HAND SURGERY

UPPER EXTREMITY PROBLEMS

The upper extremity is frequently injured at work, at play, and sometimes as simply the result of adding another year to your life. The common problems that are seen in the upper extremity include tennis elbow, carpal tunnel syndrome, tendinitis about the wrist, DuPuytren's contracture of the fingers, trigger finger, ganglion cysts, and various types of arthritis in the wrist, hand or fingers.

Carpal Tunnel Syndrome is probably the most common condition seen. Symptoms of CTS include numbness in the index and middle fingers, usually at night, but sometimes when at work, driving or writing. People with CTS frequently drop things and have difficulty picking up small objects, such as buttons or pins. The usual treatment for CTS includes splint immobilization, anti-inflammatories, cortisone injections, and discontinuance of repetitive activities. If these procedures fail, surgical division of the transverse volar carpal ligament is usually successful in symptomatic relief.

Tendinitis of the wrist is frequently seen in people who use word processors throughout the day. This is a reaction of the body to repetitive use and is frequently called overuse syndrome. Treatment of anti-inflammatories, steroid injections, and splinting is usually successful in relieving the complaints, particularly if you are able to modify the work conditions by adding a wrist rest for the keyboard, or perhaps varying the height of your work station or work chair. Rarely surgery is required.

Ganglion Cysts about the wrist are extremely common. They are sometimes the results of a single traumatic event, but more commonly, simply appear without any known cause. If these ganglion cysts are painful, cortisone injections are often effective in relieving the problem. For recurrent symptomatic ganglion cysts, surgical excision is sometimes required.

Trigger Fingers commonly affect the dominant hand and are also often associated with repetitive use. The cause for trigger fingers is usually swelling of the tendon, which causes blockage within the tendon sheath lining, resulting in inability to easily straighten the finger. When the finger does straighten, it snaps; hence, the term, trigger finger. Treatment involves anti-inflammatories, rest, cortisone injections, and occasionally surgical release.

Tennis Elbow is not restricted to tennis players but can develop in anyone who uses the arm for heavy activities. It can also be related to a sudden injury to the arm. The cause for tennis elbow (lateral epicondylitis) is thought to be partial tearing of the extensor muscles as they hook into the prominent bone on the outside of your elbow. Treatment is directed to that point and consists of immobilization, anti-inflammatories, cortisone injections, and rarely, surgical release.

DuPuytren's Contracture is an uncommon condition which causes the fourth and fifth fingers to draw down into the palm so you are unable to straighten the fingers completely. This condition tends to run in families and its only correction is surgical release.