Causes of Cubital Tunnel Syndrome

The ulnar nerve gives you feeling in your little finger and half of your ring finger. Additionally, it controls the muscles of the hand that allow you to pick stuff up and do other fine movements. It also controls bigger muscles of the forearm that allow you to grip objects.  The exact cause of cubital tunnel syndrome is not completely understood, but it is believed that the ulnar nerve is susceptible to compression at the elbow because it passes through a narrow space where there is not much tissue for protection. Keeping your elbow bent for long periods of time (like when you hold a cell phone to your ear) may cause ulnar nerve irritation and symptoms.   Other common reasons for this condition include:

• -A direct blow to the inside of the elbow or “hitting the funny bone”
• -Fluid buildup in the elbow that leads to swelling and nerve compression
• -Irritation when the nerve slides in and out of place with bending
• -Pressure on the nerve from prolonged leaning on your elbow
• -Sleeping with your elbow bent

Home Remedies for Cubital Tunnel Syndrome

The simplest thing you can do is to lay down your cell phone and avoid other activities that require you to bend your arm for long periods of time. Also, make sure your computer chair is not too low, and do not rest your elbow on the armrest a lot. Keep your elbow straight when sleeping, if possible, by wrapping a towel around your elbow region or wear an elbow pad backwards.

What the Doctor May Do at Your Visit

If the orthopedic specialist suspects you have cubital tunnel syndrome, he may order special X-rays to see if bony deformities are the cause of the problem.  Additionally, he may order electrical nerve conduction studies to determine how well your ulnar nerve is working and to identify exactly where the compression site is located.

Nonsurgical Treatment

Sometimes, non-steroidal anti-inflammatory medicines can alleviate your symptoms. The orthopedic specialist will want to decrease the swelling around the nerve with these medications. Also, he may inject a “steroid”, like cortisone around the ulnar nerve area of compression. It is not uncommon for the doctor to recommend a brace or splint for you to wear at night to keep your elbow straight. Finally, there are certain nerve gliding exercises that may help your nerve slide through the cubital tunnel so that symptoms can improve or resolve completely. These special exercises help keep the wrist and forearm from getting stiff and sore.

Surgical Treatment

For some people, nonsurgical measures are not enough to relieve the symptoms of cubital tunnel syndrome. In these cases, the orthopedic specialist recommends surgery to take the pressure off the ulnar nerve. Also, surgery is indicated for those who have severe nerve compression or muscle wasting due to the condition. The surgical procedures available include:

Endoscopic or Open Cubital Tunnel Release:  In this surgery, the ligament “roof” of the cubital tunnel is divided. This allows for an increased tunnel space and a decreased nerve pressure.   This procedure minimizes the dissection around the nerve and allows for the quickest recovery.  Dr. Weil is one of the only surgeons in the northwest performing Endoscopic Cubital Tunnel Ulnar Nerve Decompression surgery.  This method is the least invasive and allows for the fastest recovery of all ulnar nerve decompression surgeries.  Dr. Weil was highlighted on King 5 news Health Link for his treatment of cubital tunnel syndrome.

Ulnar Nerve Anterior Transposition:  With this procedure, the nerve is moved from the cubital tunnel and placed in front of that region. Ulnar nerve anterior transposition allows the nerve to lie under the skin and fat but on the muscle, within the muscle, or under the muscle. Placement will depend on your particular problem and the surgeon’s choice.

Medical Epicondylectomy:  One great option to release the ulnar nerve is to remove part of a bony section called the medial epicondyle. This technique prevents the nerve from becoming caught on one of the bony ridges so that it can adequately stretch with bending motions.

Surgical Recovery

If you must undergo a surgical procedure, the orthopedic specialist may put you in a splint following the surgery. For the endoscopic technique no splint is required, for the transposition technique, you may have to wear it as long as 6 weeks. Also, your doctor may recommend that go to physical therapy to learn exercises that will help you regain strength and motion in your arm.

Types of Childhood Forearm Fractures

The main categories of fractures are non-displaced or displaced fractures and closed or open fractures. Displaced fractures involve the bone snapping into two or more parts and these parts do not line up. A non-displaced fracture is one in which the bones break but are still in anatomic position. These fractures require a procedure to re-align the bones. A closed fracture is where the bone breaks but does not protrude through the skin. An open fracture, however, involves the bone breaking through the skin.

