New Hand, Wrist or Elbow Problem Pre-Visit Guide

Biceps tendon tears at the elbow are less common than ones at the shoulder. Unfortunately, these types of tears will not grow back to the bone and heal on their own.

If you have this tear, you will still be able to move your elbow freely, with the exception of rotating your forearm from palm down to palm up, which we call supination. This makes this condition very easy to diagnose by a trained practitioner.

Other symptoms may include:

• Swelling and bruising in the elbow and forearm
• Weakness when bending the elbow or twisting the forearm
• A strange appearance or gap in the elbow along with a bulge in the arm (due to the displaced tendon)

Most patients will need surgery. Without surgery, you will have to tolerate not having full arm function, mostly the ability to carry objects using your affected arm.

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Pain and weakness felt in the front of the shoulder could be signs that you’re experiencing biceps tendinitis. Caused by inflammation or irritation to the upper biceps tendon, this condition can lead to a tendon tear or deformity if it’s left untreated.

Biceps tendinitis often occurs alongside other shoulder problems, including:

• Damage to the rotator cuff tendon
• Arthritis of the shoulder joint
• Tears in the glenoid labrum
• Chronic shoulder instability
• Shoulder impingement

Most often, biceps tendinitis is caused from degeneration or overuse. Any repetitive movement in which there is an overhead motion (swimming, tennis and baseball), the risk of acquiring this condition is greater. Symptoms include:

• Pain or tenderness in the front of the shoulder that worsens with activity
• Pain or achiness that moves down the upper arm bone
• Occasional snapping sound or sensation in the shoulder

Typically, biceps tendinitis is treated using nonsurgical methods such as rest, ice, anti-inflammatory medications, injections or physical therapy. If your condition does not improve using nonsurgical methods, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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A broken hand can be caused by a fall, crush injury, twisting injury or through direct contact like in sports. A fracture can occur in the middle or end of any of the bones that make up your hand or wrist.

You may have a broken hand or wrist if you have any of the following symptoms:

• Swelling
• Bruising
• Tenderness or pain
• Deformity
• Inability to move the finger
• Shortened finger
• Injured finger crosses over its neighbor when making a partial fist

Somtimes, a physician can realign the bone fragments without making an incision. A cast, splint or brace is used to support the broken bone or bones and keep them in place. More complex hand fractures require surgery to realign and stabilize the bone fragments. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan based on the severity of your injury and your personal needs and goals.

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Caused by compression over time in the median nerve in the wrist, carpal tunnel syndrome often gets worse over time and can lead to nerve damage. It and can be treated both surgically and non-surgically by our orthopedic experts on hand conditions.

You may have carpal tunnel syndrome if you are experiencing these signs or symptoms:

• Weakness or clumsiness that make fine movements like buttoning a button difficult
• Numbness, tingling, burning or pain in your fingers
• Pain or tingling that continues up your arm
• A tendency to drop objects or lose awareness of where your hand is

Once diagnosed by an exam and/or imaging studies, carpal tunnel syndrome treatment typically consists of:

• Bracing or splinting
• Medications for pain relief and reduction in swelling
• Modifying activities
• Guided exercise programs or physical therapy
• Injections
• Carpal Tunnel Release Surgery

At OrthoNebraska, treatment plans are developed collaboratively between you and your care team, while discussing the risks and benefits as they pertain to you individually.

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How carpal tunnel release is performed using an open technique

When the ulnar nerve in your arm becomes compressed or irritated behind the inside part of the elbow, you may experience cubital tunnel syndrome. You may have cubital tunnel syndrome if you are experiencing numbness and tingling in your hand and fingers.

Certain factors can put you at greater risk for developing cubital tunnel syndrome, including:

• Prior elbow fracture or dislocation
• Bone spurs or arthritis
• Cysts near the elbow joint
• Prolonged activities in which your elbow is required to be bent or flexed

Nonsurgical treatments often provide the relief needed to return to normal activity. they may include:

• anti-inflammatory medications
• a brace or splint
• nerve gliding exercises.

However, if symptoms do not improve or if the nerve compression is causing muscle weakness or possible damage in your hand, surgery may be recommended.

As a patient of OrthoNebraska, your treatment plan will be developed collaboratively between you and your care team, while discussing the risks and benefits as they pertain to you individually.

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Learn more about how cubital tunnel syndrome is typically diagnosed and treated.

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When the tendons around the base of the thumb are irritated or constricted, De Quervain’s tendinosis may be present. Pain and tenderness along the thumb side of the wrist are the most common symptoms and are felt most prominently when forming a fist, grasping or gripping something or when turning the wrist.

