Hand and Upper Extremity Center of Excellence
Our Fellowship-Trained Hand & Upper Extremity Specialists
Common Hand and Upper Extremity Problems
The hands and upper extremities are unique areas of the human body made up of bone, joints, ligaments, tendons, muscles, nerves, skin, and blood vessels. These elements must all be in good working order for the hand, wrist, elbow and shoulder to function well.
The relationship between all these structures is delicate and refined. An injury or disease can affect any or all of these structures and impair their use.
A qualified hand and upper extremity surgeon is trained to diagnose and treat all problems related to these different structures in the hand, wrist, and forearm.
Our hand and upper extremity surgeons have received specialized Fellowship training in the treatment of hand problems beyond their board certified specialty training in orthopedic surgery.
Common problems treated include:
- carpal tunnel syndrome
- medial tunnel syndrome
- cubital tunnel syndrome
- rotator cuff tears
- tennis elbow
- wrist pain
- sports injuries of the hand and wrist
- fractures of the hand, wrist, and forearm
- trigger finger
- biceps tendonitis
Other conditions treated by our hand and upper extremity surgeons include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects). Not all of these conditions require surgery and we recommend the most conservative treatment options possible to achieve good outcomes including medication, splints, therapy, or injections.
If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, call us for an appointment.
Tennis Elbow Without the Racquet
You can experience the soreness of tennis elbow, or lateral epicondylitis, even if you don't play tennis.
This common condition is caused by frequent, twisting motion using the hand, wrist or forearm - like when playing tennis. Even though tennis elbow is common among those who play racquet sports, it is more often the result of other repetitive motion, like gardening or using a computer.
Burning pain associated with tennis elbow is felt in the tendons attached to the outer bone, or lateral epicondyle, of the elbow. Repetitive motion causes your tendons to constrict and become irritated.
Tendons are fibrous bands connecting muscle to bone, and several muscles attach to the lateral epicondyle in your elbow. Two forearm muscles connected to the lateral epicondyle are the anoconeus and supinator muscles. These muscles respond when you rotate or twist your arm, similar to the action required to use a screwdriver.
Extensor muscles also connect to your elbow and are responsible for extending your fingers and wrists toward the back of your hand. For example, when typing at a computer your fingers extend causing your wrists to push inward toward the keyboard. Correctly adjusting your keyboard, desk and chair may help alleviate pain caused by the repetitive motion of using a computer.
At first, the pain of tennis elbow is mild. It usually worsens over time and may spread to your forearm. In severe cases, picking up simple objects or simply moving your elbow joint can be extremely painful.
Our treatment plan for tennis elbow typically includes resting your arm, ice and anti-inflammatory medication like ibuprofen. This simple treatment usually improves your pain associated with tennis elbow in about four weeks.
If your pain persists, steroidal injections, a splint or brace may be prescribed. Once your pain is relieved, treatment may continue with physical therapy. This would include exercises for stretching and strengthening your muscles and tendons.
In rare cases, surgery may be required to remove damaged tendon and reattach healthy tendon to your bone.
The Weekend Warrior's Shoulder
The shoulder is one of the most complicated joints in the body. Because a normal shoulder has more motion than any other joint in the body, it also has the greatest potential to become the most painful one. Dr. P. Jeffrey Richards and Dr. Antonio Flores are specialists in shoulder pain.
“In Lee County, we have the most active seniors I have every seen,” said Dr. Richards. “Since most shoulder injuries worsen with repetitive use and wear and tear, and are often further aggravated by intense activity, the 70-something golfer, softball player and tennis player will have a higher likelihood of injuring their shoulders than the “couch potato.”
One of the most common causes of serious shoulder pain is rotator cuff tendonitis, also known as bursitis or impingement. The rotator cuff consists of four muscles which attach the humerus (shoulder/upper arm bone) via tendons to the rest of the body.
“This problem is common to those who participate in high-demand, overhead sports, i.e. golf, softball, tennis, and swimming,” said Dr. Flores. “A large part of the problem is caused by the normal degeneration of tendons as we age. Bone spurs at the front edge of the acromion, (the bone at the top of the shoulder), may also add to the problem. Mix degenerating tendons with bone spurs, throw in what is often poor sports’ mechanics, and you end up with a lot of pain and loss of sleep.
“This is also a formula for full rotator cuff tears, the second most common cause of shoulder pain.”
In addition to the pain a rotator cuff tear can cause, it can be functionally debilitating. Symptoms may include night pain and an inability to get into a restful position. Other common complaints are weakness, muscle spasms, and loss of motion.
“Some people can remember the exact time of day their rotator cuff tore, but most report a gradual onset of increasing pain and decreasing function,” said Dr. Richards. “Most people with torn rotator cuff tendons ask “how?”, and “why me?”. The rotator cuff is much like the best set of tires you ever had. You can buy 40,000 to 60,000 mile radials, but you still have to take care of them. The rotator cuff needs routine care as well. No matter how well you care for your tires, most don’t last 70 or more years.”