Torus Fracture

A torus fracture, is also called a “buckle” fracture, results in the top layer of the bone on one side compressing and buckling away from the growth plate. This is a stable fracture, with the broken segments not separated or displaced. These breaks hurt but do not cuase a deformity.

Metaphyseal Fracture

With a metaphyseal fracture, the break is across the upper or lower portion of the bone shaft. With this type of injury, the growth plate is not affected.

Greenstick Fracture

A greenstick fracture runs through a portion of the bone, causing it to bend on the other side. This term came about because doctors described this fracture like a green stick breaks. These types of injuries occur only in children, as adult bones won’t break in this manner.

Galeazzi Fracture

The Galeazzi fracture affects the radius and the ulna bones. These types of injuries are usually displaced with dislocation of the ulna at the wrist area.

Monteggia Fracture

With a Monteggia fracture, both forearm bones are affected. The ulna breaks and the top and the radius dislocates. This is a severe injury that requires immediate urgent care.

Growth Plate Fracture

Growth plate fractures, also called physeal fractures, occur at or across the growth plate, typically in the area where the radius attaches with the wrist. This area heals well, with less than 5 percent having complications.

Symptoms

Symptoms really depend on the type of fracture, but most fractures cause severe pain and numbness of the hand and forearm. Sometimes, the fracture causes a bent appearance of the forearm. Other symptoms include swelling, bruising, and inability to rotate or turn the arm.

Treatment

Treatment depends on the degree of displacement and the specific type of fracture. The severity of a fracture depends on the location and the amount of damage done to the tissue and bone. A minor fracture could heal within a few weeks, whereas a serious fracture could take months to heal. Treatment also depends on the age of the child, the degree of deformity, and the stability of the break. The goal of treatment to a fracture involving the growth plate is restoration of normal alignment with minimal trauma.

Nonsurgical Treatment

Many fractures of the forearm in children can be treated without surgery. Casts and immobilizing devices protect the bones while they heal. Sometimes it is necessary for the orthopedic specialist to manipulate the bones into proper alignment, a process called reduction.

Surgical Treatment

Surgery to realign the bones and secure them in place is necessary if the skin is broken, if the fracture is unstable, if bone segments have been displaced, and if the bones cannot be manipulated to realign through reduction. Once the surgeon aligns the bone segments, he may use metal implants, pins, or a cast to hold these in place.

Long-Term Outcome

Once your child’s cast comes off, the wrist joint or elbow joint may be stiff for a few weeks. This will resolve without the need for physical therapy in most cases. Your child’s healing bones will be temporarily weak following immobilization, so you should not allow rough play, climbing, or contact sports for 3 to 4 weeks after the cast comes off.

The biceps tendons attach the biceps muscle to the bones of the shoulder and elbow. If you tear this tendon at the elbow, you lose strength in your arm and have significant weakness in supination (turning hand from palm down to palm up). Unless the biceps tendon is surgically repaired, there will be significant loss of arm function. The biceps tendon at the elbow region is the distal biceps tendon. The biceps tendon that attaches to the shoulder is the proximal biceps tendon.

Rupture of the proximal portion of the biceps tendon occurs often when there is a degenerative change within the tendon leading to structure failure. However, this tendon region could rupture during trivial activity. The primary cause of a distal biceps tendon tear is sudden injury.

Risk Factors

Those at risk for distal biceps tendon tears include men, age 30 or older. Smoking and the use of corticosteroids also increase the risk of these tears.

Symptoms

A distal biceps tendon tear causes the muscle to ball up near the shoulder, sometimes called the “popeye deformity”. Oftentimes, there is bruising at the elbow. If you tear this tendon, you may hear a “pop” at the elbow region. Pain is usually severe at first, but subsides after a couple of weeks. Other symptoms include weakness in twisting the forearm, swelling in the front of the elbow, and a gap in the front of the elbow.

Usually patients will have sudden pain associated with an audible snap in the area of their shoulder. The pain is usually not significant, and, as mentioned previously, some patients may experience pain relief after the rupture. After the ruptured tendon retracts, patients may notice a bulge in their arm at the biceps muscle. This is the retracted muscle bunched up in the arm, and is sometime referred to as a “Popeye Muscle,” because the muscle is more pronounced than normal.

