The carpal tunnel is located under the base of your palm. It has rigid, unyielding boundaries: The back and sides of the carpal tunnel is made up of the bones of your wrist. The front of the carpal tunnel, just under your palm, is made up of a very thick ligament, the transverse carpal ligament. Your median nerve is the nerve that provides sensation to your thumb, index finger, middle finger and half of your ring finger. It runs through the carpal tunnel along with nine tendons that move your fingers and thumb, and the tendons’ lining, which is called the tenosynovium. Carpal Tunnel Syndrome Diagnosis & Treatment Information
Cubital tunnel syndrome is very similar to carpal tunnel syndrome. Cubital tunnel syndrome is when the ulnar (funny bone) nerve is pinched at your elbow. It gets pinched by the fascia (ligament-like tissue) over it. It gets pinched more when you bend your elbow, as this decreases the space under the fascia available for the nerve. It’s also worse when you put pressure on it, such as when leaning on you’re the funny bone part of your elbow while at a desk or when driving. This leads to numbness of the small finger, and often the ring finger. If other fingers are involved you probably also have carpal tunnel syndrome, as they often occur together. Cubital Tunnel Syndrome Diagnosis & Treatment Information
Trigger finger is when the tendon that flexes your finger (or thumb) gets stuck in the pulley (tunnel) that it goes through. As we age, or due to diabetes, thyroid disorders, or sometimes for unknown reasons, the tunnel stiffens and shrinks. The tendon that goes through it gets stuck and often ‘balls up’ to form a palpable nodule in front of the pulley. Trigger finger is often worse in the morning, and is often associated with carpal tunnel syndrome. Trigger Finger Diagnosis & Treatment Information
Arthritis commonly affects the base of the thumb. In fact, approximately 11% of post-menopausal women develop painful arthritis in this area. It’s often worse with pinching and gripping, such as when opening up a jar or turning a key. It may also occur in people who have fractured or dislocated their thumb. Basilar (Basal) Thumb Arthritis Diagnosis & Treatment Information
Arthritis can occasionally affect the fingers. The fingers can be affected by osteoarthritis (‘wear and tear’ arthritis), rheumatoid (inflammatory) arthritis, or arthritis that occurs because of joint injury (post-traumatic arthritis). There are three finger joints that can be affected. The distal interphalangeal joint (DIJ) is the smallest joint closest to your finger tip. The proximal interphalangeal joint (PIJ) is the joint in the middle of the finger. The metacarpophalangeal joint (MPJ) is the main big knuckle, where the finger attaches to the hand. Finger Arthritis Diagnosis & Treatment Information
Rheumatoid arthritis (RA) is a systemic disease (ie. it affects much of the body). The primary treatment for RA is medical, and there are many new excellent drugs that can decrease pain and greatly slow the progression of RA. Surgery is used mainly to prevent and correct deformities, to protect and repair the finger tendons that this disease damages, to treat destroyed and painful joints, and to return function. In addition, cosmesis is usually improved by surgery. Rheumatoid Arthritis Diagnosis & Treatment Information
Dupytren’s contracture is a genetic disorder in which the fascia of your hand contracts so that you can’t extend your fingers. What is fascia? When you order a piece of meat, the tough grisel around the meat is fascia.
Dupytren’s contracture occurs in people of Scandinavian (viking) ancestry. Now, the vikings got around back then, so their genes can show up in people that don’t realize that they have some vikings in their family tree. Dupytren’s Contracture Diagnosis & Treatment Information
Flexor tendon lacerations in the hand are a serious problem, especially on the palmar side, where the flexor tendons are. The anatomy of the tendon complex is complicated. The flexor tendons have to go through sheaths (tunnels) in order to function properly. There is a limited amount of space in these tunnels, and just a little bit of scar can cause the tendon to stick down so that the finger doesn’t move. Flexor Tendon Lacerations Diagnosis & Treatment Information
Spinal cord injury resulting in tetraplegia is a devastating, life-changing injury. Life becomes a battle for independence when even the smallest activity of daily living becomes a challenge.