De Quervain’s tendinosis or tenosynovitis is generally caused by overuse, but it may also be associated with other medical conditions, notably pregnancy or rheumatic disease.

In addition to the symptoms mentioned above, you may also experience:

• Pain may travel up the forearm
• Swelling over the thumb side of the wrist
• “Catching” or “snapping” sensation when moving the thumb
• May have trouble moving the thumb or wrist due to swelling

Nonsurgical treatment for this hand condition includes:

• Splints
• Anti-inflammatory medications
• Avoiding activities that cause pain and swelling
• Injections

If your hand does not get better using nonsurgical methods, it is possible that surgery will be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your needs and risk.

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Every person has a layer of tissue (called the fascia) that helps anchor and stabilize the skin on the palm side of the hand. For those suffering from Dupuytren’s Disease, the fascia slowly thickens and then tightens pulling the fingers into the palm. The cause of Dupuytren’s Disease is widely unknown, but genetics likely plays an important role.

You may be at risk for developing Dupuytren’s Disease if:

• Men are more likely than women
• You are from northern European or Scandinavian descent
• Other people in your family have had it
• Alcohol use
• Medical conditions such as diabetes and seizure disorders
• Age

Dupuytren’s Disease develops slowly over time with symptoms that include:

• Contractures (fingers are pulled toward your palm and cannot be spread apart)
• Nodules (small lumps in the palm of your hand)
• Tenderness where the nodules are located
• Cords (dense and tough cords of tissue under the skin)

There is no cure for Dupuytren’s Disease; however, it is not dangerous in the sense of threatening your overall health. Nonsurgical treatments include injections or splinting. Surgery may be recommended if your hand function is affected. Your OrthoNebraska care team will work with you to develop the right treatment plan for your individual needs.

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When the cartilage surface of the elbow is worn or damaged, osteoarthritis (elbow arthritis) develops. A previous dislocation or fracture can contribute, but most often arthritis develops from normal wear due to age and activity.

You may have elbow arthritis if the following symptoms are present:

• Pain
• Loss of range of motion
• A “grating” or “locking” sensation
• Joint swelling (often occurs over time)
• Numbness in your ring or small finger (later stages of elbow arthritis)

For patients experiencing early stages of elbow arthritis, oral medication, physical therapy and a change in activity can be used to help alleviate your symptoms. Eventually, treatments could include injections or surgery.

At OrthoNebraska, your treatment plan is developed collaboratively between you and your care team, and includes a discussion of the risks and benefits as they pertain to you individually.

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When the bursa (fluid-filled sacs) in your elbow (or more specifically, the olecranon, or bony tip of the elbow) becomes irritated or inflamed, elbow bursitis may be diagnosed. Traumatic injury or prolonged pressure on the elbow are the most common causes. Activities often associated with elbow bursitis include any occupation or activity that requires you to crawl on your knees and lean on your elbows in tight places, and holding different positions, such as a plank, for longer periods of time.

Elbow bursitis may be present if you’re experiencing the following symptoms:

• Excessive swelling
• Pain and possible restricted movement
• Skin that’s red and warm to the touch

Nonsurgical treatment may include draining the fluid from the bursa, followed by an antibiotic. Your physician may also recommend the use of elbow pads, adjusting your activities to minimize pressure on your elbow and anti-inflammatory medications to reduce swelling and pain.

If the elbow bursitis does not improve from removing the fluid and/or antibiotics, outpatient surgery may be recommended.

As a patient of OrthoNebraska, your treatment plan for elbow bursitis will be developed collaboratively between you and your care team, while discussing the risks and benefits as they pertain to you individually.

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Throwing athletes typically put a lot of stress their elbows and shoulders. Over time, without a proper rest and training regimen, the ulnar collaterial ligament (UCL) can become strained or tear. It’s a common point of failure for youth and professional athletes.

This injury will lead to pain on the inside of the elbow and the inability to achieve proper throwing velocity.

Treatment for UCL tears depends on the extent of the damage. A minor tear or strain may heal with only rest and ice. From there, treatment may progress to:

• Physical therapy
• Changes to throwing mechanics
• Anti-inflammatory medications like ibuprofen
• Injections such as Platelet Rich Plasma (PRP)
• Surgery, typically a minimally invasive elbow scope

At OrthoNebraska, we believe listening and crafting a treatment plan that works for each patient and their needs is important.