Distal biceps tendon rupture is characterized by sudden pain over the front of the elbow after a forceful effort against a flexed elbow. Usually the patient will hear a snap and have pain where the tendon rupture occurs. Swelling and bruising around the elbow are also common symptoms of distal biceps tendon rupture.

Diagnosis

Medical History and Physical Examination

After discussing your symptoms, your doctor will review the events of the injury to determine how it occurred. During the physical examination, your doctor will feel the front of your elbow, looking for a gap in the tendon. He or she will test the supination strength of your forearm by asking you to rotate your forearm against resistance. Your doctor will compare the supination strength to the strength of your opposite, uninjured forearm.
In addition to the examination, your doctor may recommend imaging tests to help confirm a diagnosis.

Imaging Tests

X-rays. Although X-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause elbow pain.
Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears.

Treatment

Patients usually do not notice any loss of arm or shoulder function following a proximal biceps tendon rupture. A slight bulge in the arm, and some twitching of the retracted muscle are usually the most significant symptoms. Surgical repair of the proximal biceps tendon is usually only considered in the case of a younger patient who is more active.

The reason there is little functional loss following a proximal biceps tendon rupture is that there are actually two tendinous attachments of the biceps at the shoulder joint (that is why the muscle is named “bi-ceps,” meaning two heads). When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed.

If pain persists following a proximal biceps tendon rupture, other causes of shoulder pain should be considered. These include impingement syndrome (rotator cuff bursitis), rotator cuff tears, or fractures around the shoulder.

Rupture of the distal biceps tendon at the elbow joint is much less common and accounts for less than 5% of biceps tendon ruptures. This injury is also usually found in middle-aged patients, although not always. There is usually some degree of tendinosus, or degenerative changes within the tendon, that predisposes the patient to rupture of the tendon.

The significance of a distal biceps tendon rupture is that without surgical repair, patients who experience complete rupture of the distal biceps tendon will notice loss of strength at the elbow. The strength will affect both the ability to bend the elbow against resistance, and the ability to turn the forearm to the palm-up position against resistance (for example, turning a doorknob or screwdriver).

Nonsurgical Treatment

Nonsurgical treatment may be considered for patients who are elderly and inactive, or who have medical problems that make them high-risk for modest surgery.

Patients must weigh the decision to proceed with nonsurgical treatment carefully, because restoring arm function with later surgery may not be possible.

The tendon should be repaired during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten.
While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.

Surgical Treatment

If you and your doctor decide upon elbow surgery,the surgery is performed as an outpatient procedure under either regional or general anesthesia. Your procedure will most likely take between one and two hours. Following surgery, your arm will be placed in a splint for several days to immobilize the elbow and allow the wound to heal. During this time gentle wrist, hand and shoulder exercises are performed.

Early range of motion is begun within three to seven days after surgery depending on the type and extent of the reconstruction. You will be able to remove the splint and use a range of motion brace in order to avoid elbow stiffness. It is particularly important to achieve elbow extension (that is to be able to straighten the elbow fully).

Procedure

Doctors use several procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use two incisions, while others only one incision. There are pros and cons to each approach.
Sometimes the tendon is attached with stitches through holes drilled in the bone. Other times, small metal implants are used to attach the tendon to the bone.

Be sure to carefully discuss the options available with your doctor.
X-rays showing metal implants called suture anchors that have been used to secure the biceps tendon to the bone.

Rehabilitation

Right after surgery, your arm may be immobilized in a cast or splint.
Your doctor will soon begin having you move your arm, often with the protection of a brace. He or she may prescribe physical therapy to help you regain range of motion and strength.

Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be gradually added to your rehabilitation plan.
Be sure to follow your doctor’s treatment plan. Since the biceps tendon takes 2 to 3 months to fully heal, it is important to protect the repair by restricting your activities.

Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months.

Although it is a slow process, your commitment to your rehabilitation plan is the most important factor in returning to all the activities you enjoy.

