HAND
Carpal Tunnel

Your hands, wrists and elbows are essential tools that allow you to work, play and perform everyday activities. In fact, how well the hand, wrist and elbow interact depends on the integrity and function of the related ligaments, tendons, muscles, joints and bones. Problems in any of these can affect upper extremity function, causing major disruptions at home and at work and negatively impacting quality of life.

The human hand itself is very complex and delicate in structure. Hand surgery requires a totally different surgical approach whether treating fractures, arthritis or deformities. Hand surgery traditionally includes treatment of the entire hand, wrist and forearm. Again, this whole region works as a single unit, and the dysfunction of a single part needs consideration of the whole. An additional year of training (fellowship) is required for those orthopaedic surgeons seeking certification in hand surgery.

Therapy may be necessary for any surgery involving the hand, wrist or elbow. The objective at OrthoWest is to provide exercise and activities designed to help return the patient to an active, productive lifestyle.

If you are among the millions of Americans experiencing hand and upper extremity problems each year, finding expert care is all-important. Whether your condition is due to arthritis, a sports injury, an accident, a work-related injury or a congenital disorder, you can feel confident in choosing the OrthoWest Hand, Wrist and Elbow Center for your care.

Frequently Treated Problems

• Arthritis
• Sprains and Strains
• Carpal Tunnel Syndrome
• Work-Related or Recreational Injuries
• Circulation Problems
• Replantation of Amputated Parts
• Cysts
• Sports Injuries
• Fractures
• Joint Replacements
• Hand or Arm Pain
• Congenital Hand Conditions
• Lacerations
• Tendon and Ligament Injuries
• Upper Extremity Nerve Problems
• Numbness and Tingling
• Tennis Elbow
• Golf Elbow
• Tendon Repair
• Ligament Repair/Reconstruction
• Epicondylitis
• Nerve Injuries
• Elbow Fracture
• Basal Joint Arthritis

What is Basal Joint Arthritis?

Arthritis is a disease that causes inflammation and stiffness in the joints. It often affects the joint at the base of the thumb, called the basal joint. Basal joint arthritis is most common in women over 40, but anyone can get it. Often it happens in both thumbs.

Causes
Basal joint arthritis occurs as a result of wear and tear on the joint. It is more likely to occur, at a younger age if you have fractured or injured your thumb. Repeatedly gripping, twisting, or turning objects with the thumb and fingers may make the arthritis worse.

Symptoms
The most common symptom is pain in the lower part of the thumb. You may feel pain when you lift something with the thumb and fingers, unscrew a jar lid, or turn a door handle or a key. You may find yourself dropping things. Weather may also make the thumb hurt. The joint may swell, and with time, the thumb may become stiff or deformed.

Treating Basal Joint Arthritis in the Thumb
Your doctor can usually diagnose basal joint arthritis from the way your thumb looks and moves. He or she may also order X-rays to see how much of the joint is destroyed. Your treatment will depend on how severe the pain is and how worn the joint it.

Nonsurgical Treatment
If arthritis is diagnosed early, it often responds to treatment without surgery. Your doctor may put a splint on your thumb for 3-6 weeks. This limits movement and helps reduce the inflammation. You may also be given oral anti-inflammatory medication, such as aspirin. If your symptoms don⿿t improve, your doctor may give you injections of an anti-inflammatory, such as cortisone.

Surgical Treatment
If nonsurgical treatment doesn⿿t relieve the pain and stiffness, or if arthritis has destroyed the joint, your doctor may recommend surgery. The diseased joint is removed. Then the joint is rebuilt, usually with a piece of tendon (graft) taken from your arm or wrist. Your arm, or sometimes your entire body, is anesthetized so you don⿿t feel anything during surgery. You can probably go home the day of surgery.

Your Recovery
First your hand will be wrapped in a dressing. Then you⿿ll have a cast or a splint on your thumb for 3-6 weeks. This keeps the thumb stable while it heals. Once you can move your thumb, your doctor will give you exercises or refer you to a physical therapist to help strengthen the muscles and make the joint more flexible. Regaining use of your thumb will take time.

Inside Your Thumb
The basal joint is formed by one of the wrist bones and the first of the three bones in the thumb. This joint allows the thumb to move and to pinch with the fingers. When arthritis occurs in the basal joint, it slowly destroys the joint.

