Hand and Upper Extremity Center of Excellence
Our Fellowship-Trained Hand & Upper Extremity Specialists
Antonio J. Flores, MD: Surgery of the Shoulder, Elbow and Hand
P. Jeffrey Richards, MD: Surgery of the Shoulder, Elbow & Hand
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.
Common hand and upper extremity problems treated include:
- carpal tunnel syndrome
- rotator cuff tears
- tennis elbow
- wrist pain
- trigger finger
- biceps tendonitis
- shoulder dislocation
- impingement
- arthritis
- broken clavicle
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.
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.
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.
Tennis Elbow: You can experience the soreness of tennis elbow, or lateral epicondylitis, even if you don’t play tennis. Tennis elbow is 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.
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.
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.
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: 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.
Broken clavicle (collarbone): 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. 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 and, a grinding sensation when trying to raise your arm.
Treatment for common hand and upper extremity problems:
Non-Surgical Treatment: For most conditions of the hand and upper extremities, the non-surgical treatment options are the same: rest, moderating your activities to reduce or eliminate those activities that cause pain, anti-inflammatory medications such as ibuprofen, strengthening exercises and/or physical therapy. Your exercise program will include stretches to improve flexibility and range of motion. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.
If non-invasive treatment fails to solve the problem, a variety of minimally invasive surgical options are available through the Hand and Upper Extremity Center of Excellence. Call for an appointment at (239) 334-7000.