Upper Extremities

Upper Extremities Conditions

Carpal Tunnel Syndrome

The most common symptoms are:

  • Numbness and tingling in the hand and fingers
  • Night symptoms
  • Hand and finger pain

Carpal tunnel syndrome (CTS) is the condition that results from increased pressure on one of the nerves in the wrist and hand. In patients with carpal tunnel syndrome, this nerve is compressed as it passes through the wrist. Because of the compression, the nerve does not function properly.

One can have a wide variety of carpal tunnel syndrome symptoms, but the condition typically causes numbness and tingling (paresthesias) in the hand, weakness in some of the muscles of the hand, and pain in the hand and wrist. Many of these symptoms become more pronounced at night, and patients with this condition often complain of inability to sleep.

Cubital Tunnel Syndrome

The most common symptoms are:

  • Numbness and tingling in the hand and small and ring fingers
  • Night symptoms
  • Hand and finger pain

There are several suggested causes for cubital tunnel syndrome. Part of the reason might reside in the very way the elbow is designed to work. One common factor might be the constant bending of the elbow itself–reaching, lifting, or pulling levers. When this occurs, the ulnar nerve is stretched several millimeters. At times the ulnar nerve will shift or snap over the bony point on the inside of the elbow called the medial epicondyle. Over time, this can progressively irritate the nerve, resulting in the pain, tingling, and numbness along with weakness of some of the muscles of the hand and forearm. Nerve damage can result. The ulnar nerve can also be damaged from trauma inflicted directly to the cubital tunnel.

Dupuytren's Contractures

Dupuytren's contracture is a condition that affects the palmar fascia, the connective tissue that lies beneath the skin in the palm of the hand. The condition causes contractures, or tightening, of this tissue in the hand. Because of the contractures, the fingers can become permanently flexed and the function of the hand is impaired.

The palmar fascia is a thick tissue that lies above the tendons and below the skin of the hand. The fascia is attached both to the skin above and to structures below. Through these attachments the palmar fascia acts as an anchor to enhance the grip ability of the hand. In Dupuytren's, the fascia becomes diseased and thickened, which leads to the finger contractures.

There is no effective means by which the course of Dupuytren's disease can be altered, so the early, nodular stages are usually a case of observation only. Patients are generally seen by a physician every few months to monitor the extent of the condition.

Ganglion Cyst

A ganglion cyst is a tumor or swelling that appears on the top of a joint on the back or front of the wrist or the base of a finger. It looks like a sac of liquid. The inside of the cyst is composed of a clear, thick, colorless, jellylike substance. The cyst may feel firm or spongy to the touch. Often, this is dependent on its size. One large cyst or several smaller ones may appear. And although ganglion cysts in Philadelphia patients are relatively common, they do not spread and they are not cancerous. Ganglion cysts are more common in women, and usually occur in individuals between the ages of 20–40. Often they may occur after an injury, but for the most part, it isn't known exactly why they appear. They are capable of changing in size and may simply disappear on their own. If you are looking for ganglion cyst Philadelphia care, call Rothman today to schedule a visit.

Hand and Wrist Arthritis

The wrist and hand have many small joints that work in conjunction with each other to produce motion. This provides individuals the exquisite dexterity required to tie a shoelace or thread a needle. However, when joints become afflicted with arthritis, daily activities can become difficult. Arthritis can appear in only one or multiple joints of the wrist and hand.

Cartilage works as a natural "shock absorber." It provides a smooth, gliding surface for joints. With this loss of cartilage, the joint is deprived of its painless, mobile area of motion. Once cartilage is lost, our bodies cannot replace it. This condition is termed "arthritis."

The body attempts to accommodate the lost cartilage by producing extra tissue in the joint lining (termed synovium). In addition, the joint lining created more of the lubricating (synovial) fluid that is normally found in joints. This addition of extra tissue and fluid causes the joint to swell, thus restricting motion. The swelling also causes stretching of the joint covering, which in turn causes further pain. With time, the bones of the joint can lose their normal shape as bone spurs form. This creates even more pain while further limiting motion.

Risk Factors/Prevention

Statistics indicated that approximately 20 percent of people living in the United States suffer with symptoms or signs of arthritis in at least one joint. Nearly half of all arthritis sufferers are under 50 years old. In fact, arthritis ranks as the leading cause of disability in the country. The precise number of individuals with arthritis in the wrist and hand is unknown.

Types of Arthritis

The two most common types of arthritis are degenerative and inflammatory. Degenerative arthritis (also named osteoarthritis) is most common, and can occur from "wear and tear" on the joints and generally affects older individuals. Some younger patients, especially women, are often afflicted by osteoarthritis of the thumb. Another subset of younger patients who develop osteoarthritis is those with a history of injury about a joint, a condition termed post-traumatic arthritis. The most common injuries that lead to arthritis are fractures, especially fractures that involve the joint surfaces.

The second type of arthritis is inflammatory arthritis, which is often associated with systemic symptoms that may appear throughout the individual's body. The most common form of this type of arthritis is rheumatoid arthritis, and other common forms are psoriasis and lupus.

The development of arthritis does not necessarily have to result in a sedentary or painful existence. Early treatment is essential to helping the individual maintain a healthy and active lifestyle.

Mallet Finger (jammed finger)

The extensor tendons, which are located on the back of the hand, allow individuals to straighten the thumb and fingers. These tendons originate from the muscles in the forearm. The tendons become thin and flat as they continue on into the fingers of the hand. It is these small tendons that allow for coordination and delicate finger motions.