Arthritis Destroys the Joint
The ends of the bones are covered with cartilage. This covering acts like a cushion, allowing the bones to move smoothly. Arthritis destroys the cartilage. Then the bones rub against each other when you move your thumb. This causes the joint to become inflamed and painful. With time, the small bone at the base of the thumb may collapse. Then you can no longer straighten your thumb.

Using Your Thumb Again
Once the joint heals, you should have little or no pain ⿿ as long as you don⿿t overuse your thumb. Be sure to do any exercises your doctor or physical therapist gives you to strengthen the joint. The thumb may never be quite as good as new, but you should be able to return to many of your normal activities.

⿢De Quervain⿿s Tenosynovitis

De Quervain⿿s Tenosynovitis (ten-oh-sin-oh-VY-tis) is an inflammation of tissue on the thumb side of the wrist. Tendons (cordlike fibers that attach muscle to bone) and synovium (a slick membrane that allows the tendons to move easily) become irritated, causing pain.

Causes
Making the same motions over and over, such as repeatedly unscrewing jar lids, grasping a tool, or picking up a child under the arms, can irritate the tendons. So can an injury to the thumb side of the wrist.

Symptoms
The most common symptom is pain on the thumb side of the wrist. You may feel pain when you pinch or grasp things, turn or twist your wrist, or make a fist. The thumb may also ⿿catch⿿ when you bend it. The thumb side of the wrist may be tender to the touch, and you may feel a small ⿿knot⿿.

Diagnosing and Treating De Quervain⿿s
Your doctor can usually tell by moving your thumb whether the tendons are inflamed. Treatment will depend on how severe the pain is.

Evaluating Your Thumb
To diagnose De Quervain⿿s, your doctor may ask you to make a fist with your fingers over your thumb. He or she will then gently bend your wrist toward your little finger. A sharp pain in the wrist is a sign that the tendons are inflamed.

Pain when you make a fist and bend your wrist toward your little finger is a sign of inflamed tendons.

Nonsurgical Treatment
Just taking a break from the activities that caused your pain may be enough. Your doctor may also have you take oral anti-inflammatory medication, such as aspirin, or wear a splint for a few weeks to rest the thumb and wrist. To reduce the swelling, your doctor may inject an anti-inflammatory, such as cortisone, around the tendons. You may have more pain at first, but in a few days, your thumb should feel better.

Surgery
If other kinds of treatment don⿿t relieve your pain, or if the pain is severe, your doctor may recommend surgery. The sheath that surrounds the tendons is released so the tendons can move more easily. This helps reduce the inflammation and allows you to straighten your thumb without pain. Usually, surgery takes a few minutes and is done with local anesthetic, so you can go home the same day. You will probably have a splint or dressing on your wrist for a few days while the tissue heals. Your doctor will discuss the risks and possible complications of surgery with you.

Inside Your Thumb
Tendons connect muscles in your wrist and forearm to the bones in your thumb. The tendons are surrounded by a protective tendon sheath. This sheath is lined with synovium, which produces a fluid that allows the tendons to slide easily when you straighten your thumb. If the tendons are irritated or injured, they become inflamed.

When the Tendons Are Inflamed
When the tendons are inflamed, they cause the lining of the tendon sheath to swell and thicken or the tendon sheath itself may thicken. Then the sheath pinches the tendons. They can no longer slide easily inside the sheath, and straightening your thumb and wrist may become painful.

Using Your Thumb Again
The goal of your treatment is to relieve your pain and allow you to use your thumb again. Once the tendons have healed, your doctor may give you exercises, or refer you to a therapist to help you regain strength and movement in your thumb. Following your doctor⿿s directions will help you get back to your normal activities.

⿢Dupuytren⿿s Contracture

What is Dupuytren⿿s Contracture?
Dupuytren⿿s Contracture is a disease that can lead to limited use of your hand. This may happen when certain tissue in the palm thickens. While it often doesn⿿t cause pain, it can make it hard to straighten your fingers.

Who Gets It?
People whose families come from northern European countries are the most likely to get Dupuytren⿿s Contracture. Symptoms most often appear in 50- to 60-year-old-men. But some women also may have this problem.

Dupuytren⿿s Contracture can make simple tasks like shaking hands awkward.

What Are the Signs and Symptoms?
Dupuytren⿿s Contracture signs and symptoms start slowly. They can steadily progress, but they also may stop before they limit hand use. Signs and symptoms include:
⿢ A hard lump forming on your palm;
⿢ Inability to place your palm flat on a surface;
⿢ Scarlike bands forming across your palm;
⿢ Fingers bent toward your palm; and
⿢ Hand pain (less common).

