Minor hand, wrist and elbow injuries are common. Symptoms often develop from everyday wear and tear, through overuse or as the result of an injury. Injuries are often caused by sports, hobbies or work-related tasks.

The hand is one of the most intricate structures in the human body, unsurpassed in sensitivity, mobility and strength. Because of its usefulness and complexity, the hand is particularly susceptible to injury and requires specialized care.

The upper extremity is frequently injured during sports or from accidental falls. The chances of having an injury is higher in contact sports, such as wrestling, football or soccer; and high-speed sports, such as in-line skating, skiing and snowboarding. Forearms, wrists, hands and fingers are injured most often.

At one time or another, most people have experienced an elbow problem that may have caused pain or swelling. Elbow pain may include symptoms of swelling, numbness and tingling, or changes in temperature or skin color. Home treatment can often relieve minor aches and pains. Conditions that may contribute to symptoms include osteoarthritis, pinched nerves and overuse of the joint.

Most people may not remember having a specific injury when their symptoms get worse over time, but overuse problems are actual injuries. Overuse injuries occur when stress is placed on a joint or other tissue, often by "overdoing" or repeating the same activity. Overuse injuries can include bursitis, tendonitis, nerve compression, tennis elbow, stress fractures and carpal
tunnel syndrome.

Treatments may utilize the application of a brace, splint or cast, physical therapy, medicines, and in some instances surgery. Specialists at the Midwest Orthopedic Specialty Hospital provide outstanding care to help patients recover from the most intricate hand, wrist and
elbow injuries.

Mallet Fingers

• Injury occurs from ball sports or from jamming a finger
• Can cause the tendon or a piece of the bone to pull off
• Treatment includes splinting until the tendon heals, usually 6-12 weeks

Jersey Fingers

• An injury to the tendon at the very end of the finger
• Tendon is pulled off of the last bone of the finger and requires surgical reattachment
• Repair must be done in the first weeks following injury
• Recovery usually takes 12 weeks and includes therapy

Sprains, Strains & Dislocations

• A sprain is an injury to a ligament, the connective tissue that connects bones to bones
  across a joint
• Symptoms include painful swelling and bruising
• Initial treatment includes icing, elevation and anti-inflammatory medications
• If pain lasts more than a few days the injury should be evaluated by a orthopedic
  hand specialist
• Treatment includes taping, splinting and, in severe cases, surgery

Gamekeeper's Thumb

• Gamekeeper's thumb is an injury to a ligament in the thumb
• Commonly occurs in skiing injuries where the thumb is bent into an extreme position
• Should be evaluated to determine if a splint should be worn, or if surgery is required to repair the ligament

Trigger Fingers

• Occurs when the flexor tendons -- tendons that bend the fingers -- are swollen and cause a painful snapping or locking of the fingers or thumb
• Generally seen in children less than 2 years old or adults older than 50
• People with diabetes and rheumatoid arthritis have a much higher rate of incidence
• Treatment can consist of cortisone injections or surgery if indicated

Dupuytren's Disease

• Genetic disease that affects the palms and fingers
• Often found in individuals of Northern European, Scandinavian and Russian descent
• Symptoms include lumps or nodules in the palm, most often at the base of the ring and
  small finger
• Over time, the patient may not be able to straighten his fingers
• Treatment includes observation or hand orthopedic surgery depending upon the severity of the disease

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the most common nerve root compression problem. Symptoms include:

• Numbness and tingling in the thumb, index, middle and ring finger
• Pain in the hand, particularly at the base of the thumb and wrist
• Problems with gripping and grasping

Initial treatment options include:

• Splints worn at night
• Stretching exercises
• Vitamin B6, 100 mg per day
• Cortisone injections

If symptoms persist or progress, EMG and nerve conduction studies are performed. If orthopedic hand surgery is recommended, it can generally be performed under local anesthetic and take less than 15 minutes. Surgery releases the ligament that covers the carpal tunnel. Releasing this ligament increases the space and stops nerve compression. Recovery takes about 6 weeks.