Extensor tendons are located just beneath the top surface of the skin, directly on the bone, and on the back of the fingers and hands. Due to their location, these tendons are often injured. Even the common trauma of jamming a finger could cause these thin tendons to rip away from their attachment to the bone. After an injury of this type, it may prove difficult to straighten one or more of the finger joints. Treatment is required to help return the tendon to normal functionality.

Causes

A mallet finger is caused when the extensor tendon which helps to extend the knuckle of the finger closest to the tip of the finger is pulled off the bone. is damaged. When an object such as a ball strikes the tip of the finger or thumb, the force of the blow damages the thin tendon required to straighten the finger. This type of injury is often referred to as a "baseball finger." The injured finger may droop noticeably and is usually swollen, bruised, and very painful.

Trigger Finger

Trigger finger is an inflammation of tissue inside your finger or thumb. It is also called tenosynovitis (ten-oh-sin-oh-VY-tis). Tendons (cordlike fibers that attach muscle to bone and allow you to bend the joints) become swollen. So does the synovium (a slick membrane that allows the tendons to move easily). This makes it difficult to straighten the finger or thumb.

Causes

Repeated use of a tool, such as a drill or wrench, can irritate and inflame the tendons and the synovium. So can arthritis or an injury to the palm of the hand. But often the cause of trigger finger is unknown.

Wrist Tendonitis

Wrist tendonitis is one of the most common causes of wrist pain. This condition is primarily characterized by inflammation and irritation of the tendons surrounding the wrist joint. Wrist tendonitis is also called tenosynovitis, and it usually affects one of the wrist tendons, but it may also involve two or more tendons. In most cases, wrist tendonitis develops at those points where the tendons cross each other or pass over a bony prominence.

As wrist tendons pass by the wrist joint, they slide through sheaths that contain fluid. These tendon sheaths are designed to allow the tendons to glide effortlessly in a relatively low-friction manner.

Wrist tendonitis becomes a problem when the tendon sheath becomes thickened and begins to constrict the smooth gliding motion of the tendons. The accompanying inflammation also makes the movements painful.

Upper Extremities Education

When is it Time to Think About Surgery?About the SurgeryPreparing for SurgeryWhat to Expect After SurgeryComplications and Risks of SurgeryRecovery PeriodReturning to WorkPrintable PDF

You may need carpal tunnel release surgery if you are experiencing numbness, tingling, burning and weakness of the affected hand and fingers. You may also have radiating pain to your forearm, shoulder or neck. When these symptoms affect daily activities such as reading the paper and driving your car, or they cause you to lose sleep, it’s usually time to consider having surgery.

Your doctor will order an electromyography test (EMG test) to diagnose this disorder and better understand the level of nerve irritation. This nerve irritation occurs when your median nerve at your wrist is compressed due to a decrease in the diameter of the tunnel or increased blood flow through the tunnel.

When you have carpal tunnel release surgery, the doctor makes an incision at the base of the palm of your hand. The ligament across your wrist is cut, which takes the pressure off your median nerve. This procedure is done as an outpatient surgery and you will go home the same day with a splinted wrist in a bulky dressing.

You will have pre-admission testing done before your surgery to ensure that you are healthy enough for the planned procedure. Testing may include lab work, an EKG and a chest x-ray.

Anti-inflammatory medications, aspirin, and blood-thinning medications should be discontinued one week before your surgery. These medications affect your blood clotting factors and could increase your risk for bleeding.

You will find a bulky hard splint on your wrist and hand, and an IV in your opposite arm to replace your fluids. You will be in the recovery room after surgery until your vital signs are stable and you are awake.

Bleeding: Please contact the office if your dressing/ band aide becomes saturated with blood.

Infection: Please contact the office if your wound develops a foul smell, drainage, increased swelling, redness, fever, or chills.

Painful scar formation: Tissue around your scar may heal tight and be uncomfortable. After 4 weeks you may massage the area to help break up this scar tissue. Recurrence of symptoms: Your symptoms may not completely disappear after severe nerve damage has occurred. You may continue to experience some symptoms even after surgery.

Nerve damage: There is a slight risk that surrounding nerves may be damaged during carpal tunnel release surgery.

Your recovery time will vary depending on the degree of nerve damage caused by the compression. Nerves typically regenerate an inch per month, so recovery may take 4-6 months. If nerve damage is severe the nerve may be irreparable, but surgery will prevent further nerve damage.

Patients usually return to work approximately 3 days after their surgery with the restriction of using only their non-affected hand. You should not lift more than 5 lbs. or do any repetitive gripping, and you should avoid heavy use of your surgical hand for 4 weeks after your surgery. After 4 weeks you may return to regular duties.

Upper Extremities Specialists


Dr. Jeffrey K. Anhalt
Dr. Jeffrey K. Anhalt
Dr. Dirk A. Bakker
Dr. Dirk A. Bakker
Dr. Rick A. Baszler
Dr. Rick A. Baszler
Dr. Phillip J. Dabrowski
Dr. Phillip J. Dabrowski
Dr. Daniel J. Fett
Dr. Daniel J. Fett
Dr. Yousif I. Hamati
Dr. Yousif I. Hamati
Dr. Martin M. Pallante
Dr. Martin M. Pallante
Dr. Aaron D. Potts
Dr. Aaron D. Potts
Dr. Jeffrey D. Recknagel
Dr. Jeffrey D. Recknagel
Dr. James R. Ringler
Dr. James R. Ringler
Dr. Edward J. W. Shields
Dr. Edward J. W. Shields
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