Health News
Health News
March 19, 2021
Upper Body Orthopedics

It is easy to take for granted the vital role our upper extremities – the upper arms, forearms and hands – play in our lives each and every day.  However, if something goes wrong with them, we will be sure to notice an impact on our day-to-day activities. 

The shoulders, elbows and wrists are versatile and amazing joints, giving us the ability to make essential motions like pushing, pulling, lifting and swinging.  In concert with our arms, our hands perform essential tasks from the time we wake up to when we retire for the evening – brushing teeth, tying shoes, cooking a meal, eating, driving and more.

Injuries to the upper extremities can occur in a few different ways.  A sudden trauma, such as a car wreck or slipping and falling, is one cause.  Athletes, both amateur and professional, can sustain an injury to an arm or hand, as well.  Perhaps a pick-up game of basketball or neighborhood football scrimmage gets a little too physical, or maybe you attempted to lift too much weight at the gym.  Many sports-related upper orthopedic issues develop gradually.  Activities that involve repetitive motions, such as golf and tennis, can lead to problems over a long period of time. 

Orthopedic issues are not always a result of traumatic injury or weekend warrior adventures, however.  Many people develop these injuries as a result of their profession – vocations that require repetitive movements may strain the joints over time.  Painters, window washers, grocery store stockers and others are at risk for these types of injuries.  Even working at a desk can be a risk to your health –typing at a computer all day, every day can increase risk for hand and wrist problems. 

Thankfully, there are medical specialists who are here to help when those situations arise: orthopedic surgeons and sports medicine physicians. 

The field of orthopedic medicine involves every part of the human musculoskeletal system.  That includes bones, ligaments, joints, tendons, muscles and nerves – all of the body parts that enable us to have mobility and the ability to perform a physical task.

Privia Medical Group North Texas includes physicians who specialize in many types of orthopedic conditions.  Whether it’s treating the elite athlete who sustained a career-threatening injury on the football field or the person who got hurt doing a mundane household chore, Privia’s orthopedic and sports medicine physicians are here to get you on the mend.    

Carpal Tunnel Syndrome

The carpal tunnel is literally a tunnel that runs through our wrist.  This tunnel is formed by the carpal bones on the bottom and sides, with the “roof” of the tunnel formed by the transverse carpal ligament, a very strong band of connective tissue.  Because of the composition of the tunnel, it is very rigid. 

The median nerve, which controls feeling in the thumb, middle, index and ring fingers, as well as the muscles near the base of the thumb, passes through the carpal tunnel from the forearm into the hand.  The carpal tunnel also serves as the passageway for the flexor tendons, the nine tendons that allow us to bend our fingers and thumb. 

“If the carpal tunnel narrows or the tissues surrounding the flexor tendons swell, pressure builds on the median nerve.  This in turn can create numbness, tingling, weakness and pain in the hand,” says Dr. Bryan Reyes, an orthopedic surgeon specializing in hand surgery. “This is what is known as carpal tunnel syndrome, one of the most common conditions a hand specialist sees.” 

While anyone can get carpal tunnel syndrome, people more at risk include:

  • Women
  • Older people
  • Those with family history of carpal tunnel syndrome
  • People who engage in repetitive hand and wrist motions
  • People who have certain health conditions, such as rheumatoid arthritis, diabetes and thyroid gland imbalance; these have all been associated with carpal tunnel syndrome.

Anyone experiencing numbness, tingling, weakness or pain in the hands should see a fellowship-trained orthopedic hand doctor for an examination.  “Sometimes, people ignore these early symptoms of carpal tunnel syndrome and wait too long to get a diagnosis and treatment,” says Dr. Stephen Troum, an orthopedic surgeon specializing in hand surgery. 

“Conversely, these symptoms may be caused by something else entirely.  It is not uncommon for people to be misdiagnosed as having carpal tunnel syndrome,” continues Dr. Troum.  “That’s why it’s vital that people visit a hand surgeon for a proper diagnosis and treatment plan.  The sooner we can see you and find out what’s going on, the better chance we will have of a successful treatment.”

The physician will conduct a physical examination of your hands, which will then likely be followed by an imaging exam, such as an x-ray, MRI or ultrasound. The doctor may also order an electrophysiological test, which can measure how effectively the nerves are carrying signals, as well as measure electrical activity in the muscles. 