The human mind and the human hand are wonderfully adaptable. Many determined tetraplegics can accomplish much without functioning fingers. Writing can be accomplished by wedging pens and pencils in the web spaces of the fingers. Both hands and the mouth can be used to manipulate objects. However, performing tasks in this way is neither fluid, effective, or time efficient. Tetraplegic Reconstruction Surgery Information
DeQuervain’s tendinitis leads to pain on the radial (thumb’s side of the) wrist. It’s usually worse with lifting and gripping. DeQuervain’s tendinitis is due to a space problem, that is too much stuff in too little space. The tendons of your wrist travel through tunnels. When you overuse them, swelling enters the tunnels, pinching the tendon. Pregnancy can also cause fluid to enter the tunnel, leading to pain. Sometimes, diabetes, thyroid disorders or simply aging can cause the tunnel to become too tight. DeQuervain’s Tendinitis Diagnosis & Treatment Information
Ganglion cysts come from joints. When there is damage to the ligaments or joint capsule (balloon) around the joint, an area of weakness is created. The joint fluid that lubricates your joint can herniate through this area of weakness, forming a fluid-filled cyst called a ganglion. A one-way valve mechanism forms from the joint lining and prevents the fluid from going back into the wrist, trapping it in the cyst. Because they come from your joints, ganglions can sometimes get bigger during periods of heavy activity and get smaller during periods of rest. Ganglion Cysts Surgery Information
Distal radius fractures are the most common fracture of the entire arm. They come in many different types and patterns, which are all treated differently. If the fracture is minimally-displaced (hasn’t moved significantly), it’s treated in a short-arm cast for 5 weeks. If the fracture is displaced, an attempt at ‘setting the fracture’ (closed reduction) may be attempted in the office for certain fracture patterns. Following closed reduction, you need to get follow-up radiographs every week for three weeks to make sure it doesn’t move back to an unacceptable position, which unfortunately can happen. Distal Radius Fractures Diagnosis & Treatment Information
The scaphoid is probably the worst bone in the entire arm to break. It has a poor blood supply, it is subjected to high stresses, and it is a very important wrist bone. Scaphoid fractures are serious injuries. Textbooks have been written about them. They love to not heal (ie. ‘go on to non-union’) and/or have part of the bone die (avascular necrosis: like a heart attack of bone). And if they don’t heal, the wrist inevitably develops arthritis. Scaphoid Fractures Treatment Information
The triangular fibrocartilage complex (TFC) is a complex constellation of tissues on the ulnar (small finger) side of your wrist. The TFC may become injured by a trauma (fall, sports injury, etc) or over time if the ulna bone (the forearm bone on the small finger side) is longer than your radius (the forearm bone on the thumb side). Triangular Fibrocartilage Tear Diagnosis & Treatment Information
Wrist arthritis is very common. There are a number of reasons that arthritis of the wrist occurs: from scaphoid fractures, ligament injuries, distal radius fractures, metabolic diseases (involving altered body chemistry) or just from plain old wear and tear.