The physical therapy team at Hoag is orthopedic specialized, and they will work closely with your surgeon to establish a personalized rehabilitation plan for you. About six weeks after your surgery, elbow strengthening exercises may begin. For patients who remain dedicated to physical therapy the chances of complete recovery are very high, at above 90 percent.

Wrist Sprains

The most common sporting injury to the wrist is a wrist sprain. There are many ligaments in the wrist that can be torn or stretched, resulting in a sprained wrist. This commonly occurs when the wrist is bent forcefully or in a fall onto an outstretched hand. Sprains to the wrist can range from mild to severe and are graded depending upon the degree of ligament injury that exists.

Grade 1 – mild sprain where the ligaments are stretched but not torn
Grade 2 – moderate sprain where the ligaments are partially torn
Grade 3 – severe sprains that occur when there is significant complete tearing of ligaments

With grade 1 sprains, there is some mild discomfort and decreased range of motion. With grade 2 sprains there is more serious loss of function. Grade 3 sprains result when the ligament tears away from the bone and require surgical treatment. Many times this tearing leads to a small chip of the bone being torn away with the ligament. This is known as an avulsion fracture.

The most common symptoms of a wrist sprain include:

• Swelling of the wrist
• Bruising or discoloration of the skin around the wrist
• Pain at the time of the injury
• A feeling of popping or tearing inside the wrist
• Persistent pain when you move your wrist
• Tenderness at the injury site
• A warm or feverish feeling to the skin around the wrist

Most sprains can be treated with immobilization and rest. However, your orthopedic specialist may have to perform surgery to correct your wrist injury. This all depends on the severity of the sprain and intensity of the torn ligament. Surgery involves reconnecting the ligament to the bone. This procedure is followed by a period of rehabilitation with exercises to strengthen your wrist and restore motion. Although the ligament can be expected to heal in 6 to 8 weeks, rehabilitation for a full recovery could take several months.

Other Injuries of the Wrist

Tendinosis – This is a syndrome that involves a series of very small tears (called microtears) in the tissue in and around the tendon. Common symptoms are pain, tenderness, decreased strength of the wrist, and limited movement.

De Quervain’s Tendonitis – This can occur in the hand and wrist when the thumb extensor tendons and the sheath covering these tendons swells and becomes inflamed. This leads to pain, tenderness, and decrease in motion of the wrist.

Carpal Tunnel Syndrome – This is caused by pressure on the median nerve in the wrist. The symptoms of this syndrome include numbness, tingling, weakness, and pain in the fingers, hand and wrist areas.

Colles’ Fracture – This type of fracture is a break across the radius that occurs when the hand is extended out during a fall. The break occurs causing the wrist to become shortened and extended. Teens that enjoy outdoor sporting activities often develop these types of fractures because falls often occur.

Symptoms of a Colles’ fracture include inability to straighten the wrist or to hold heavy objects, distortion in the shape or angle of the forearm above the wrist, and pain and swelling of the injured area. Many of these fractures are not severe and you can be placed in a splint and sling. Sometimes, the orthopedic specialist applies a fiberglass cast. More severe fractures may require surgery including placement of pins or plates and screws. Recovery from this injury ranges from 6 weeks to 6 months depending on the severity of the fracture.

The ‘carpal tunnel’ is a tunnel-like structure of the wrist. The wrist bones called the carpal bones form the floor and walls of the tunnel. The roof of the carpal tunnel is a strong band of connective tissue called the transverse carpal ligament. The median nerve travels through the carpal tunnel and this nerve provides sensation to the palm side of the thumb, index, middle and half of the ring finger. It also controls the muscles of the thumb. Flexor tendons travel through the carpal tunnel with the median nerve. These tendons are necessary to bend the fingers and thumb.

Carpal tunnel syndrome occurs when the tissues adjacent to the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium and they lubricate the tendons to make it easier to move the fingers. With carpal tunnel syndrome, the synovium swells and narrows the confined space affecting the median nerve.

What is Involved with Endoscopic Carpal Tunnel Release Surgery?

Endoscopic surgery involves the use of a small camera. This small camera is known as an endoscope and it is guided through a one centimeter incision in the wrist to view the inside of the carpal tunnel. The endoscope allows the orthopedic hand specialist to see the structures of the wrist without opening the entire area with a large incision.

