appropriate for you. Remember good information from your local Orthopaedic Surgeon is the corner stone to understanding your condition or disease.

Please contact ( Dr. Herb Von Schroeder, Orthopaedic Surgeon Toronto, ON ) to enquire if this health care provider is accepting new patients. Orthopedic surgeons also perform hip replacement and knee replacement surgeries due to arthritis. During hip or knee replacement surgery, the surgeon removes the painful joint and replaces it with an artificial joint made from plastic, ceramic and/or metal.