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Hand

Q: I heard that injuries to your hands are among the most common in the upper body and are likely to result in more serious problems later in life. Is this true?

A: In order to accomplish all that they’re able, hands are comprised of a number of joints with many supporting ligaments, muscles and nerves. This, combined with the fact that they are such an integral part of our daily life and the first line of defense when shielding ourselves from a blow or breaking a fall, makes them vulnerable to a host of injuries over the course of our life.

Nearly 90 percent of women and 80 percent of men between the ages of 75 and 79 have X-ray evidence of osteoarthritis in their hands.

Repeated injury to any joint can create an unstable environment and possibly scar tissue that further disrupts joint function - all of which contribute to joint degeneration and related problems. Ensuring that torn ligaments, dislocations and fractures are successfully treated when they happen and that the affected joints are periodically monitored for changes can greatly reduce the risk of serious problems in the future.


Q: I fell on my thumb in a game of football and tore the ulnar collateral ligament. It was surgically repaired, but the doctor said that there could be future problems. What could these be?

A: Because of the flexibility of the thumb and its unique joint construct, it requires strong stabilization and monitoring. Occasionally the metacarpophalangeal (MCP) joint of the thumb remains unstable following an ulnar collateral ligament injury - and surgical repair. Chronic instability in a joint can predispose the joint to arthritis. It is important to periodically assess the joint for any changes.


Q: What sometimes causes numbing in my hands after a long bike ride - is this nerve-related, or circulation? What can be done to prevent it?

A: This is not a serious problem and is usually caused from compression of the ulna nerve at the base of the hand. Wear good gloves and change the position of your hands frequently. You may also want to consider triathlon bars for better hand positioning and more comfortable grip.
Wrist

Q: I have a small lump under my skin at my wrist. I'm afraid it might be a tumor, but it feels kind of soft. What do you think it is?

A: While an X-ray could definitively identify the mass, a tumor is generally not soft. Another type of bump that has a tendency to form on the hands and wrist is a Ganglion Cyst. Ganglions are small sacs filled with clear, jellylike fluid, growing out of a joint and rising from the connective tissues between the bones and muscles to form a round bump visible from under the skin. The size of the bump usually varies depending on a person's level of activity, and they are generally painless.

While the cause is unknown, Ganglions are thought to be a reaction to an injury that causes the tendon sheath covering the tendon, or the joint capsule protecting the joint, to form extra fluid and balloon out.

These cysts are usually addressed with conservative treatment.


Q: My doctor said I have "carpal instability." What is that exactly and is it serious?

A: Because of the large role the wrist plays in daily activities, it is often prone to stress and injury that results in pain and instability.

The proximal bones of the wrist - the scaphoid, lunate, and triquetrum - have no muscular attachment. With the help of many strong ligaments, their main purpose is to stabilize the wrist joint. Damage to any of these ligaments that bind the proximal bones together can result in a malalignment of the carpal bones creating "carpal instability," which, if left untreated, could cause abnormal wear and tear and eventually lead to osteoarthritis.

As long as the instability is identified and addressed, future degeneration can be prevented.
Forearm and Elbow

Q: I have suffered from golfer's elbow for some time and now notice some numbing in my hand. Could the two be related?

A: Golfer's elbow does not generally cause pain or numbing in the hand. The symptoms may spread to the forearm, but usually remain localized - on the inside of the elbow (medial epincondyle). It is possible, though, for the same repetitive stress placed on the elbow and resulting in Golfer's Elbow, to also be irritating other tendons and nerves in the area.

The ulna nerve travels behind the medial epicondyle and when compressed can cause tingling and numbing in the hand, as well as in the ring and little fingers. This condition is called cubital tunnel syndrome and could be the condition currently causing these new symptoms. A physical examination and patient profile will help confirm the diagnosis.


Q: I'm a pitcher and I've been having elbow problems. I'm afraid the diagnosis could hurt my baseball career. What is it likely to be?

A: Years ago, some elbow injuries commonly treated today would mean the end of an athlete's career. But an increased understanding of the cause, combined with advances in treatment, permits athletes to recover completely from elbow injury and regain the same strength and force as before.

Baseball pitchers are particularly vulnerable to elbow and shoulder injuries because of the tremendous force used to propel the ball. One of the most common elbow injuries is an ulnar collateral ligament (UCL) tear, because this ligament crosses the inside of the elbow and prevents the elbow from bending too far to the side. It is engaged in pitching to a much greater extent than in most any other sport.

This type of injury actually popularized a procedure know to physicians as an ulnar collateral ligament reconstruction and to athletes as Tommy John surgery, after a former major league pitcher suffering from a UCL tear was the first to undergo the procedure and successfully return to sports.
Upper Arm

Q: I tore my biceps tendon and was told that I would need to have surgery. I'd rather not and would like to know if it will just heal on its own?

A: Conservative nonsurgical treatment is usually successful in treating biceps tendon tears and involves cold compression to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program. But, results depend on the severity of the injury and the health and lifestyle of the patient. If the tendon was injured performing an activity or task that the patient will or must continue to do - such as those related to sports or work - surgical repair may be necessary.


Q: I was in an automobile accident and injured my leg. I was on crutches for a while and just got off of them. Now I have pain in my arm. Could this be from the crutches? What can I do to relieve it?

A: Sometimes one of the nerves that run down your arm and assists in muscle movement and sensation can become compressed under the arm. This is called Radial nerve dysfunction.

The Radial nerve aids the movement of the triceps muscle located at the back of the arm, as well as facilitates extension at the wrist and sensation in the wrist and hand. Radial nerve dysfunction is generally caused by a direct trauma, long-term pressure on the nerve, or compression resulting from nearby swelling or injury. It is most commonly associated with fractures of the humerus or upper arm bone, but may also result from unusual compression to the underarm, such as using crutches for an extended period of time.

Symptoms may include difficulty extending the arm at the elbow, as well as difficulty extending the wrist. There may also be some numbing, reduction in sensation, a burning feeling and pain. Depending on the severity of the condition, patients may experience a wrist drop or finger drop, as a result of a weakened muscle.

The first phase of treatment for radial nerve dysfunction in the triceps is conservative and includes refraining from the activity responsible for the condition, as well as those irritating the condition. A lightweight plastic removable arm splint may be indicated at night if pain worsens during sleep. When the condition is nonresponsive to conservative treatment and symptoms persist, an outpatient procedure that helps to decompress the nerve may be indicated.
Shoulder

Q: I was told that I have Rotator Cuff Disease. Can that spread to other parts of my body?

A: No. Rotator Cuff Disease describes the vulnerable environment created within the shoulder joint by a history of shoulder overuse or repetitive stress conditions - including rotator cuff tendonitis, subacromial bursitis, impingement syndrome, and general dysfunction involving partial or complete tearing of the rotator cuff tendons.

It is a disorder of the musculotendinous cuff surrounding the glenohumeral joint and is a continuum of pathology involving a range of rotator cuff conditions leading to degenerative shoulder stability. It is isolated to the shoulder and is not a disease that can spread to other parts of the body.