The easiest way to take care of shoulders that don’t currently have problems is to do stretches and light muscle coordination exercises. If you can perform the following exercises without problems or pain, it’s likely safe for you to do them. However, if any cause pain, you should stop and be evaluated by your healthcare professional prior to continuing.
Try these prior to playing sports or at least three times a week. Spend 30 seconds to one minute on each and your shoulder will love you for it. Remember, if the above activities cause pain stop and contact your physician or therapist.
- Place your back against a wall, then intertwine your fingers and place your hands behind your head. Next try to touch the wall with your elbows. Normal motion will allow both elbows to touch the wall at the same time.
- Shoulder pinch – stand up and imagine that I just placed a $1 MILLION DOLLAR bill between your shoulder blades. If you want to keep it you got to squeeze it.
- Lawnmower pulls – While standing, place one foot slightly in front of the other, then take the opposite hand and act like you have a lawnmower in front of you and pull nice and slow.
- Back scratches – Take one hand and reach behind you as if you were scratching your back, and reach up as high as you can. Normal motion will allow you to at least touch the bottom of the opposite shoulder blade.
If you experience shoulder pain that isn’t caused by an event (such as a fall or activity resulting in a loud pop), initial treatment at home should include ice, rest, and anti-inflammatory medications (if your stomach allows). If that doesn’t relieve the pain, you should be evaluated by a physician with extensive experience in shoulder care.
If your shoulder pain was related to a fall or if you heard a pop come from your shoulder prior to your functional loss, and you experience significant limitations, you need to be evaluated by a healthcare professional sooner rather than later.
Your treatment program should be individualized and may require formal physical therapy, proper sports’ mechanics training, a cortisone injection, or surgery.
For more information, call for an appointment.
A Hand Up
Your body's upper extremity includes your hand, wrist, shoulder, arm and elbow. The intricate bones, joints, muscles, tissue and nerves in the upper extremity make it possible for you to hold a book while reading, pick up a child, type on the computer, chop garlic, rake leaves, throw a baseball or knit a scarf.
Injury or degenerative diseases such as arthritis in any part of your upper extremity can make everyday tasks and the activities you enjoy a painful challenge. According to the American Academy of Orthopaedic Surgeons, some common upper extremity conditions include:
Carpal Tunnel Syndrome: The median nerve travels from the forearm to the hand through the carpal tunnel in the wrist. Carpal tunnel syndrome occurs when the median nerve is "squeezed" at the wrist, resulting in numbness and tingling in the hand.
Trigger Finger: This condition affects the tendons and pulleys in the hand that make it possible for the finger to bend. Tendons connect the forearm muscles with the bones of the fingers and thumb. The tendons are covered by a slick lining allowing the tendons to easily glide back and forth, guided by the pulley. If the tendon lining becomes irritated or inflamed, a knot may develop preventing the tendons from gliding easily and causing the finger to become locked in a "trigger" or bent position. Although the cause is unknown, people over 40 with diabetes or rheumatoid arthritis seem to be at a greater risk for developing trigger finger.
Tennis Elbow: A degenerative condition of the tendon fibers attached to the bony "outer" portion of the elbow. The tendons affected fasten the muscles that allow you to extend or lift the wrist and hand. Repetitive and rigorous use of the forearm muscles, such as playing tennis, may result in deterioration of the involved tendons. The result is often a severe, burning pain in the outside part of the elbow.
Biceps Tendinitis: The biceps muscle in the front upper arm stabilizes the upper arm bone in the shoulder socket. Tendons connect the biceps muscle to the shoulder, as well as to the bone in the lower arm. The biceps controls arm movements over your head, such as swinging a tennis racket or throwing a ball. Tendinitis occurs when tendons become irritated or inflamed. Injury to the biceps tendons are typically caused by repetitive motion. The result is often pain when the arm is over the head or bent, or a snapping sound in the shoulder area.
Rotator Cuff Tears: Muscles and tendons surrounding the top part of the upper arm bone make up the rotator cuff. These muscles and tendons hold the rotator cuff in the shoulder joint. Repetitive motion or injury may cause a painful tear of the rotator cuff. Symptoms include consistent pain especially when the arm is over the head, cracking sounds when the arm is moved and limited motion.
Arthritis: This disease affects the joints in the body including those in the hands, elbow, arm and shoulder. Osteoarthritis is the most common degenerative joint disease, caused when the cartilage between joints wears out and bone rubs against bone. Rheumatoid arthritis is the most common inflammatory arthritis typically affecting the joints in the fingers, wrists, arms and legs.
If you are experiencing a problem in your hand, wrist, shoulder, arm or elbow, talk with one of our Hand and Upper Extremity Specialists.
Shoulder Problems Make Everyday Tasks Difficult
Each year about four million people in the U.S. visit the doctor for shoulder problems like sprains, strains, dislocation and other problems, according to the American Academy of Orthopaedic Surgeons.
The pain and discomfort associated with shoulder problems turn simple day-to-day functions into difficult tasks - pulling a shirt over your head, blow drying your hair, driving a car, reaching for a box of cereal on the top pantry shelf.