Fractures

• Most hand fractures occur as a result of direct trauma to the hand
• Occurs when one of the small bones of the hand is broken
• Common symptoms include pain, swelling and difficulty moving the fingers
• Possible treatments of hand fractures include cast and splints, pins, metal plates
  and screws
• It is often necessary to work with a hand therapist in order to help regain finger motion

Arthritis

• Arthritis at the base of the thumb is one of the most common types of arthritis
• Symptoms include pain with gripping and grasping
• Exam shows pain to palpation as well as a grinding sensation at the base of the thumb
• X-rays will show loss of cartilage and bone spur formation

Treatment options include:

• Activity modification and anti-inflammatory medications
• Splints to decrease the forces at the joint and resolve inflammation
• Cortisone injections
• Orthopedic hand surgery can be performed to remove the arthritic joint and reconstruct it using a tendon from the wrist

Arthroscopy

• During this procedure, the surgeon inserts a small camera into the joint
• Provides the clearest picture of the joint without having to make a large incision
• Arthroscopy is an invasive procedure and should not be used as a routine diagnostic tool

Hand Tumors

• The most common tumor in the hand or wrist is a ganglion cyst -- a benign, fluid-filled out-pouching of a joint or tendon sheath
• Giant cell tumors of the tendon sheath, also benign, are the second most common hand tumor
• Tumors of fat (lipomas), nerve (neuromas or schwannomas), fibrous tissue (fibromas) and glomus tumors can all be found in your hand
• Treatment of hand tumors ranges from observation to orthopedic hand surgery, with other possible therapies

Tendon Injuries

• The most common problem people experience after a tendon injury is stiffness -- losing the ability to fully bend or straighten the finger
• If the injury involved a cut, medical evaluation is particularly important to determine whether or not a tetanus shot, antibiotics or other treatment is required
• If surgery is needed, there is a limited amount of time to operate and get the best
  possible results
• Surgery delayed for more than two weeks has less of a chance for success
• In addition to orthopedic hand surgery, therapy is an essential treatment for most people recovering from a flexor tendon injury
• Hand therapy usually involves making one or more custom splints and performing
  prescribed exercises

Scaphoid Fractures

The most common types of wrist fractures are those involving one of the wrist bones, such as the scaphoid bone. Treatment depends on the type of break. Your doctor may recommend:

• Moving the fingers and doing exercises right away
• Wearing a splint or a cast
• Undergoing surgery to set the break, possibly using hardware (pins, screws, wires, etc.) to hold the pieces in place

Distal Radius Fractures

• Distal radius fractures are very common
• The break usually occurs when a fall causes someone to land on outstretched hands
• Often the fracture is the result of a car accident, bike accident, skiing accident, and
  similar situations
• Depending on the fracture there are a number of options for holding the bone in place, including a cast, metal pins, a plate and screws, an external fixator, or any combination of these techniques

Ganglion Cysts

A ganglion cyst contains a thick, clear, mucus-like fluid similar to the fluid found in the joint. No one knows what triggers the formation of a ganglion. Women are more likely to be affected than men. Ganglia are common among gymnasts, who repeatedly apply stress to the wrist.

Treatment options include the following:

• Observation: Because the ganglion is not cancerous and may disappear in time, waiting and watching may be enough to make sure that no unusual changes occur
• Immobilization: Activity often causes the ganglion to increase in size. A wrist brace or splint may relieve symptoms, letting the ganglion decrease in size. As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.
• Aspiration: If the ganglion causes a great deal of pain or severely limits activities, fluid may be drained from it. The area around the ganglion cyst is numbed and the cyst is punctured
  with a needle.
• Orthopedic surgery: The ganglion cyst can be removed through outpatient surgery, but this is no guarantee that the cyst will not grow again. Surgery may also include removing part of the involved joint capsule or tendon sheath. Normal activities may usually be resumed two to six weeks after surgery.

