Upper Extremity FAQs
Hand and wrist FAQs
What is the rotator cuff?
The rotator cuff is a group of tendons that surround the shoulder joint. The group of tendons connect individually to muscles that originate at the scapula. When the muscles contract, the rotator cuff tendons are pulled. This causes the shoulder to either rotate inward or outward and enables the arm to elevate, thus the name “rotator cuff.”
What is shoulder impingement syndrome?
In a healthy shoulder, the uppermost tendon of the rotator cuff smoothly glides underneath the bone on the top of the shoulder. Repetitive movement of the arm above shoulder level squeezes the lubricating tissue and tendons.
Impingement syndrome happens when the tendons and the tissue become inflamed and swollen. The space between the bony prominence at the top of the shoulder and the head of the upper arm bone can also be reduced by a down-growth of bone, causing irritation.
What is the initial treatment for rotator cuff impingement?
For minor impingement or rotator cuff tendonitis, putting ice on the top and front of the shoulder for 20 minutes three to four times a day can provide some immediate relief. The symptoms can be also improved with oral medications, a cortisone injection, physical therapy and rest. Refrain from activities that cause pain until pain has improved.
How successful is rotator cuff surgery?
The success of surgery relies largely on patient compliance and participation in rehabilitation, as prescribed by the surgeon and physical therapist. Perfect outcomes from the surgery are less likely if the patient has a severe injury, such as a large bony spur or tendon breakdown. However, even with severe injuries, the surgery does provide pain relief and improved strength with minor decreased mobility.
What is a “frozen shoulder”?
“Frozen shoulder” is the more commonly used term for adhesive capsulitis or stiff shoulder. The soft-tissue lining of the shoulder ball-and-socket joint becomes inflamed and scarred, causing the shoulder to lose its ability to move freely above the head and to rotate away from the body.
With physical rehabilitation, most patients improve their range of motion. This can take as little as one month or as long as two years. However, some patients do not improve with this conservative treatment and may need to have their shoulder either surgically manipulated or have arthroscopic removal of the scarred tissue. The surgery can result in a significant increase in range of motion, which can be lost if the patient does not comply with follow-up rehabilitation.
The exact cause of a frozen shoulder is unknown, but having a shoulder injury, rotator cuff disease or diabetes seem to be factors in its development.
What causes elbow pain when you’re playing sports?
Sports-related elbow problems include the development of painful bone spurs, tendonitis, loose fragments of cartilage or bone (known as “loose bodies”), and cartilage defects. Later on, athletes may develop osteoarthritis and stiffness.
What is tennis elbow and golfer's elbow?
Tennis elbow is a pain on the outer part of the elbow at the bony prominence. The muscles and tendons that pull the wrist backwards partially start at this point and can become inflamed, causing pain. Golfer’s elbow is a similar condition to tennis elbow, except that pain starts on the bony prominence on the inner part of the elbow.
I have tennis elbow. Will I need surgery?
Most tennis elbow symptoms can be managed without surgery. Initially, the best way to manage the symptoms is to conduct a home rehabilitation program as prescribed by your doctor. This program generally consists of deep tissue massage, tendon stretching and ice therapy two to three times per day.
If the home rehabilitation program fails to improve symptoms after two to three months, a steroid injection may help to improve the results of the continued rehabilitation therapy. If this conservative approach fails to resolve the symptoms, and the symptoms are still significantly bothersome, then arthroscopic surgery may be helpful.
Why do I have a stiff elbow?
Stiffness of the elbow can be extremely troublesome. Stiffness can occur as a consequence of arthritis or after an injury. If the stiffness is due to arthritis, the arthritis will need to be addressed first. If the stiffness occurs after an injury, it can often be treated successfully without surgery if treatment is initiated early and if the patient is compliant with instructions.
After an elbow injury and/or surgery, the patient should try to move the elbow as soon as the doctor says it is safe to do so. To improve range of motion, the patient will work on bending and straightening the elbow. He or she will also work on keeping the elbow at the side and turning the forearm so that the palm faces up, then down. These stretches should be held for about five minutes.
What are the symptoms of elbow arthritis?
Common symptoms of elbow arthritis include pain, stiffness, swelling, clicking, catching and locking in the elbow joint. The patient may experience creaking and grinding sensations, which occur because the cartilage of the joint surface is worn and the bones on the two sides of the joint rub together.
If the patient has rheumatoid arthritis, pain may be worse in the mornings. If the patient has more pain in the evening or when attempting physical activity, he or she may have osteoarthritis.
What are the treatment options for elbow arthritis?
When treating a patient with elbow arthritis, many factors have to be considered including age, activity level, expectations and other medical conditions. You and your doctor will discuss which treatment will work best for you. Treatment options include:
Oral analgesic and anti-inflammatory medications
Injections of steroids or viscosupplements
A surgical treatment such as:
interposition of a membrane between the bones
partial or total joint replacement
joint fusion or joint removal
Hand and Wrist FAQs
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel, a canal that runs from the wrist to the hand. The carpal tunnel is formed by the small bones of the wrist and the transverse carpal ligament across the top of the wrist. The median nerve provides sensory and motor functions to the thumb and three middle fingers. When it is compressed, patients may experience many symptoms including numbness.
What causes carpal tunnel syndrome?
Carpal tunnel syndrome can be caused by:
Repetitive, small movements with the hands, such as typing
Repetitive, grasping movements with the hands, which is common in physical activity
Joint or bone disease such as osteoarthritis or rheumatoid arthritis
Hormonal or metabolic changes such as menopause, pregnancy or a thyroid imbalance
Injuries to the wrist such as strains, sprains, dislocation, a break, or swelling and inflammation
However, many cases of carpal tunnel syndrome are idiopathic, meaning they have no known cause.
What are the symptoms of carpal tunnel syndrome?
Patients with carpal tunnel syndrome may experience some or all of the following symptoms:
“Pins and needles" in the fingers, especially at night
Numbness of the hand, predominantly the thumb and three middle fingers. The numbness also commonly occurs at night, waking the patient from sleep.
Difficulty gripping and holding on to objects
A sensation of swollen fingers
Relief from the above symptoms by shaking out the hand
What is the treatment for carpal tunnel syndrome?
Patients with carpal tunnel syndrome will often use one or more of the following treatments:
Wrist splints to prevent excess motion and decrease nerve compression
Altering the wrist position and wrist usage – for example, switching to an ergonomic keyboard when typing
Oral or injected anti-inflammatory medication
Surgery to remove the source of nerve compression
How complicated is surgery for carpal tunnel syndrome?
Carpal tunnel surgery is an outpatient procedure. Local anaesthetic will be used to numb an area in the front of the wrist about the size of an egg. The surgeon will make a one- to two-centimeter incision on the front of the wrist and will release the nerve from compression. The skin is closed with one stitch and the wrist is wrapped in soft dressings.
It is important to keep the wrist and fingers moving and elevated to help prevent swelling and stiffness. Pain medications and ice therapy are usually needed for the first two or three days following surgery. The length of recovery varies depending on both the individual and how long the nerve had been compressed. Stitches are generally removed after two weeks, at which point most normal activities can be resumed. However, some patients may take up to six months to fully recover.
What is a trigger finger?
Sometimes the finger can get stuck in a bent position, and the patient will have to straighten the finger with the help of the other hand. When the finger is stuck in this position and is forcibly straightened, sometimes the finger will snap, or “trigger,” back into a straight position. Trigger finger is caused by inflammation of the tendon sheath around the finger. The inflamed tendon prevents smooth bending of the digit.