Some common shoulder problems include:
Rotator Cuff Tear: This shoulder problem is especially common in people over age 40. Muscles and tendons surrounding the top part of the upper arm bone make up the rotator cuff. These muscles and tendons hold the rotator cuff in the shoulder joint. Repetitive overhead motion, such as pitching a baseball or lifting heavy objects, or injury may cause a painful tear of the rotator cuff. Symptoms include consistent pain especially when the arm is over the head, cracking sounds when the arm is moved and limited motion.
Shoulder Dislocation: Because the shoulder joint is one of the most agile joints in the body, it is capable to moving in many different directions. This agility can also make it easy to dislocate. If the top of the upper arm bone is only partly out of the shoulder socket, this is a partial dislocation. A complete dislocation occurs when the shoulder is totally out of the socket. If you experience shoulder dislocation frequently, you may have shoulder instability.
Impingement: This is one of the most common shoulder problems in adults. The rotator cuff is a tendon connecting four muscles in the shoulder, which work together to lift and rotate the shoulder. The shoulder blade is made up of two parts - the "front" is the acromion. Impingement occurs when the shoulder is lifted and the acromion gets in the way of the rotator cuff, causing it to rub on the cuff's surface. This causes pain and stiffness when lifting the arm, and some possible swelling in the front of the shoulder.
Arthritis: Two joints make up the shoulder and both can be affected by arthritis. The first joint is the acromioclavicular, or AC joint. The AC joint is formed where the collarbone meets the tip of the shoulder bone. The second joint is the glenohumeral joint, which is located where the upper arm bone meets the shoulder blade.
Broken Collar Bone: This injury is typically caused by the force of a fall and is common among athletes. The collar bone is part of the shoulder that helps connect the arm to the body.
If you experience pain of the shoulder, our specialists can diagnose the problem and the treatment options available. Call us.
Collared: Understanding Broken Collarbones
Your clavicle, or collarbone, is an important part of your skeletal structure because it connects your arms to your body. This bone stretches across the top of your chest from the sternum (breastbone) to your scapula (shoulder blade). It is easy to feel your clavicle, because unlike other bones which are covered with muscle, only skin covers a large part of the bone.
As with any bone in your body, your collarbone can break from injury. Clavicle fractures are most common in children and adult athletes. Because, your collarbone does not completely ossify, or harden, until about 20 years of age, a baby's collarbone can break during birth. A child's collarbone can easily break from direct impact. Most adult clavicle fractures occur during sports or as a result of a fall on an outstretched hand or directly upon your shoulder.
According to the American Academy of Orthopaedic Surgeons, typical symptoms of a broken collarbone include:
- Pain and inability to lift your arm
- A bump where your fracture occurred
- The shoulder sagging down and forward
- A grinding sensation when trying to raise your arm
Although it is rare for a bone fragment to break your skin, it may push your skin into a "tent" formation
Although a clavicle fracture is usually obvious, an Orthopedic Specialist’s physician will perform a careful exam to determine the exact break location and to ensure there is no damage to your nerves and blood vessels located immediately below your collarbone.
A broken collarbone may take up to 12 weeks to heal. Treatment of clavicle fractures is usually conservative consisting of activity modification and arm immobilization. Depending on the location of your break, an arm sling or a figure-eight strap is used to help keep the shoulder in position.
Anti-inflammatory medications, such as aspirin or ibuprofen, may be prescribed to help manage pain. Surgery is required in rare situations when either the skin is broken or the fractured area is severely displaced.
Stretching and exercises to improve range of motion are introduced as part of a therapy program when the pain subsides. As the fracture heals, a bump will develop but usually fades over time and with healing. You can return to sports and other activities once your shoulder is completely healed and back to full strength.
For more information about clavicle fractures, or to schedule an appointment, call us today.
Shoulder Pain Often Caused by Rotator Cuff Tears
Your shoulder joint has more flexibility and a wider range of motion than any other joint in your body. This is due in large part to your rotator cuff, a group of four muscles and their tendons.
The muscles making up the rotator cuff wrap around the shoulder joint providing stability and guiding shoulder movement, similar to the motion needed to reach behind you and close a door.
Rotator cuff tears are one of the most common causes of shoulder pain for people over age 40. There are two types of rotator cuff tears: chronic and acute.
Chronic tears are more common and occur gradually over time as a result of repetitive overhead motion like painting, lifting, swimming, pitching or tennis. An acute tear is caused by a direct injury to your shoulder.
Because chronic tears are gradual, the pain associated with the tear is often also progressive. To start, your pain may be mild and only experienced when reaching or lifting. Over time, your pain may become more intense and happen even when your shoulder is at rest. Weakness, stiffness and popping sensations in your shoulder are also common.
Rotator cuff tears caused by injury are associated with an immediate snap or pop followed by pain and the inability to fully move your shoulder.
To determine if you have a torn rotator cuff an orthopedic specialist will perform an examination and use x-rays or other imaging studies, such as MRIs.
Depending on the severity of the tear, non-surgical and surgical treatment options are available. Our orthopedic hand and upper extremity physicians will work closely with you to determine the treatment options best suited for your injury and activity needs.
For more information about rotator cuff tears, call us.
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