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How Tommy John surgery is performed

When a finger bone is fractured, your whole hand may be out of alignment. If you feel you may have a finger fracture, it’s important to seek medical attention as soon as possible.

Finger fractures are often the result of an injury to your hand. This could be as simple as slamming your fingers in a door or from misusing tools like power saws or drills. Symptoms of finger fractures include:

• Swelling of the fracture site
• Tenderness at the fracture site
• Bruising at the fracture site
• Inability to move the injured finger in completely
• Deformity of the injured finger

Most often, your bone can be put back into place without surgery. Once reset, you may be asked to wear a splint or cast. For more severe finger fractures, surgery may be recommended. Your OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your finger injury.

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Pressure on the ulnar nerve can be felt at your wrist, where numbness and tingling are common. You may also feel weakness when you pinch or grip objects. A soft tissue tumor is more typically the cause. However, repetitive trauma or chronic pressure can also cause finger numbness or tingling.

As symptoms increase it may become difficult to open jars, hold objects or coordinate your fingers while typing or playing an instrument.

Treatment varies by the cause of the pressure on your nerve. If it’s caused by how your wrist is positioned while you type, a simple change in position and padding may correct the feeling of numbness or tingling. However, if your nerve pressure is the result of repeated trauma, you may need to make a more significant lifestyle change, take anti-inflammatory medications or use a wrist splint temporarily. If your symptoms are not helped using nonsurgical methods, it is possible that surgery will be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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Flexor tendons help control movement in your hand. When they’re damaged, it can become hard or impossible to bend your fingers or thumb. A torn or cut tendon in your forearm, wrist, palm or along a finger is considered a flexor tendon injury.

Common causes of flexor tendon injuries include:

• Sports activities (football, wrestling, rugby)
• Deep cut
• Health conditions (rheumatoid arthritis)

You may have a flexor tendon injury if the following symptoms are present, usually as a result of trauma like a fall:

• Open injury such as a cut
• Inability to bend one or more joints of your finger
• Pain when your finger is bent
• Tenderness along our finger on the palm side of your hand
• Numbness in your fingertip

A splint may be used to give your arm or finger more protection as it heals, however, if your tendon is cut surgery will likely be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your individual needs.

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Elbow fractures and dislocations come in many shapes and sizes. Mostly caused by traumatic injury, they are more common in women and those between the ages of 30 and 40.

The most common elbow fractures are radial head fractures, which symptoms including:

• Outside elbow pain or swelling
• Pain and difficulty when straightening the arm
• Inability to turn the arm, such as turning a doorknob.

Disclocations have similar symptoms, but are typically very painful, especially full dislocations, which are often confirmed by X-ray.

Doctors classify fractures according to displacement, or how far out of the normal position they are. Less severe fractures with small cracks and/or minimal bone movements may be treatable without surgery. In these cases, a splint or sling will be used to ensure proper healing, with a gradual return to normal. More severe fractures may require surgery to avoid creating long-term problems or movement restrictions. The surgery typically involves resetting the bones in place using screws and plates, along with any necessary repairs to the surrounding ligaments.

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Arthritis can occur in any of the joints on your hand or fingers as it is a natural process of cartilage in the joints wearing down over time. It is relatively common as people reach an older age, and more common among those who have worked their hands hard over the years or had traumatic injuries. Rheumatoid arthritis is also very common in the hands.

While not every person with arthritis experiences symptoms, the following may be signs that you have hand or finger arthritis:

• Pain
• Swelling
• Reduced range of motion or stiffness
• Weakness in the joint

While there is no cure for arthritis, there are several non-surgical treatments to help alleviate your pain and minimize any other symptoms:

• Change in activity
• Immobilization (splint)
• Anti-inflammatory medications
• Exercise
• Injections
• Additional therapies

If your symptoms are not improved with nonsurgical treatments or if function is already severely impacted, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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The most common lump found on the hand, Ganglion cysts are not cancerous and are typically harmless. These cysts can appear, disappear and change size but do not generally affect the use of your hand. In some instances, though, Ganglion cysts can cause pain.

Ganglion cysts can develop on the top and underside of the wrist, at the end joint of a finger and at the base of a finger. While the cause is unknown, women between the ages of 15 and 40 are the most likely to be affected by this form of cyst.

You might have a Ganglion cyst if any of the following symptoms are present:

• Visible lump
• Pain, tingling and muscle weakness

Most of the time, the Ganglion cyst will disappear on its own; however, there are nonsurgical treatment options as well. This includes immobilizing your hand and wrist with a brace or other supportive device or aspiration (draining of the cyst). If your symptoms are not helped using nonsurgical methods, it is possible that surgery will be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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Most golf injuries develop over time due to repetitive movement. One of the most common injuries from playing golf, Golfer’s elbow, occurs when the tendons that attach your forearm muscles to the inside of the bone at your elbow become damaged from overuse.