The transverse carpal ligament is cut during endoscopic carpal tunnel release surgery and this ‘releases’ the pressure that is on the median nerve and thus relieves carpal tunnel syndrome symptoms. The small incision made to the surgical site are closed with sutures and the ligament that was cut will eventually heal by being filled with scar tissue. This type of procedures is done on an outpatient basis, with most patients receiving sedation and arm “block”.

Why Is Carpal Tunnel Release Surgery Done?

If you still have symptoms even after a long period of nonsurgical treatment, your orthopedic specialist may recommend carpal tunnel release surgery. If there are signs of nerve damage, the surgeon may urge you to consider this procedure immediately. Another reason the surgery is done is that severe symptoms that persist restrict your activities of daily life.

How Well Does It Work?

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand afterwards. In rare incidences, however, the symptoms return or there is temporary loss of strength when gripping or pinching objects. The surgery works best when there is no nerve damage or serious damage to the internal structures of the wrist. If the muscles are wasted away or weakened before the surgery, there is more likelihood that there will be decreased hand strength and function after the procedure.

What Should I Expect After Surgery?

There is a shorter recovery period after an endoscopic surgical procedure than after open surgery. This is because the structures of the hand and wrist are not manipulated and there is less of an incision to heal. The pain and numbness due to nerve compression should be relieved immediately following the endoscopic carpal tunnel release surgery.

You will have to avoid heavy use of your hand for two or three weeks following this procedure. Your doctor will advise you on when you can return to work and this will depend on whether or not your dominant hand was operated on, what is involved in your work activities, and the effort that you put into your rehabilitation and physical therapy.

The symptoms of trigger finger occur without injury most of the time, or they may follow a period of heavy hand usage. A tender lump can develop in your palm and there may be swelling. The main symptom is inability to straighten the finger without pain and the finger will catch or pop. The stiffness of trigger finger tends to worsen after periods of inactivity and many find that it is worse in the mornings.

Often times, trigger fingers can be treated with a steroid injection in the office. If the finger continues to catch or lock after a steroid injection, the treatment for this condition becomes surgery to open up the flexor tendon sheath in order to eliminate the catching or locking.

What Do I Need to Do Before Trigger Finger Release Surgery?

Before you undergo this procedure, your orthopedic hand specialist will discuss with you exactly what will happen before, during, and after the procedure. You can prepare yourself by asking questions to help you be well informed so you can go ahead with the consent for surgery and sign the necessary forms. The operation is done under local or regional anesthesia, which means you will be awake and alert during trigger finger release surgery. Your hand will be totally numb, however, allowing your surgeon to operate painlessly.

What is Involved with Surgery?

Once the anesthetic has taken effect, your orthopedic hand specialist will make a 2cm incision into the palm of your hand so he or she can get to the tendon. The surgeon then will release the tendon by making a small incision in the first annular pulley of the tendon sheath. Once this has occurred, you may be asked to move your fingers and to make a fist. Don’t worry, because of the anesthesia, this won’t hurt. Once the doctor is sure the tendon is properly released, he will close the incision and cover the wound area with a bandage.

What Can I Expect After the Trigger Finger Release Surgery?

It may take several hours before the feeling comes back in your hand so you must be careful not to bump or knock the area. You may need to take pain medication for a few days following this operation as well.

If you have general anesthesia, you will need to rest in a recovery room until the effects of it have worn off. The nurse or doctor will give you follow-up care advice and a follow-up appointment. You will need to keep your dressing and stitches clean and dry for around ten days and then they will be removed. It usually takes about three or four weeks to fully recover from trigger finger release surgery, so it is important that you follow your orthopedic specialist’s advice during this time.

Cubital tunnel syndrome often presents as a tingling sensation in your hand like you have hit your “funny bone.” When you do hit your elbow a certain way, the sensation you feel is the result of irritation to the ulnar nerve. This leads to a shooting sensation of tingling, pain, and numbness into the small finger and the ring finger. Your ulnar nerve will transmit a signal to your brain to allow these sensations to be felt.

What causes Cubital Tunnel Syndrome?

Cubital Tunnel Syndrome is the result of some form of pressure on the ulnar nerve. Pressure on the ulnar nerve develops in several different ways. The ulnar nerve is located right next to the bone and doesn’t have much padding over it. When pressure is put on this nerve, the syndrome develops.