Fortunately, there are some very predictable procedures that can be used to treat wrist arthritis. Initial treatment is nonoperative, including splints, steroid injections, and avoiding painful activities. If these don’t work, and the wrist is painful enough, the best treatment option is often a partial fusion. This means fusing some of the small bones of the wrist, while leaving other joints alone to retain some motion. Wrist Arthritis Diagnosis & Treatment Information
Tennis elbow is very common. It occurs most commonly on the outer side of your elbow, but may also occur on the inner side, and occasionally even in the back of the elbow. When it occurs on the inner side of the elbow it’s called “golfer’s elbow,” but it’s really the same problem. The problem is tendon over-use, leading to tendon breakdown. This is called tendinosis, which means tendon degeneration. We used to call it tendinitis, which means tendon inflammation, but we now know that this is incorrect. The pain comes from the breakdown and degeneration of overused tissue, not from inflammation. Tennis Elbow Diagnosis & Treatment Information
Distal biceps tears occur most commonly in men aged 40-60 years old, especially those engaged in manual labor, athletics or weight lifting. The biceps usually tears with a painful pop when lifting or moving heavy objects. Tenderness, swelling and bruising often occurs. The torn biceps muscle retracts upwards, towards the shoulder. Elbow flexion (bending) and supination (turning your palm up, such as while using a screwdriver, etc) become painful and weak. Without surgery, there is a permanent loss of 30% loss of elbow flexion strength and a 40% loss of supination strength and endurance. Most patients wantto have the biceps tendon fixed to regain their strength. If surgery is performed within 3-4 weeks, normal strength and endurance of the muscle is usually regained. After 4 weeks, surgery can still be done, but scarring and muscle retraction may lead to some stiffness and weakness following repair. Distal Biceps Tendon Tear Diagnosis & Treatment Information
Olecranon Fractures: Isolated displaced fractures of the olecranon are usually fairly straightforward injuries that require surgical fixation. I believe that plate fixation is best for most olecranon fractures. Early motion can usually be started and these fractures usually do very well following surgical fixation. Fractured Elbow Diagnosis & Treatment Information
Medial collateral ligament (MCL) injuries: MCL injuries occur most commonly in throwing athletes. Most non-throwing athletes, recreational athletes, and even professional football players who tear the MCL do not require surgical treatment. In throwing athletes, the MCL is an important ligament about the elbow, and usually needs to be repaired in order to allow the athlete to return to his previous level of athletics. If the MCL tears with an acute ‘pop’ an MRI with dye in the joint (MR arthrogram) will usually be ordered to confirm the diagnosis. If the MCL is torn in a high-level thrower, it should probably be repaired or reconstructed. In the absence of a pop, at least 3 months of nonoperative treatment, including strengthening the muscles about the elbow, should be tried to see if surgery can be avoided. Elbow Ligament Injuries Diagnosis & Treatment Information
Elbow arthritis can be due to osteoarthritis (wear and tear arthritis), post-traumatic arthritis (after a fracture or dislocation) or due to rheumatoid arthritis (a systemic, inflammatory disease). Elbow arthritis can limit function, cause pain, and lead to serious impairment of the arm. Elbow Arthritis Diagnosis & Treatment Information
We used to think that the problem was rotator cuff tendinitis, which means inflammation of the rotator cuff, but since shoulder surgeons started looking at this injured tissue under the microscope we now know that this is not correct. What really happens is that the rotator cuff degenerates, without inflammation. The technical name for this degeneration is rotator cuff tendinosis.
Rotator cuff tendinosis, is an overuse injury. Overuse occurs when repetitive activity leads to tissue damage quicker than the body can heal. This repetitive trauma eventually leads to chronic tissue breakdown and pain. Rotator Cuff Tendinosis Diagnosis & Treatment Information
Many rotator cuff tears occur due trauma, such as falls, motor vehicle accidents, etc. These traumatic tears are usually best treated by early surgery. However, over 50% of rotator cuff tears occur without trauma, often as part of the aging process. As we age, we lose our hair, our bone density, and often a certain part of our rotator cuff. In patients under 60 years of age, or those who have a rotator cuff tear following trauma, the rotator cuff tear is probably not part of the aging process, and should be repaired. In patients over the age of 60 years who haven’t had significant trauma and who can elevate their arms above their heads, 50-82% of patients with rotator cuff tears may feel better by simply strengthening their rotator cuffs and the muscles about the shoulder blades. If 3 months of strengthening fails to provide good pain relief, a rotator cuff repair should be considered. Rotator Cuff Tear Diagnosis & Treatment Information
The shoulder ligaments can be stretched out by either a single traumatic event, such as a dislocation, or by multiple minor insults without trauma, such as excessive swimming or throwing. Shoulder instability can cause pain, weakness, and impairment. Shoulder Instability Diagnosis & Treatment Information
SLAP lesions are tears of the superior labrum (meniscus-like tissue around the glenoid socket) that include the ‘root’ of the biceps tendon. These are uncommon injuries, except in throwing athletes and in patients who have had significant trauma (ski accidents, bad falls, motor vehicle accidents, etc). It is rare to see a painful SLAP tear in a patient who is not an overhead athlete and has not sustained a significant trauma. SLAP Lesions Diagnosis & Treatment Information