Golfer’s elbow is mostly diagnosed based on pain and tenderness on the inside of the elbow. There are several exercises that, when done regularly, can help prevent Golfer’s elbow. Anti-inflammatory medications can be taken before golfing to help; however, speaking with an elbow expert is recommended to ensure your long term recovery.

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Stretching for Golfer’s or Tennis Elbow

Perform only as instructed by your surgeon or other healthcare provider.

An injury to the thin tendon that straightens the end joint of a finger or thumb, mallet finger is also known as “baseball finger”. This finger condition is caused when an object strikes the tip of a finger or thumb and forces it to bend further than it’s intended to go.

If you have mallet finger, symptoms include pain, swelling and bruising. The fingertip will often droop noticeably.

If your finger is left untreated, permanent stiffness and deformity may occur. Nonsurgical treatment for mallet finger typically includes splinting until the fingertip straight again. If there is more significant damage such as a fracture in your finger, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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Most often, the ring finger and thumb are affected by trigger finger. This hand condition causes pain, stiffness and a sensation of locking or catching when you bend or straighten your finger. Trigger finger occurs when the flexor tendon in your finger becomes inflamed and develops a small nodule on its surface.

You may be experiencing trigger finger if you have any of the following symptoms:

• Tender lump at the base of the finger on the palm
• Catching, popping or locking sensation with finger movement
• Pain when you bend or straighten your finger

Your initial treatment will include nonsurgical methods such as:

• Resting your hand
• Splinting
• Stretching exercises
• Anti-inflammatory medications
• Injections

If your finger does not get better using nonsurgical methods, it is possible that surgery will be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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How trigger finger surgery is performed

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Overuse of a joint is often the cause of pain or inflammation. Tennis elbow is common among athletes and those who spend long periods of time making the same motion repeatedly. This condition results when forearm muscles and tendons become damaged causing pain and tenderness on the outside of the elbow. Tennis elbow is most common in your dominant hand but can affect both arms.

Those most at risk for developing tennis elbow include:

• Tennis and other racquet-based sports
• Painters
• Plumbers
• Carpenters
• Auto Workers
• Cooks/Butchers

You may be experiencing tennis elbow if you have any one or more of these symptoms:

• Pain or burning on the outside of your elbow
• Weak grip strength
• Pain at night

Nearly all patients with tennis elbow see results without needing surgery. Nonsurgical treatment could include:

• Rest
• Anti-inflammatory medications
• Physical therapy
• Brace
• Injections
• Shock wave therapy
• Sports equipment check

If surgery is needed, your OrthoNebraska team will work collaboratively with you to create the right treatment plan for your individual needs.

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Stretching for Golfer’s or Tennis Elbow

Perform only as instructed by your surgeon or other healthcare provider.

Throwing athletes typically put a lot of stress their elbows and shoulders. Over time, without a proper rest and training regimen, the ulnar collaterial ligament (UCL) can become strained or tear. It’s a common point of failure for youth and professional athletes.

This injury will lead to pain on the inside of the elbow and the inability to achieve proper throwing velocity.

Treatment for UCL tears depends on the extent of the damage. A minor tear or strain may heal with only rest and ice. From there, treatment may progress to:

• Physical therapy
• Changes to throwing mechanics
• Anti-inflammatory medications like ibuprofen
• Injections such as Platelet Rich Plasma (PRP)
• Surgery, typically a minimally invasive elbow scope

At OrthoNebraska, we believe listening and crafting a treatment plan that works for each patient and their needs is important.

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How Tommy John surgery is performed

Arthritis can occur when any joint in your body becomes inflamed. The three most common types of wrist arthritis are:

• osteoarthritis (wear and tear)
• rheumatoid arthritis (chronic disease)
• post-traumatic arthritis (post-injury)

While not every person with arthritis experiences symptoms, the following may be signs that you have wrist arthritis:

• Pain
• Swelling
• Reduced range of motion or stiffness
• Weakness in the joint

While there is no cure for arthritis, there are several non-surgical treatments to help alleviate your pain and minimize any other symptoms:

• Change in activity
• Immobilization (splint)
• Anti-inflammatory medications
• Exercise
• Injections
• Additional therapies

If your symptoms are not improved with nonsurgical treatments, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your situation.

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