It is pertinent for you to have healthy hands and elbows—both serve a wide variety of functions and are necessary for achieving our most basic needs and performing our most complex movements. Any hand injury has the potential to significantly affect your quality of life. From repairing traumatic injuries to treating repetitive motion injuries, arthritis, and congenital conditions, MedStar St. Mary's Hospital orthopedic specialists have the training and the experience necessary to restore your hand and wrist function and minimize your pain.
Hand and Elbow Conditions
Whether your condition is simple or complex, the expert orthopedic hand and elbow specialists at MedStar St. Mary's Hospital offers you effective and advanced options for diagnosis, treatment, and rehabilitation. Our goal is to help you return to your regular activities healthy and pain-free.
Hand conditions we treat include:
- Hand Nerve Entrapment; Carpal Tunnel Syndrome, Cubital Tunnel Syndrome
- Dupuytren's Contracture
- DeQuervain’s Disease
- Finger Conditions
- Hand Cysts and Tumors
- Thumb Arthritis
- Fractures and Dislocations
- Reflex Sympathetic Dystrophy
- Tendon Conditions
- Ulnar Nerve Compression
Hand Nerve Entrapment
When the protective covering surrounding the nerves in your hand, arm, or elbow tightens, and squeezes the nerve itself, a condition called hand nerve entrapment can result.
Carpal Tunnel Syndrome
The carpal tunnel is a space in the wrist where a nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome is a type of hand nerve entrapment that occurs when swelling in the tunnel compresses the median nerve. As a result of the pressure on the median nerve, patients with carpal tunnel syndrome may experience symptoms including:
- Pain in the hand and fingers, including burning, tingling, and numbness
- Pain in the wrist or hand, extending to the elbow
- Sensation that the hand is swollen, even if it is not
- Weakened grip and difficulty picking up small items
- Problems with fine finger movements in one or both hands
- Numbness in hands
This condition is common in people who perform repetitive wrist and hand motions, such as typing on a computer keyboard. It also affects those who grip tightly or uses their wrists consistently, such as cashiers, cyclists, meat cutters, and musicians.
Many nonsurgical courses of treatment for carpal tunnel syndrome are available, such as
- Splints or braces to immobilize and rest the wrist
- Adjustments to how you perform daily activities
- Oral anti-inflammatory medications
- Steroid injections
If nonsurgical treatment is not successful or treatment is sought too late, surgery may be required. This surgery involves enlarging the carpal tunnel, which will relieve the swelling and pressure on the nerve.
Cubital Tunnel Syndrome
The cubital tunnel is a narrow tube of tissue at your elbow that contains the ulnar nerve. The ulnar nerve runs from your shoulder down to your wrist and controls movement in your ring and pinky fingers. Cubital Tunnel Syndrome is a type of hand nerve entrapment that forms when this tunnel swells, putting pressure on the ulnar nerve, causing pain and numbness in the hand and fingers.
Cubital tunnel syndrome can cause the following symptoms:
- Tingling in the ring and pinky fingers, making it more difficult to use them
- Numbness in the ring and pinky fingers
- Weakness in the hands
The cubital tunnel is more likely to swell if
- You sleep or lean on your elbow for too long
- You bend the elbow back and forth repeatedly
- Fluid builds up in the elbow
- You hit or fall on the elbow with force
Other conditions that can contribute to the development of cubital tunnel syndrome include elbow arthritis, fractures, cysts, and bone spurs.
Treatment for cubital tunnel syndrome depends on how severely your nerve is compressed and whether you are beginning to develop muscle weakness. Nonsurgical treatment options may include
- Injections of steroids or anti-inflammatory medications
- Physical therapy
If nonsurgical treatment does not relieve your symptoms, or your muscles are weakening too much, you may need surgery. Surgical options can relieve symptoms by:
- Widening the cubital tunnel to release the pressure on your nerve
- Moving the nerve so it is more protected from injury
Dupuytren's contracture is an abnormal thickening of the tissue between the skin and the tendons in the palm, which may limit the use of one or more fingers or may eventually cause the fingers to be pulled in toward the palm in a bent position.
