Cubital tunnel syndrome is a common cause of numbness, tingling and pain in the small and ring fingers. For many patients, this condition feels like “hitting the funny bone”. Some cases can result in hand weakness, poor dexterity and loss of muscle tone. Please watch this video by the American Society for Surgery of the Hand regarding diagnosis and treatment of this common condition. Raleigh Hand Center physicians treat cubital tunnel syndrome with conservative treatment as well as surgery if needed.
A SLAP lesion is an injury in the shoulder that is characterized by a tear of the labrum and long head of the biceps tendon insertion (see image below). SLAP stands for Superior Labrum from Anterior to Posterior, which signifies the location of the labrum injury at the top of the shoulder joint and the direction of the tear running from front to back that is typical for this type of injury.
What are the signs of a SLAP lesion?
Pain is the most common symptom and is often a vague discomfort deep within the shoulder that is aggravated with overhead activity, throwing, lifting, or holding the arm out in front of the body. Occasionally, with larger tears, mechanical symptoms of popping or clicking with shoulder motion are noted.
What causes a SLAP lesion?
A SLAP lesion typically occurs in overhead athletes such as baseball pitchers, volleyball and tennis players, but can happen with work related injuries, falls or overuse conditions as well. A sudden forceful exertion of the shoulder can cause the biceps tendon to detach the labrum from where it attaches to the shoulder, or repetitive small injuries can lead to an overuse type of injury with gradual onset of pain over time. Depending on the severity of the injury, the SLAP lesion can either be a partial injury with fraying of the labral attachment, or a complete tear with displacement of the tissues. An MRI is often required to diagnose and determine the severity of the SLAP lesion.
What are the treatment options?
Many SLAP lesions respond favorably to nonsurgical treatment with anti-inflammatory medication, corticosteroid injection and a therapy program. Conservative treatment is typically the first line of treatment. Occasionally, surgery is required to address the SLAP lesion in cases that fail to respond to nonsurgical treatment, especially for more severe, complete tears. The particular surgical procedure depends on the type of tear and the health and activity level of the patient. Some SLAP injuries are amenable to arthroscopic repair by reattaching the labrum to the glenoid with suture anchors. Alternatively, in certain situations a biceps tenodesis procedure can have excellent results as well. Biceps tenodesis involves detaching the biceps tendon from the labrum and reinserting the biceps further down on the humerus outside of the shoulder joint. Regardless of the type of surgery performed, a period of shoulder immobilization with a sling is required followed by a rehabilitation program with gradual return to work and sports.
If you have signs or symptoms of a SLAP lesion, feel free to call our office to schedule an appointment with one of our fellowship trained Orthopaedic hand and upper extremity surgeons that specialize in both the non-surgical and surgical treatments of shoulder pathology.
Frozen shoulder, also called “adhesive capsulitis,” is an inflammatory condition of the shoulder that results in tightening of the shoulder capsular ligaments. This results in a stiff and often painful shoulder and can make it difficult to perform normal activities of daily living.
What are the signs of frozen shoulder?
Pain and stiffness are the hallmark signs of a frozen shoulder and most commonly there is a loss of external rotation range of motion. A frozen shoulder typically goes through three stages of symptoms that last for a variable period of time. Stage I (Freezing Stage) is the first stage and is the most painful. There is a progressive loss of motion in the first stage that can last from 6 weeks to 9 months. Stage II (Frozen) is characterized by a plateau of the pain and stiffness and can last from 4 to 12 months, or more. Stage III (Thawing) is characterized by decreasing pain with a gradual return of motion and can last from 1 to 4 years without treatment. Although frozen shoulder usually resolves on its own with time, permanent stiffness is possible.
What causes frozen shoulder?
Frozen shoulder is often caused by an injury to the shoulder that leads to an inflammatory reaction and the resultant tightening of the shoulder capsule and ligaments. It can also result from an injury elsewhere in the arm or hand if the arm is immobilized for a long period of time. Other medical conditions are associated with frozen shoulder, but the relationship is not entirely clear. These associated medical conditions include diabetes, respiratory/lung problems, adrenal disease, thyroid problems, recent chest surgery, and an extended hospitalization. Regardless of the original cause, the synovial lining of the shoulder joint thickens, and the capsular ligaments contract, limiting the range of motion of the shoulder.