Treating Dupuytren⿿s Contracture
The only way to treat Dupuytren⿿s Contracture is with surgery. It⿿s not a cure. Symptoms can recur in a few years but surgery helps many patients regain a better range of finger motion. Your doctor may suggest surgery if use of your hand is sharply limited. Talk with your doctor to find out if surgery is a good choice for you.

Your Surgery Experience
Surgery removes some of the palmar fascia. This can take a few hours. You may be awake but drowsy during surgery. Or, you may have general anesthesia (where you ⿿sleep⿿). Your doctor may use a zigzag-shaped incision to reach the fascia. A zigzag allows better healing and finger motion. When surgery is complete, part of your incision may be left open to help drainage. As you heal, it will close on its own. A thick bandage or cast will be placed over your hand and forearm. You most likely will go home the same day of surgery.

After Surgery
In the first few days, keep your hand elevated to reduce swelling, and take any pain pills your doctor may have prescribed. If you⿿re asked to use ice, follow your doctor⿿s advise. In about a week, your stitches will be removed. You then may need to wear a splint. Soon, you⿿ll start hand therapy and exercises that can help you heal.

Risks and Complications
Your doctor will give you details about the possible risks and complications of surgery. These may include:
⿢ Stiff fingers;
⿢ Thick scarring on palm;
⿢ Numbness in hand;
⿢ Swelling around finger joints;
⿢ Impaired blood flow to hand; and
⿢ Long-term pain in hand (rare).

Inside Your Hand
Your palm contains a tough, fibrous layer of tissue called the palmar fascia. It forms a protective barrier between your skin and tendons (tissue that connects muscle to bone). The fascia gives your palm a flexible firmness.

When the Fascia Thickens
For reasons not fully known, the palmar fascia can thicken. When this happens, it contracts (pulls in). Small, hard knots called nodules may form just under the skin near the base of the fingers. Hard bands also may form across the palm. Nodules, bands, and the contracting palmar fascia can make your fingers (especially the ring and little fingers) bend toward your palm.

As You Heal
By doing your exercises and wearing a splint if needed, you can speed up recovery. It may take a few weeks before you have use of your hand, but with time, you will regain most of your hand function.

⿢Flexor Tendon Lacerations

When a Flexor Tendon Is Cut
Tendons are cordlike fibers that connect muscle to bone. The flexor tendons attach muscles in the forearm to bones on the palm side of the fingers. These tendons allow you to bend your fingers. If a flexor tendon is cut all the way through (lacerated), the finger can no longer bend on its own. If nearby nerves are also injured, the finger may be numb.

Causes
A flexor tendon injury is most often caused by a deep cut on the palm side of the wrist, hand or fingers. A deep knife wound or a gash from broken glass or another sharp object can cut a flexor tendon. A deep cut can also occur while using machinery or power tools. Sometimes a flexor tendon can snap when a finger is yanked or jerked, such as during a football game.

Treating Flexor Tendon Lacerations
Your doctor can tell if your flexor tendon is cut by examining your finger. If the wound is very deep, the finger may be X-rayed to make sure the bone isn⿿t damaged, too. If the flexor tendon is cut all the way through, your doctor will do surgery to rejoin the two ends of the tendon and repair any other damaged tissue. After surgery, you⿿ll need to follow a specific exercise program to regain movement in the finger.

Your Surgery
Your surgeon first exposes the cut tendon with a zigzag-shaped incision. Then he or she finds the two separated ends and stitches them back together. In some cases, your surgeon may need to graft a new tendon to replace the cut one. Nerves and other soft tissue may also need to be repaired. Surgery generally takes 2-3 hours. Your entire body may be anesthetized, or only the hand and arm may be numbed. In either case, you feel no pain during surgery and can usually go home the same day.

Starting Your Recovery
Your hand may be in a splint or cast for several weeks after surgery. This protects the tendon as it heals. You will probably start a gentle exercise program soon after surgery. Exercising your finger as directed by your doctor or therapist is very important. Surgery creates scar tissue inside the finger. Without regular exercise, this tissue will stick to the tendon and the bone, then you won⿿t be able to bend your finger easily. As the tendon heals, you⿿ll slowly begin to strengthen the tendon and muscles and move your finger more. Recovery usually takes 6-12 weeks.

