Hand & Elbow
Our hands enable us to do all sorts of things that humans need to do. Figuratively, we can lend a helping hand, earn money hand over fist, throw up our hands, and even talk with our hands.
More literally, we use our hands to accomplish many amazing tasks. With 27 small bones (8 in the wrist and 19 in the hand itself) and their related nerves, tendons, muscles and ligaments, we put our hands to use manipulating objects in our environment. With hands, we can cradle our children, grip a garden trowel, type a report, grab a baseball bat, and so much more.
At Southlake Orthopaedics, we have physicians who specialize in the diagnosis and treatment of your hands, wrists and forearms. They are experts in hand surgery, which is a sub-specialty of orthopaedics requiring additional training dealing with complexities of hand anatomy and micro-vascular conditions.
Orthopaedic services for hand/wrist and elbow
Sprains of the Thumb
What is the difference between a human hand and an animal paw? A thumb! It helps you pick up a coffee cup, button a shirt, and hold a pencil to write. Anatomically, there is one main ligament connecting the thumb to the hand, the ulnar collateral ligament.
When this ligament (fibrous tissue that joins bone to bone) is stretched beyond its normal range of motion, it impairs your ability to pinch and grasp objects. The condition is known as a sprain.
If your thumb ligament is over-stretched or even partially torn, your orthopaedist will probably immobilize your thumb joint with a bandage, cast, or splint until it heals. A complete tear, however, may require surgery to repair and regain normal range of motion.
Sprains of the Wrist
Your wrist enables many activities we take for granted each day like turning a door knob, using a knife and fork, or just waving to a neighbor. When one of the many ligaments in your wrist is damaged, it is called a sprain.
A wrist sprain is often brought about by falling and landing on your hands with your palms outstretched. Depending on the severity of the strain on the ligament, whether it is over-extended, partially torn, or completely torn, your orthopaedist will recommend the best treatment for your injury.
The most critical sprains occur when a ligament is completely torn. These are significant injuries that will likely require surgical care. As the ligament tears away from the bone, it may also take a small chip of bone with it. When this happens, it is called an avulsion fracture.
Flexor Tendon Injuries
Your flexor tendons lie just beneath your skin and help control movement in your hand. These sinews are similar to ligaments, but rather than connecting bone to bone, they connect bone to muscle. They are also under tension, so if your flexor tendon is torn or cut, the ends of the tendon will pull apart, making it impossible for the tendon to heal on its own.
Because they are so close to the surface, a deep cut on the palm side of your hand or forearm will most likely hit a flexor tendon. A flexor tendon injury can result in an inability to bend your fingers or thumb.
Certain sports activities like football and wrestling can also cause flexor tendon injuries. Also, some health conditions such as rheumatoid arthritis can weaken the flexor tendons and make them more likely to tear.
Since injured tendons cannot heal unless the ends are touching, torn tendons must be surgically repaired in most cases. Fortunately, flexor tendon surgery is usually performed on an outpatient basis.
Soon after surgery, you will need to begin a program of occupational therapy. Specific exercises will help you gradually regain motion and function.
Mallet finger is often the result of a sports injury that happens when, rather than actually catching a ball, one of your fingers is “jammed” by it. When the force is strong enough, it can damage your extensor tendon, leaving you unable to fully straighten your fingertip.
In most cases of mallet finger, your doctor will apply a splint to hold your fingertip straight until it heals. However, when the tendon injury is combined with a fracture, surgery may be required to help properly align the joint.
Fracture of the Scaphoid Bone (Wrist)
The scaphoid is largest of the 8 bones in your wrist, but it is only about the size of a cashew. It is located on the radial or thumb side of your wrist, in the area where the wrist bends. Your scaphoid bone can be broken when you fall and land on your outstretched palm. This fracture usually causes pain and swelling at the base of your thumb.
Every break is different, and several factors must be considered by your surgeon to determine the proper treatment method. If the fracture is closer to your thumb, the blood supply is usually adequate to help it heal with only a splint or cast. However, if it is broken elsewhere, your doctor may recommend surgery to correct this type of break. Depending on your specific injury, the surgery may involve metal hardware to help hold the bones in place, or a bone graft to help multiple broken pieces knit back together.
Fractures of the Hand, Fingers, or Thumb
Whereas the bones of the wrist are your carpal bones, the bones in your hand are the metacarpals, and your fingers are multiple phalanx bones or phalanges. When a break occurs in your hand or fingers, the resulting fracture normally causes swelling, inability to move your fingers or thumb, shortened fingers, or depressed knuckles.
Commonly, broken metacarpals or phalanges can be realigned and immobilized using a cast or splint without requiring surgery. Other hand fractures require surgery to stabilize and align the bones.