If carpal tunnel syndrome is diagnosed at an early stage, non-surgical treatment may alleviate the symptoms.  Wearing a wrist brace or splint can relieve pressure on the median nerve by keeping the wrist straight, especially at night, when symptoms tend to be more noticeable.  Taking an over-the-counter anti-inflammatory medication such as ibuprofen or naproxen may reduce inflammation in the wrist.  Additionally, reducing repetitive physical activity that may have contributed to the onset of the carpal tunnel syndrome can help to reduce symptoms. 

Cortisone injections are also used as a non-surgical alternative to relieve pain. Injected directly into the carpal tunnel, cortisone helps reduce inflammation. These non-surgical treatments may prove effective at reducing pain and other symptoms for a while. 

If these treatments do not work or decrease in efficacy over time, your physician may recommend surgery if carpal tunnel syndrome is causing severe pain or limiting your mobility and lifestyle.  Minimally invasive carpal tunnel surgery is known as a “carpal tunnel release,” the goal of which is to relieve pressure on the median nerve by cutting the ligament that forms the roof of the tunnel.  This has the effect of widening the tunnel and reducing pressure on the nerve.  This procedure is accomplished through a small incision in the palm of the hand. 

This surgery is usually performed on an outpatient basis, under either local or general anesthesia.  Recovery from this surgery may take some time, as it can be a few months before complete grip and pinch strength return to the hand. 

Wrist arthritis

Arthritis, a disease affecting the joints, is one of the most common chronic conditions in the United States.  More than one out of five American adults have been diagnosed with arthritis by a physician.  The most common type of arthritis is osteoarthritis.  Especially prevalent in older people, osteoarthritis occurs when the cartilage in between joints wears down.  Cartilage is a hard and slippery tissue that enables our bones to glide over one another when we bend our joints, such as the fingers, wrists, elbows and shoulders.  Over time, the cartilage can deteriorate, causing bone to rub against bone and leading to pain, swelling and stiffness.  There is no cure for arthritis, but there are numerous treatments and therapies that can help relieve symptoms. 

The wrist is a complex joint, meaning it is actually comprised of several smaller joints.  When the cartilage wears down on one or more of these smaller joints, arthritis of the wrist develops.  If you are experiencing pain, swelling, stiffness or weakness in the wrist, your doctor will conduct a physical examination and may also order an x-ray to help diagnose the cause of the symptoms.

Modification of activity and use of anti-inflammatory drugs, exercise and steroid injections can all help to alleviate the symptoms of wrist arthritis.  If these treatments do not help reduce the effects of the arthritis, your physician may recommend surgery.  The goal of the surgery is reduce or eliminate the bone-on-bone contact that causes the pain.  This can be accomplished through one of these procedures:

  • Proximal row carpectomy: In this procedure, the three carpal bones closest to the forearm are removed, which will help to reduce pain while preserving some motion in the wrist.
  • Fusion: If the movement of the bones in the wrist is the source of the pain, your surgeon may fuse the bones together, essentially creating one bone. This can eliminate the pain but also immobilizes the wrist.  In some cases, a partial fusion is performed in order to preserve partial motion. 
  • Total wrist replacement: In this procedure, the surgeon removes the damaged cartilage and bone in the wrist and inserts an artificial joint; this procedure removes the source of the pain and provides for movement in the wrist. 

Trigger finger

Trigger finger is a condition in which a finger does not extend all the way out and “catches” before it pops out straight with the other fingers.  Trigger finger is caused when the flexor tendon that controls finger movement becomes irritated, causing the finger to get “stuck” before it pops out. 

The cause of trigger finger is unknown.  It is more common in women and most prevalent in people between the ages of 40-60. 

Trigger finger can be treated through non-surgical options, including anti-inflammatories and cortisone injections.  In cases where a finger is permanently stuck, your doctor may recommend surgery.  Surgery for trigger finger involves widening the opening of the tunnel that the tendon slides through so it can move more easily and not get stuck. 