The first sign of the condition is usually a small lump or nodule in the palm, often occurring in the crease of the hand that is closest to the base of the ring and little fingers. Further indication is that at a certain point, the palm cannot be placed flush with a flat surface such as a table. As the disease progresses, the involved finger is drawn toward the palm by the band of fibrous tissue that forms there.
Dupuytren's contracture is a hereditary condition and the cause is not known. It is more common in men over the age of 50. The disease appears later in women.
Treatment is most effective when sought at the nodule (small lump) stage. Collagenase injections are available as a nonsurgical option. Surgery will only temporarily restore use to the fingers. With time, the condition will return. Your doctor will discuss with you your individual case and whether surgery is a viable option for you.
DeQuervain's disease is an irritation and swelling of the sheath or tunnel that surrounds the thumb tendons as they pass from the wrist to the thumb. The source of DeQuervain's disease is often unknown, but it may be caused by overuse and repetitive motions and has been associated with pregnancy and certain inflammatory conditions such as rheumatoid arthritis. Although anyone can get DeQuervain's, it affects women considerably more often than men.
Symptoms may include
- Twinges of pain at the base of the thumb or the thumb side of the wrist.
- Pain that appears gradually or suddenly, and it is felt in the wrist and can travel up the forearm.
- Pain that is usually worse with use of the hand and thumb, especially when forcefully grasping things or lifting items such as a gallon of milk.
In almost all cases, nonsurgical treatments are explored first. Splints, oral anti-inflammatory medications or injections may help reduce the irritation and swelling. Temporary avoidance of activities that cause pain may also ward off symptoms.
For those cases that do not respond to nonsurgical treatments, surgery may be recommended. The procedure enlarges the tendon compartment to make more room for the irritated tendon. Normal use of the hand can be resumed once comfort and strength return.
Mallet finger is a rupture of the tendon at the tip of the finger, which causes the tip of the finger to drop or bend downward, creating a mallet shape. It is usually not painful unless a piece of bone is broken as well. Mallet finger can be caused by a direct blow to the finger and commonly affects athletes.
Nail bed injuries often occur when fingers are crushed, causing the bone beneath the nail to fracture, a cut to the nail bed itself, or, simply, a tremendous bruise. These injuries tend to cause hematomas, blood pooled under the nail that appears black or blue. The pressure of the blood can be very painful and, in some cases, permanent deformity can result. The pain can be reduced by having the blood drained by a physician.
Skier's and goalkeeper's thumb, the most common of all ligament tears, is a tear of the ligament at the base of the thumb where it meets the palm. Skier's/goal keeper's thumb is usually caused by falling on an outstretched hand and thumb. Nonsurgical treatment involves splinting and casting, but surgery may be required to repair the tear.
Trigger finger is the common name for a condition that leads to swelling in the tendons that control finger bending. Such swelling prevents the tendons from gliding smoothly, which causes pain, popping, or a catching feeling. Whenever possible, nonsurgical treatment are attempted first. Splints, oral anti-inflammatory medications, steroid injections, and adjustments in daily activities may be successful in reducing the swelling around the tendon. If the finger does not respond to nonsurgical treatments, surgery may be recommended.
Hand Cysts and Tumors
A tumor is any kind of unusual group of cells that grow in your body. We often associate tumors with cancer, but most hand tumors are not cancerous.
A ganglion cyst is the most common hand tumor and generally grows either on the top or inner side of your wrist. These fluid-filled pouches can put pressure on your nerves, causing pain.
- The earliest indicator you will see is the lump (ganglion cyst) itself. The lumps are typically very painful but they can sometimes be painless.
- Pain and tenderness will increase with extended use of the hand, and range of motion may be restricted.
- Ganglions often change in size and may disappear spontaneously and completely.
A giant cell tumor of tendon sheath is another common hand tumor, but it is solid, rather than filled with fluid. It grows on the protective covering that surrounds the tendons in the fingers.
Physicians generally seek to heal ganglion cysts without surgery. In some cases, ganglion cysts disappear on their own without any treatment. For cysts that do not resolve themselves, treatment options include:
- Brace or splint: Wearing a brace or splint keeps the affected wrist from moving. Resting the wrist keeps the cyst from growing, and helps to relieve pain.