Carpal and Cubital Tunnel Syndromes
Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by inflammation in the tissues surrounding the flexor tendons in the wrist. This swelling in turn presses on the median nerve and causes numbness and tingling in the hand. Carpal tunnel syndrome generally gets progressively worse without intervention.
Many things contribute to the development of carpal tunnel syndrome, including heredity, medical conditions, and how the hand is used. A nerve conduction study is performed to diagnose carpal tunnel syndrome.
Sometimes, a simple brace or splint that keeps the wrist in a neutral position can alleviate the symptoms of carpal tunnel syndrome. A change in activities, medications, or steroid injections may also be helpful. In some cases, surgery to relieve the pressure on the nerve is required.
In most cases, carpal tunnel surgery is done on an outpatient basis. Open Carpal Tunnel Release Surgery Your doctor will discuss the treatment plan that best meets your needs.
Cubital Tunnel Syndrome
The ulnar nerve travels from your neck down into your hand, and is one of the three main nerves in your arm. Pressure on the nerve from a point of entrapment can cause numbness or pain in your elbow, hand, wrist, or fingers.
The most common place where the ulnar nerve gets compressed is behind the elbow, resulting in cubital tunnel syndrome. Most of the symptoms occur in your hand, specifically in your ring finger and little finger. They commonly feel as though they have fallen asleep. This seems to happen more often when your elbow is bent during activities like driving or holding a phone.
If your symptoms interfere with normal activities or last more than a few weeks, be sure to schedule an appointment with your doctor. A nerve conduction study can be performed to determine if you have cubital tunnel syndrome.
Your orthopaedist will recommend treatment based on his assessment of your condition. Often, simple changes in your routine or physical therapy can help. Sometimes he may suggest a surgery; either a release procedure that relieves the pressure on the nerve or a transposition procedure where the nerve is relocated.
Generally speaking, arthritis means inflammation of a joint, whether the result of a disease, an infection, a genetic defect, or some other cause. Although more than 100 types of arthritis have been identified, there are two primary types of arthritis that may affect your hand: osteoarthritis and rheumatoid arthritis (RA).
In addition to pain, the arthritis inflammation may produce fever or swelling at the affected joint. You may also feel a sensation of grating or grinding; this crepitation is caused by damaged cartilage surfaces rubbing against one another.
One form of treatment for arthritis is a steroid injection. These typically provide pain relief for several weeks. However, possible harmful side effects limit the number of times these types of injections can be used.
If nonsurgical treatment is unsuccessful, there are many surgical options to consider. If there is any way the joint can be preserved or reconstructed, this method is usually chosen. When the damage is severe enough, a joint replacement or a fusion (arthrodesis) is performed. As with any surgical procedure, you should consult with an orthopaedist who is well versed in current surgical techniques and discuss the best option for your particular needs.
De Quervain’s Tendinitis
De Quervain’s tendinitis is a painful inflammation of tendons in the thumb extending to the wrist. Symptoms are pain, tenderness, and swelling over the thumb side of your wrist, and difficulty gripping. The pain may also radiate up your arm. The cause of the disease is unknown; a direct blow to the thumb area, overuse of the thumb, repetitive grabbing and inflammatory conditions can all trigger the ailment. Racquet sports, workplace activities or even gardening may also worsen the disease.
As with other tendon injuries, non-invasive treatment such as wearing a splint or resting from aggravating activities often provides relief. Surgery may be recommended if symptoms are severe or do not improve with nonoperative means. Your orthopaedic surgeon can advise you on the best treatment for your situation.
A ganglion cyst is a swollen bump that sometimes appears on the back of the hand or wrist. These cysts are benign, fluid-filled capsules that have no specific known cause. Typically, they balloon out from the sheaths surrounding the tendons in the wrist and have little means of dissipating on their own, so a cystic structure forms.
Sometimes the cyst grows large enough to put pressure on surrounding structures, which is usually the reason someone seeks treatment. One method of treatment is known as aspiration, where a needle is inserted and drains away the fluid inside.
A ganglion cyst can also be removed through outpatient surgery. Ganglion Cyst Removal However, there is always a chance that the cyst will regrow after either surgical excision or aspiration procedures are performed.
Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Not surprisingly, this painful condition is often reported by athletes who play racquet sports.
The onset of tennis elbow is often gradual. Signs commonly include pain or burning on the outer part of your elbow and weakened grip strength. The symptoms are often worsened with forearm activity. In fact, in addition to athletes, craftsmen such as carpenters or painters often develop lateral epicondylitis.
A majority of patients have success with nonsurgical treatment. Resting from aggravating activities, checking for a proper fit in sports equipment, and physical therapy can often alleviate the pain of tennis elbow. You may also benefit from the use of a brace or a steroid injection to relieve the inflammation in the affected tendon