Inside Your Hand
Your hand is made up of bones, joints, and ⿿soft tissue⿿ such as nerves, muscles, and tendons. Each finger has three joints and two flexor tendons, which allow the finger to bend. One flexor tendon attaches to the middle bone of the finger. The other attaches to the bone at the tip of the finger.

When a Flexor Tendon Is Cut
Tendons are naturally taut. When a flexor tendon is cut, the two ends pull away from each other much like the two ends of a rubber band when it breaks. If you finger is bent when the tendon is cut, the ends pull even farther away when you straighten the finger. With the tendon cut, the muscles are no longer attached to the bones, and you can⿿t bend your finger.

Your Role in Healing
You play a major role in helping your finger to bend again after surgery. You will need to do special exercises several times a day for 4-6 months. Our doctor will oversee your exercise program or refer you to a trained therapist. Be sure to do only the exercises recommended by your doctor or therapist. Following this program is the key to regaining use of your finger.

⿢Ganglion Cysts

What is a Ganglion Cyst?
A ganglion (GANG-lee-on) cyst is a firm, fluid-filled lump that can suddenly appear on the front or back of the wrist or at the base of a finger. These cysts grow from normal tissue in the wrist and fingers and range in size from a pea to a peach pit. Although ganglion cysts are common, they don⿿t spread, and they don⿿t become cancerous. They can occur after an injury, but many times it isn⿿t known why they grow. Ganglion cysts can change in size and may go away on their own.

Symptoms
A ganglion cyst is sometimes painful, especially when it first occurs. Constantly using your hand or wrist can make the cyst enlarge and hurt more. Some hand and wrist movements, such as grasping things, may also be difficult.

How a Ganglion Cyst Develops
Your wrist and hand are made up of many small bones that meet at joints. Tendons attach muscles to the bones at the joints. The tendons allow the joints to bend and straighten. Both tendons and joints are lined with tissue called synovium. This tissue produces a thick fluid that keeps the joints and tendons moving easily. Sometimes the tissue balloons out from the joint or tendons and forms a cyst. As the cyst fills with fluid and grows, it appears as a lump you can feel.

Where Ganglion Cysts Occur
A ganglion cyst can occur anywhere on the hand near a joint. Cysts most commonly appear on the back or palm side of the wrist or on the palm at the base of a finger. Your doctor can usually diagnose a cyst by examining the lump. He or she may draw off a little fluid or order an X-ray to rule out other problems.

Treating a Ganglion Cyst
Your doctor may just keep an eye on your ganglion cyst. Many shrink and become painless without treatment, while some disappear altogether. If the cyst is unsightly or painful, or makes it hard for you to use your hand, your doctor can treat it or, if needed, remove it surgically.

Nonsurgical Treatment
To shrink the cyst, your doctor may massage the fluid back into the surrounding tissue or remove (aspirate) the fluid with a needle. If the cyst hurts, your doctor may also give you an injection of an anti-inflammatory, such as cortisone, to relieve the irritation. Your hand may then be wrapped to help keep the cyst from recurring.

Surgery
If the cyst reappears after treatment, your doctor may remove it surgically. A section of the tissue that lines the joint or tendon is removed along with the cyst. This helps prevent another cyst from forming. Usually, only your hand or arm is numbed, and you can go home a few hours after surgery. Your hand may be in a splint for several days.

Common but Harmless
Ganglion cysts are quite common. Many people get them at some time in their lives. These cysts are not dangerous and often go away on their own. Ganglion cysts are never cancerous and don⿿t lead to other problems in the hand. Rarely do they keep you from doing the things you enjoy, such as playing sports or a musical instrument.

Tennis Elbow

What Is Tennis Elbow?
Tennis elbow is an inflammation around the bony knob on the outer side of the elbow. It occurs when the tissue that attaches muscle to the bone becomes irritated. The bony knob is called the lateral epicondyle, and tennis elbow is also called lateral epicondylitis (ep-ih-kon-dah-LY-tis).

Causes
Playing a racket sport can cause tennis elbow. So can doing anything that involves extending your wrist or rotating your forearm ⿿ such as twisting a screwdriver or lifting heavy objects with your palm down. With age, the tissue may become inflamed more easily.

Symptoms
The most common symptom of tennis elbow is pain on the outer side of the elbow and down the forearm. You may have pain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch, and it may hurt to grip things, turn your hand, or swing your arm.