- Aspiration: Your physician may drain the fluid within the cyst, helping it to heal and disappear.
- Surgery: Surgery is recommended for giant cell tumors of tendon sheath and ganglion cysts that return even after aspiration. Minimally invasive hand surgery is employed to remove the cyst or tumor, as well as any affected surrounding joint tissue.
Arthritis is an inflammation of the tissues that line your joints. This inflammation can cause pain, swelling, and joint damage. Learn more.
Hand and Wrist Arthritis
Types of arthritis that most often affect your hand and wrist include:
- Osteoarthritis: The natural aging process can wear away at the protective cartilage that allows the many bones in your hand, wrist, and elbow to move smoothly, causing inflammation, swelling, and pain.
- Rheumatoid arthritis: This immune system dysfunction attacks and wears away at the cartilage lining between the small delicate bones in your hand and wrist. Rheumatoid arthritis generally affects the joints on both hands.
Hand arthritis symptoms can include:
- Pain or burning in the hand joints, especially in the morning and with heavy use
- Warmth due to inflammation
- Nearby joints become unusually flexible to compensate for the affected joint
- Feeling or hearing grinding of the joint inside the hand
- Appearance of cysts on the fingers
Arthritis of the wrist generally causes symptoms including:
- Lack of strength
- Difficulty moving the wrist
Along with the symptoms above, rheumatoid arthritis can also cause:
- A weak grip
- Difficulty using the hand
- Pain in the knuckles
- Weight loss
The surgeons at MedStar Health have the expertise to help you overcome any challenge your arthritis presents. We treat the entire spectrum of arthritis disorders—from early-stage management to end-stage joint replacement—and offer advanced arthritis treatment options, including the latest arthroscopic and minimally invasive surgical techniques. We will work with you to develop a treatment plan tailored to your individual needs and the demands of your daily life.
Thumb arthritis, also called basal joint arthritis, is a type of osteoarthritis caused when cartilage wears away in the joint at the base of the thumb.
People who work with their hands and perform repetitive gripping movements are more likely to develop the condition. Massage therapists, hairdressers, or others who work with tools or instruments have the greatest risk of developing the disease. Basal joint fractures or ligament injuries can also increase the likelihood of developing thumb arthritis.
Left untreated, thumb arthritis can cause severe pain and make it difficult to perform even simple tasks. The best way to minimize the damage of thumb arthritis and treat it successfully is to see your doctor when symptoms begin. The sooner you begin treatment, the more options you’ll have to manage the condition.
Symptoms often include
- Pain felt at the base of your thumb when you grip or pinch something.
- Pain when you apply pressure to the heel of your hand.
- Stiffness in the morning that gets better during the day, but begins to ache in the evening.
- Swelling and tenderness at the base of the thumb.
- Aching in the joint after prolonged use.
- A limited range of motion in the thumb, or loss of strength while gripping or pinching items
- A bump on the joint or an enlarged, out-of-joint appearance
In the early stages of thumb arthritis, a number of treatments can alleviate symptoms, including:
- Oral or topical medications, such as acetaminophen, ibuprofen, prescription pain relievers, or pain-relieving gels
- Icing the area for five to 15 minutes as needed throughout the day to relieve pain and swelling
- Working with a hand therapist to strengthen supporting muscles and tendons and learning adaptive techniques to lessen the strain on the joint
- Wearing a supportive splint or brace to limit thumb movement and allow the joint to heal
In many cases, your doctor will suggest a combination of treatments to control symptoms. When medications, self-care, and physical therapy aren’t successful, steroid injections can relieve pain and swelling for several months. Because steroid injections can’t be used indefinitely, they only offer a temporary solution.
When nonsurgical treatments are no longer effective, surgery can offer relief. Most often, surgeons use the ligament reconstruction and tendon interposition (LRTI) technique, which can restore thumb movement and eliminate pain. During this outpatient procedure, surgeons remove the arthritic joint and replace it with a graft from one of your tendons to stabilize the thumb. Because tendons are used, rather than a metal or plastic implant that can wear out, the surgery can provide a long-term solution.
Generally, fractured hands, fingers, and wrists will heal without surgery and nonsurgical treatment often includes splints or casts and physical therapy.