Pressure on the ulnar nerve can also occur when you keep your elbow bent in a certain position for a long time. This stretches the nerve as it crosses through the cubital tunnel and narrows the tunnel itself. This often occurs during sleep. It may also occur when holding a phone for a prolonged period of time. For some people, the connective tissue over the nerve gets thicker and this causes pressure on the nerve. Cubital Tunnel Syndrome occurs when the pressure is significant enough and sustained enough to interfere with the way this particular nerve functions.

What are the symptoms of Cubital Tunnel Syndrome?

If you have this syndrome, you will have pain, numbness, and tingling in the small finger and the ring finger. These symptoms are generally felt when you have pressure on the nerve such as sitting with the elbow on an arm rest or during a repetitive motion of moving the elbow in a bending position and then straightening it. In addition, you will have weakness of the muscles in the hand or clumsiness with use of the hand. These weakened muscles are called the intrinsic muscles of the hand, and they help with finger movements. People who have more severe symptoms will frequently drop objects that they pick up and also have difficult with the fine motor movements of the fingers.

How is Cubital Tunnel Syndrome diagnosed?

The diagnosis of Cubital Tunnel Syndrome is concluded after a complete history and examination is done by an orthopedic specialist. If there is a concern that something abnormal may be causing the nerve compression, X-Rays and other imaging may be necessary to evaluate this elbow, arm and hand. Nerve conduction studies, called EMGs, will help the doctor determine the extent and location of the nerve compression.

How is Cubital Tunnel Syndrome treated?

Many people can be treated for Cubital Tunnel Syndrome with anti-inflammatory medications, especially if the EMG test shows that the pressure is only minimal. Sometimes, the orthopedic specialist will splint the elbow, especially at night. Another treatment option is the use of padding for the elbow during work or sporting activities. If these non-operative treatments fail to provide relief, surgery will be necessary to eliminate the pressure from the ulnar nerve.

Surgery for Cubital Tunnel Syndrome

The goal of surgical treatment for Cubital Tunnel Syndrome is to alleviate the pressures on the Ulnar Nerve. This can be accomplished through a minimally invasive technique called Endocscopic Cubital Tunnel Release. Dr. Weil is currently the only surgeon at Swedish Hospital performing this type of surgery. It involves a small incision behind the elbow in order to insert the camera into the tunnel and to release the nerve.

Post-operatively, patients are placed in a soft bandage for 4 days and can resume light activities immediately after surgery. The recovery from this type of surgery is much faster than traditional open surgical approaches.

Patients who are not candidates for this procedure can be treated with open procedures such as an ulnar nerve transpostion. This involves moving the ulnar nerve from the back of the elbow to the front of the elbow. The nerve may be put under a layer of fat, under the muscle tissue, or deep within the muscle. Following surgery, recovery depends on what the surgery entailed and what needed to be done. Most people recover well in a couple of months.

Most of these types of fractures can be placed in a splint and an arm sling. Sometimes, a lightweight, fiberglass cast is necessary. If the bone is no longer in line and straight, the fracture may need to be ‘reduced’ or straightened by way of wrist surgery. The Orthopedic Specialist will use a local anesthesia before reducing this type of fracture. In some cases, surgery is warranted. The break may need to be fixed with wrist surgery using a plate, screws, pins, or other metal hardware. Some surgeons can use plastic hardware, too.

What are the Symptoms of a Colles Fracture?

This type of fracture changes the shape and angle of the forearm in the area just above the wrist. The injured person will have pain and inability to hold objects. Most always, a Colles’ fracture causes swelling just above the wrist and the person is unable to lift with that hand.

What is the First Aid for a Colles Fracture?
• Place the wrist and hand in a splint in normal position.
• Place a rolled up sock in the palm and wrap the hand and wrist area with an elastic bandage.
• Use an ice pack to reduce swelling.
• Go to the emergency room or your Orthopedic Specialist’s office.
• Do NOT try to move or straighten the hand and wrist.

What Can the Orthopedic Specialist Do?
• Stabilize the fracture.
• Order X-Rays and other scanning tests.
• Reduce the fracture if necessary.
• Perform wrist surgery on the fracture if necessary.
• Prescribe a rehabilitation plan to prevent deformity.