Sprains & Strains

• Wrist sprains and strains most commonly occur when falling on an outstretched hand
• Most mild sprains heal with "R.I.C.E." (rest, ice, compression and elevation) and exercise
• Moderate sprains and strains may also require a period of bracing. More severe injuries often require surgery to repair torn ligaments

Arthritis

• Osteoarthritis of the wrist joint results in swelling, pain, limited motion and weakness
• Rheumatoid arthritis of the wrist joint results in swelling, tenderness, limited motion and decreased grip strength. Hand function may also be impaired, and there may be pain in the knuckle joints

Non-surgical options include:

• Modifying your activities
• Immobilizing the wrist in a splint
• Taking anti-inflammatory medications such as aspirin or ibuprofen
• Following a prescribed exercise program
• Receiving a steroid injection in the joint

Surgical options include:

• Removing the arthritic bones
• Joint fusion (making the joint solid and preventing any movement at the wrist)
• Joint replacement

Dequervain's Stenosing Tenosynovitis

Dequervain's Stenosing Tenosynovitis is a painful inflammation of the tendons in the first dorsal compartment of the wrist. The synovial sheath lining this compartment thickens and swells, producing extra synovial fluid, and giving the enclosed tendons less room to move. A painful cyst may also form.

Treatment options include the following:

• A course of anti-inflammatory medication, while the wrist and thumb are immobilized
  with splints
• Steroid injections to help decrease the inflammation
• If symptoms are long-standing or unresponsive to conservative management, orthopedic surgery is indicated and usually performed on an outpatient basis

Arthroscopy

• During this procedure, the surgeon inserts a small camera into the joint
• Provides the clearest picture of the joint without having to make a large incision
• Arthroscopy is an invasive procedure and should not be used as a routine diagnostic tool

Cubital Tunnel Syndrome

Cubital tunnel syndrome is the effect of pressure on the ulnar nerve, one of the main nerves of the hand. It can result in a variety of problems, including elbow pain on the side of the arm next to the chest.

Treatment options include:

• Over-the-counter anti-inflammatory medication such as aspirin, ibuprofen, naprosyn
  or ketoprofen
• Taking Vitamin B6, 100 mg daily
• Using a splint or brace while sleeping to keep the elbow from bending
• Modifying posture to avoid long periods of time with your elbow bent
• Waiting and observation
• Orthopedic surgery to provide more space for the nerve and tendons, and permanently reduce the amount of pressure on the nerve

Lateral and Medial Tennis Elbow

Lateral tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow.

The counterpart to lateral tennis elbow is medial tennis elbow, often called Golfer’s Elbow. The pain of Golfer's Elbow usually occurs at the elbow joint on the inside (medial) side of the upper arm near the elbow. It commonly causes a shooting sensation down the forearm and is often experienced while gripping objects.

Both injuries are the result of repeated motions of the wrist or forearm. Although these conditions are typically associated with tennis and golf, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to these injuries.

Treatment may include:

• Heat therapy
• Local injection of cortisone
• Anti-inflammatory medications such as ibuprofen, naproxen or aspirin
• Physical therapy
• Pulsed ultrasound to break up scar tissue, increase blood flow and promote healing
• Use of a splint to keep the forearm and elbow immobilized for 2 to 3 weeks
• A splint may be worn during activities that aggravate the condition, or certain activities may need to be limited
• If pain persists despite non-surgical treatments, orthopedic surgery may be necessary. The majority of those who have surgery show an improvement in symptoms

Radial Tunnel Syndrome

• Occurs when the radial nerve is squeezed where it passes through a tunnel near the elbow
• Symptoms are similar to those of tennis elbow. However, in radial tunnel syndrome the pain is centered about two inches further down the arm, over the spot where the radial nerve goes under the supinator muscle
• Nerve pressure inside the radial tunnel leads to weakness in the muscles on the back of the forearm and wrist, making it difficult to steady the wrist when grasping and lifting