What are the treatment options?
Most cases of frozen shoulder can be successfully treated with anti-inflammatory medicines, a corticosteroid injection and a therapy program. The medication and injection help to decrease the pain and inflammation, and the therapy helps restore range of motion. Occasionally for severe cases, if these methods fail to resolve the frozen shoulder, a manipulation of the shoulder under anesthesia and/or surgery may be required to release the tight capsule/ligaments in the shoulder. The surgery is typically performed arthroscopically with small incisions in a minimally invasive manner.
If you have signs or symptoms of frozen shoulder feel free to call our office to schedule an appointment with one of our fellowship trained Orthopaedic hand and upper extremity surgeons that specialize in both the non-surgical and surgical treatments of hand, wrist, elbow, and shoulder problems.
As the weather gets better, many of us are spending more time outside. Gardening is a great hobby and a good way to stay active. Unfortunately, for those with hand arthritis, this hobby can be painful. When activities you love cause pain, it’s time to think about what you can do to minimize pain and further damage to your joints. The following tips can help you enjoy gardening for many years to come!
1. Plan ahead. Think about what activities may require help. If you are handling heavy plants or maneuvering pots, ask for assistance. You’ve heard the saying, “Two hands are better than one”. Well, for those with pain, four hands are better than two! If you use less effort on the heavier tasks, you can do more enjoyable activities like planting flowers and tending to your vegetables.
Planning ahead may also mean organizing your time. Trying to finish the whole garden in one shot may not be good for your joints! Make sure you take breaks and spread the project over several days to avoid unnecessary pain.
2. Finds tools to help your body work more efficiently. For those with arthritis in the hands, there are a variety of gardening tools to decrease strain on your joints. Typically, tools with wider grips and curved handles are better. These can help place joints in better positions for less pain, but also allow you to use larger muscle groups to do the work.
3. Know your limits. If you are performing a task and it is painful, you probably shouldn’t be doing it! Is there a different way to complete the task which doesn’t cause pain (i.e. reposition hands/body, use different tool, etc). There is almost always more than one way to finish a project. And your joints with thank you when you find that way!
Arthritis can be painful and debilitating. But with the right tools and knowledge, gardening is one activity that you can enjoy for a long time! The following websites may be helpful in completing your goals.
Trigger finger, also known as “stenosing tenosynovitis of the finger,” is a condition affecting the hand function of many people. Symptoms occur when there is a size mismatch between the flexor tendons of the fingers or thumb and the sheath which surrounds the tendons. Instead of gliding smoothly through the sheath, the tendons can meet resistance within the tight sheath, which can be painful. Some patients report “catching” or “clicking” of the finger with range of motion. Some people may feel a tender nodule or “bump” at the base of the finger/thumb. In advanced cases, the finger can become stuck or “locked” in flexion, requiring the person to straighten the finger with the other hand. These symptoms are often worse in the morning
What causes trigger finger?
The cause of trigger finger is unknown in most cases. Repetitive, forceful gripping or trauma may contribute to the process. Sometimes rheumatoid arthritis (RA), diabetes, gout, and thyroid disorders are associated with trigger finger. In some conditions, the tenosynovium, which is normally thin tissue surrounding the tendons, becomes thickened and obstructs tendon gliding.
Who is at risk for trigger finger?
Trigger finger is more common in females than males. It typically occurs in people between 40 and 60 years of age. Diabetics and patients with RA have a higher risk. Despite the name, trigger finger can occur in any finger, and it is common in the thumb. Children may also have a trigger finger, however, this is much less common. “Congenital trigger thumb” is occasionally diagnosed in infants who cannot fully straighten the end of the thumb.
How is trigger finger diagnosed?
Trigger finger can be diagnosed by history and physical exam. Laboratory tests, x-rays, ultrasound, and MRI are usually not necessary to confirm the diagnosis. Often a cyst or nodule arises from the tight sheath, which can be felt in the palm.