Tennis Elbow

One of the most common elbow ailments is known as Tennis Elbow, a form of tendonitis that results from overuse of the elbow joint.  As the name suggests, sports such as tennis and racquetball can lead to the onset of tennis elbow, but there are also several non-sports activities and professions that have been associated with the injury.  In fact, the vast majority of Tennis Elbow cases are caused by everyday activities.  People whose jobs require them to make frequent and repeated use of the forearm, such as plumbers, cooks, painters and carpenters have all been known to get tennis elbow. 

Tennis elbow occurs when muscles in the forearm become weakened due to overuse, resulting in instability in the arm and small tears in the tendon that connects the forearm muscles.  A sharp pain, sometimes radiating into the forearm, a burning sensation in the elbow and inability to grip objects are possible symptoms.

Several non-surgical strategies can be used to treat tennis elbow with the goal of helping the tendon heal.  A common treatment involves the use of a strap on the forearm that helps to stabilize the muscle and relieve tension from the aggravated tendon.  Other possible therapies include anti-inflammatories, steroid injections and special stretching exercises.  If these treatments are not effective, surgery can be used to repair the tendon. 

Shoulder Injuries

Shoulder injuries often result from activities involving repetitive and frequent overhead motion: swimming, tennis, pitching and weightlifting all fall in this category.  However, just as with other common injuries, mundane tasks such as lifting boxes up into the attic, painting a ceiling or trimming hedges can cause strain and injury to the shoulder.

Sometimes, shoulder injuries can heal through rest, restricting movement of the shoulder and strengthening exercises.  Other times, an injury may necessitate injections or surgery.  “If your shoulder is stiff or you cannot rotate it the way you normally would, you should make an appointment to see an orthopedic surgeon,” says Dr. Jonathan Guevara, an orthopedic surgeon who specializes in shoulder and elbow conditions.  “Additionally, if your shoulder feels like it may pop out of its socket or seems unusually weak, those are also indications you should see a shoulder specialist.”

One of the most common types of shoulder injury is to the rotator cuff, a group of muscles and tendons that holds the bones of the shoulder together.  The rotator cuff is the part of the shoulder that enables us to lift our arms overhead.  Rotator cuff surgery can be done arthroscopically and involves repairing the torn tendon by suturing it to the humerus, as well as cleaning out any debris and removing bone spurs. 

“A rotator cuff injury can be caused by an event, such as falling off a ladder, or result from sustained wear and tear over a long period of time,” explains Dr. Andrew Lee, an orthopedic surgeon who specializes in shoulder and elbow surgery.  “Rotator cuff injuries tend to get worse over time, so it is best to see an orthopedic specialist at the first sign of shoulder pain.  In some cases, rotator cuff tears may be successfully treated without surgery if a diagnosis is made early enough.”

Protect Yourself from Injury

While the types of injuries described above may be common, they do not have to be inevitable.  There are a number of steps you can take to reduce your risk, particularly when exercising.  People tend to injure themselves when they rush into an exercise program or sport without proper planning and pacing. Taking proper precautions will significantly reduce risk of injury, including:

  • Proper form & technique: If you have never lifted weights before, you should work with a personal trainer to help you with proper technique.  Lifting a dumbbell the wrong way could hurt your shoulder or back.  Good form will help prevent injuries. 
  • Take it slow: Avoid over-exerting yourself, both in the length of time you work out and in the amount of effort you give.  Playing tennis too long can cause unhealthy strain on your elbow.  Lifting a weight that is too heavy can compromise your form, leading to injury.  Start with a lighter weight to ensure you can complete the movement safely while using the correct form.  Gradually increase the amount of time you exercise and the exertion level. 
  • Cross-train: Don’t focus on just one sport or activity. Mix up your routine by engaging in different types of activity, such as incorporating jogging with your weight-lifting routine.  This helps develop more muscles in the body and makes you stronger and fitter overall.
  • Recover: One of the most common causes of injury is that people do not allow for adequate recovery time.  Overuse of the same muscles without adequate rests leads to injury.  Rest is your friend!

Following these precautions can help reduce your chances of injury to your joints.  And if you do find yourself experiencing discomfort in the upper extremities, get in touch with one of the orthopedic specialists at Privia Medical Group North Texas – we are here to help!

The American Academy of Orthopaedic Surgeons

Overuse injury: How to prevent training injuries - Mayo Clinic

Carpal Tunnel with Dallas Hand Surgeon Dr. Stephen Troum - YouTube