Hand Fractures

The hand is made up of many small bones, and these bones work together as the supporting framework. A fracture occurs whenever there is enough force applied to one of the bones. When a fracture occurs, there is pain, decreased range of motion, and swelling. These could be simple or complex, depending on what part is injured. Some fractures happen in the main body of the bone known as the shaft. Others occur on the joint surface. A comminuted fracture is when the bone is shattered into many pieces and this is from a high energy impact. An open fracture is called a compound fracture, and this is when a piece of the bone comes through the skin.

How does Fractures Affect the Hand?

A fracture can cause stiffness, loss of movement, and pain of the hand. Some will cause a deformity, such as a crooked finger, too. Many fractures of the hand are painless and no deformity develops. Fractures can injure a joint surface and this will lead to arthritis.

What Can the Orthopedic Specialist Do?
• Order a medical evaluation with X-Rays.
• Provide a splint or cast
• Perform hand surgery by open reduction or closed reduction and internal fixation (surgery).
• Prescribe a specialized rehabilitation plan.

Wrist Sprains and Strains

One of the most common causes of wrist pain in athletes is a sprain of the wrist. A wrist sprain generally occurs after a fall on an outstretched hand stretches or tears the ligaments of the wrist. Common causes of wrist sprains include falls during sports such as inline skating, skiing, snowboarding, skateboarding, soccer, football, baseball, and volleyball. When an athlete falls on the outstretched hand, the muscles, tendons and ligaments in the wrist take the brunt of the impact, and can be stretched and perhaps torn. If these tissues are inflexible or fragile, the risk of injury intensifies. Basically, a sprain is an injury to a ligament. Ligaments are the tough, fibrous tissues that connect bones to other bones.

A strain results when a muscle or tendon is injured. Tendons are the structures that connect muscles to bones. This can occur when the athlete falls on an outstretched hand, much like a sprain. Strains result when there is overstretching of the muscle, also. Mild strains of the wrists are not as severe as sprains of the wrist. However, strains that are severe result in complete tears of the tendon and muscle tissue and these are quite painful.

Symptoms of Sprains and Strains of the Wrist

With a wrist sprain, there is pain, tenderness, and swelling over the wrist after the fall. It often is tender, red, and warm to the touch, too. With a strain, there may be bruising, decreased range of motion, and a deep dull ache in the wrist area. If you suspect you have either of these conditions, you should seek medical attention. Some strains require wrist surgery.

Solutions for Sprains and Strains

The first line medical treatment involves the R.I.C.E. formula. This includes:

Rest – If you have an injury, stop activity and don’t use the injured wrist for 48 hours or until your doctor says it is OK. Wait for sure until the pain and swelling has subsided.

Ice – Apply ice to the wrist by means of a cold pack (ice wrapped in a towel) or a bag of peas from the freezer. Do this for around 20 minutes, off for 20, then back on again for 20. Continue this until swelling subsides.

Compression – Use an elastic compression bandage (commonly known as an ACE wrap) to secure the wrist and limit swelling. Start the wrap at the base of the fingers and stop just below the elbow. The wrap should be snug, but be careful not to wrap it tight and cut off circulation to the fingers.

Elevation – Keep the injured wrist higher than your heart as often during the day and at night for the first 48 hours after the injury. You can do this with an arm sling or elevating it on pillows. This will help drain fluid and reduce swelling that may form around the wrist.

Tendonitis

Tendonitis of the wrist is simply irritation and swelling that occurs to the tissue. The area affected where the ‘tunnel’ occurs is the tissues around the thumb. The most common symptom is pain in the front of the wrist and pain with bending and extending of the wrist. Mild swelling that is visible often occurs, as well. Tendonitis of the wrist is caused by injury to the arm, over use, biomechanical problems, and poor equipment operation. Sometimes, when someone begins a new activity or exercise, tendonitis will flare up.

Treating Tendonitis

If detected and treated early, tendonitis will improve quickly. The Orthopedic Specialist may give you steroid injections or an anti-inflammatory medication. More serious tendonitis requires hand surgery and wrist surgery, but this is rarely the case. If you feel that you have this condition, rest the wrist and do the R.I.C.E. therapy for a few days.