If your injury caused your bones to shift out of place or break through the skin, you may need surgery to restore the proper alignment. During surgery, your orthopaedic surgeon may use wires, screws, or plates to secure your bones back to the correct position.
MedStar also offers advanced surgical options, including:
- Advanced wrist arthroscopy
- Complex fracture repair of the hand and wrist
Reflex Sympathetic Dystrophy
Reflex sympathetic dystrophy (RSD) is a condition of chronic, burning pain; stiffness; swelling; sweating; and discoloration of the hand or arm that may become disabling. It occurs from over-activity in the sympathetic (unconscious) nervous system that controls the blood flow, sweat glands, and other involuntary bodily functions. Additionally, a patient with RSD who sustains an injury usually feels a greater amount of pain than a person without RSD who has sustained the same injury.
RSD has three stages:
- Acute: May last up to three months. Symptoms include pain and swelling, increased warmth and redness in the affected part/limb, and excessive sweating.
- Dystrophic: Can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. Pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.
- Atrophic: Lasts one year or more. The skin of the affected area is now pale, dry, tightly stretched and shiny. The area is stiff, pain may decrease, and the chance of getting motion back is decreased.
In some cases, the cause of RSD is unknown. RSD may follow a sprain, fracture, injury to nerves or blood vessels, or the symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack.
The pain of RSD may be severe, resulting in physical and psychological alterations. A coordinated multidisciplinary approach to treatment is best, which may include medication (oral and injections), physical or occupational therapy, and/or surgery.
The tissues that attach your bones to your muscles are called tendons. When your muscles flex, tendons spring into action, helping to move your bones. It is easy to injure the tendons in the arms and hands, since we use them so often.
Tendinitis is an inflammation of a tendon that causes pain near a joint. It generally develops when an accident or injury cuts or damages the tendon.
- Tennis elbow is the common term for one of the most common types of tendinitis. It is an overuse injury that causes an inflammation of the tendon fibers that attach the forearm muscles to the outside of the elbow. As the name suggests, tennis players, as well as golf players and other athletes, often suffer from this type of tendinitis. But it can also affect you if you twist your wrist repeatedly on a regular basis, or if you type on a computer keyboard without proper support.
Although tendinitis can be painful, the good news is that it rarely becomes chronic if caught early and treated properly with the following
- Cortisone injections
- Ceasing or changing your activity
- Wrist splints
If surgery becomes necessary, arthroscopic procedures are minimally invasive, provide a relatively short recovery period, and can produce long-lasting results.
Tendon Flexor Injuries
The muscles located in the hand and forearm that control the bending or flexing of the fingers are called flexor muscles. The tendons of the flexor muscles that lead to the fingers and the thumb begin just beyond the middle of the forearm.
Deep cuts on the palm side of the wrist, hand, or fingers can cause tendon flexor injuries. With partial cuts, fingers may still bend, but the motion will be painful and the tendon may eventually rupture. When both tendons are cut completely through, the finger joints cannot bend on their own at all.
It is more than likely that your doctor will recommend surgery to repair your cut tendon. Following surgery, and depending on the type of cut, the injured area will either be protected from movement or started on a very specific limited motion program for several weeks.
Trigger finger is the common name for a condition that leads to swelling in the tendons that control finger bending. Such swelling prevents the tendons from gliding smoothly, which causes pain, popping, or a catching feeling.
Whenever possible, nonsurgical treatment are attempted first. Splints, oral anti-inflammatory medications, steroid injections, and adjustments in daily activities may be successful in reducing the swelling around the tendon. If the finger does not respond to nonsurgical treatments, surgery may be recommended.
Ulnar Nerve Compression
The ulnar nerve is what people commonly call the funny bone. It fits in a groove in the bottom of the elbow and is very vulnerable to stress, trauma, or overuse. Ulnar nerve compression can cause a lack of sensation, muscular weakness, and shooting pain from the elbow down to the pinkie and ring finger. Numbness and tingling in ring and pinkie fingers are the most common symptoms.
Nonsurgical treatments such as splints, oral anti-inflammatory medications, and adjustments in daily activities are typically pursued as the initial course of action. If the swelling around the nerve does not respond to nonsurgical treatments, surgery may be recommended.