Understanding Your Elbow Problem
The muscles that allow you to straighten your fingers and rotate your lower arm and wrist are called the extensor muscles. These muscles extend from the outer side of your elbow to your wrist and fingers. A cordlike fiber called a tendon attaches the extensor muscles to the elbow. Overuse or an accident can cause tissue in the tendon to become inflamed or injured.

When the Tendon Is Inflamed
When the tendon is inflamed, the nerves around the tendon become irritated. Then moving your elbow is painful. Turning your hand or grasping objects can also be painful.

Diagnosing Tennis Elbow
Your doctor can usually diagnose tennis elbow from your symptoms and from the look and feel of your elbow. He or she may order an X-ray to be sure the bone is not diseased or fractured. In some cases, other tests may be needed.

Treating Tennis Elbow
Your treatment will depend on how inflamed your tendon is. The goal is to relieve your symptoms and help you regain full use of your elbow.

Rest and Medication
Wearing a tennis elbow splint allows the inflamed tendon to rest, so it can heal. Using your other hand or changing your grip also helps take stress off the tendon. Also, oral anti-inflammatory medications and heat or ice can relieve pain and reduce swelling.

Exercises and Therapy
Your doctor may give you an exercise program, or refer you to a therapist, to gently stretch and then strengthen the muscles around your elbow.

Anti-Inflammatory Injections
Your doctor may give you injections of an anti-inflammatory, such as cortisone, to help reduce the swelling. You may have more pain at first, but in a few days your elbow should feel better.

Surgery
If your symptoms persist for an extended amount of time, or other treatments don⿿t provide relief, your doctor may recommend surgery to repair the inflamed tendon.

Preventing a Flare-Up
To prevent a flare-up after treatment, you may need to change the way you do some things. Gripping with the palm up, lifting heavy objects with both hands, or varying activities throughout the day will help reduce stress on the tendon. When you play racket sports or golf, be sure to condition your muscles, do warm-up and cool-down exercises, and use the correct strokes.

⿢Trigger Finger

What Is 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.

Symptoms
The first sign of trigger finger may be pain where the finger or thumb joins the palm. You may also notice some swelling. As the tendon becomes more inflamed, the finger may start to catch when you try to straighten it. When the locked tendon releases, the finger jumps, as if you were releasing the trigger of a gun. This further irritates the tendon and may set up a cycle of catching and swelling.

Diagnosing and Treating Trigger Finger
Your doctor can usually tell from examining your finger or thumb whether a tendon is inflamed. Your treatment will depend on how severe your condition is.

Evaluating Your Finger
Your doctor will ask you to make a fist and then straighten your fingers. The affected finger or thumb may stay curled and then suddenly pop to a straight position, or you may have to straighten it with your other hand. Your doctor may also feel for tenderness and swelling at the base of the finger or thumb.

Nonsurgical Treatment
If your symptoms are mild, your doctor may have you rest the finger or thumb and take oral anti-inflammatory medication, such as aspirin. If this does not reduce the swelling, your doctor may give you injections of an anti-inflammatory, such as cortisone, in the base of the finger or thumb.

Surgery
If other treatments don⿿t relieve your symptoms, your doctor may recommend surgery. The sheath that surrounds the tendon is opened to enlarge the space and release the swollen tendon. This allows the finger to bend and straighten normally again. Surgery takes about 20 minutes and can often be done under a local anesthetic. You can usually go home the same day. Your hand will be wrapped in a soft bandage, and you may wear a plaster splint for a short time to keep the finger stable and more comfortable. The stitches will be removed in about two weeks. Your doctor will discuss the risks and possible complications of surgery with you.

Inside Your Finger
Tendons connect muscles in your forearm to the bones in your fingers. The tendons in each finger are surrounded by a protective tendon sheath. This sheath is lined with synovium, which produces a fluid that allows the tendons to slide easily when you bend and straighten the finger. If a tendon is irritated, it becomes inflamed.

When a Tendon Is Inflamed
When a tendon is inflamed, it causes the lining of the tendon sheath to swell and thicken, or the tendon itself may thicken. Then the sheath pinches the tendon, and the tendon can no longer slide easily inside the sheath. When you straighten your finger, the tendon sticks or ⿿locks⿿ as it tries to squeeze back through the sheath.

Using Your Finger Again
The goal of your treatment is to relieve your pain and allow you to straighten your finger or thumb again without it sticking. Once the tendon is no longer inflamed, your doctor may give you exercises to help you regain movement in the finger. You may also need to vary the way you hold or lift things. Following these directions will help you get back to your normal activities.