Treatment options include the following:

• Avoid the repetitive activity that caused the problem
• Modify the worksite or demands of the job
• Take frequent breaks as you work or play
• Limit heavy pushing, pulling or grasping
• Wearing a splint on the affected arm may allow the nerve to recover from irritation
• Anti-inflammatory medications can decrease inflammation and relieve pain
• If none of these steps help to relieve pain, orthopedic surgery may be suggested

Elbow Ulnar Collateral Ligament Injury

The ulnar collateral ligament (UCL) can become stretched, frayed or torn through the stress of repetitive throwing motions. Professional baseball pitchers are treated most often for this problem. Javelin throwers and football, racquet sports, ice hockey and water polo players have also been reported to injure the UCL. A fall on an outstretched arm can lead to UCL rupture, often with
elbow dislocation.

Treatment options include the following:

• Rest and/or activity modification
• The athlete's posture, strength and mechanics must be analyzed and corrected
• Anti-inflammatory drugs and analgesics may be used to reduce pain and inflammation
• Icing may help when used with caution
• When conservative care does not improve the condition, orthopedic surgery may be indicated

Total Elbow Replacement For Treating Arthritis

Total elbow replacement orthopedic surgery (arthroplasty) can help restore comfort and function to elbows damaged by rheumatoid arthritis.

In elbow arthritis, the joint surface is destroyed by wear and tear, inflammation, injury or previous surgery. This joint destruction makes the elbow stiff, painful and unable to carry out its
normal functions.

• Elbow replacement arthroplasty helps restore functional mechanics to the joint by removing scar tissue, balancing muscles, and inserting a joint replacement in place of the destroyed elbow
• One part of the artificial joint is fixed to the inside of the humerus (arm bone) and the other part to the inside of the ulna (one of the forearm bones). The two parts are then connected using a hinge pin that gives the joint stability
• The two-hour procedure is performed under general or nerve block anesthesia
• Recovery of strength and function may continue for up to a year after surgery

Elbow Dislocations & Fractures

Although the elbow is one of the most stable joints in the body, dislocations and fractures are common. In adults, elbow dislocations are second only to shoulder dislocations in frequency. An elbow dislocation occurs when the bones of the forearm (the radius and ulna) move out of place with the bone of the upper arm (the humerus). The elbow joint, formed where these three bones meet, becomes dislocated or out of joint.

The doctor will treat your elbow by pulling down on your wrist and levering your elbow back into place. This can be painful, so pain medications may be given before performing this procedure. After the joint is back in place, your elbow will be placed in a splint to keep it bent.

You can fracture an elbow in any number of ways, from athletic injuries and overuse to an acute traumatic event, fall or direct blow. Elbow fractures are classified as distal humeral, radial and ulnar. In adults, radial head fractures are the most common type.

Treatment of a fractured elbow depends on the type of injury that you have sustained. Your treatment may be as simple as elevating your splinted arm, applying ice to any swollen areas, and taking pain relievers. Treatment can also include orthopedic surgery to repair bones, nerves and blood vessels.

Distal Biceps Tendon Injuries

In distal biceps tendon injuries, the distal biceps tendon is injured around the elbow joint. This injury usually occurs with heavy lifting, or as the result of sports-related injuries in middle-aged men. Most patients with a distal biceps rupture will elect to have orthopedic surgery to repair the torn tendon.

Repetitive Strain Injuries

Repetitive strain injuries (RSIs) from computer use or deskwork can cause pain through the elbow. This isn’t surprising considering the majority of the muscles that bend the wrist and the fingers attach to the inner portion of the elbow. Conversely, the majority of the muscles that straighten the wrist and the fingers attach to the outer portion of the elbow.

• Repetitive strain injuries are generally treated with rest, ice, compression, elevation, medication and physical therapy
• Inflammation control, activity modification and rehab help most patients with these injuries
• Surgical consultation may be necessary for patients with nerve entrapment, intra-articular pathology or refractory lesions