Elbow & Wrist Problems
- Medial Epicondylitis (golfers elbow)
- Lateral Epicondylitis (tennis elbow)
- Arthritis of Elbow Joint
- Tardy Ulnar nerve
- Carpal Tunnel Syndrome
- Ganglion Cyst
- Trigger Finger
- de Quervain's Tenosynovitis
Elbow
Medial Epicondylitis
Medial epicondylitis is caused by ripping the tendon that inserts on the inside portion of the elbow. This is frequently called “golfers elbow” and can be a persistent problem. With chronic tearing of the tendon insertion on the medial epicondyle, scar tissue develops which in many cases does not go away with conservative treatment.
Diagnosis
Diagnosis of medial epicondylitis is made with physical exam, and ultrasound is helpful in demonstrating the exact area and size of scarring in the tendon.
Treatments
Treatment to medial epicondylitis, at first is exercise and stretching, but frequently, will come down to ultrasound guided multiple trephination technique to revascularize the medial epicondyle, and possible use of platelet rich plasma.
Lateral Epicondylitis
Lateral epicondylitis is tearing of the extensor tendon from the lateral epicondyle of the elbow. Scar tissue develops in this region and frequently is not amenable to conservative treatment.
Diagnosis
Diagnosis of lateral epicondylitis is conveniently done by ultrasound technique. The amount of scar tissue present, size and location is easily documented.
Treatment
Treatment of chronic lateral epicondylitis is multiple trephination technique with ultrasound guidance, cortisone injections, and possible use of platelet rich plasma.
Degenerative Arthritis of the Elbow
Degenerative arthritis is common in older age, resulting in decreased ROM of the elbow.
Diagnosis
Diagnosis is made with physical examination, plain x-rays and ultrasound is useful in determining the amount of tissue thickening and cartilage destruction present.
Treatment
Initial treatment to elbow arthritis is exercise with stretching and strengthening, anti-inflammatories, and possible cortisone injections. In rare instances, surgical procedures may need to be performed.
Tardy Ulnar Nerve
Tardy ulnar nerve is essentially having a pain in your elbow that travels down to your little and ring finger like an electric shock. It is very similar to hitting your funny bone, but the tingling continues.
Diagnosis
Diagnosis of tardy ulnar nerve is performed by physical examination and ultrasound technique, which can see the swelling or contractures around the ulnar nerve.
Treatment
Treatment is generally conservative, but in rare incidences, surgery may need be employed to release the pressure on the nerve. Ultra sound guided release of the Ulnar Nerve with hydrodisection is also useful.
Wrist
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is essentially squeezing of the median nerve at the wrist caused by overgrowth of the lining of the tendons that go through the same compartment. As the nerve is progressively squeezed, weakness and tingling occurs in one’s hands. People are frequently awakened at night, or bothered with such things as driving or blow-drying their hair.
Diagnosis
Diagnosis is made with physical examination, an EMG or an ultrasound is useful to see the amount of compression on the median nerve.
Treatments
Initial treatment is stretching and strengthening. Specific maneuvers can be avoided and performed to help lessen the amount of swelling in the carpal canal. Frequently, patients will benefit from a steroid injection placed in the carpal canal, and it is not uncommon to undergo carpal release.
Ganglion Cyst
Ganglion cysts are frequent and they on the top part of the wrist, most commonly in the center of the wrist. These are caused by irritation of a ligament in the wrist, which has allowed part of the wrist fluid to leak into a pouch called a ganglion cyst.
Diagnosis
Diagnosis of a ganglion cyst is generally performed by physical examination.
Treatment
Treatment of a ganglion cyst can involve aspiration and multiple trephine technique at the origin of the ganglion cyst. Steroid injections are also frequently employed. If the ganglion cyst becomes recurrent and bothersome, surgery is indicated.
Trigger Finger
Trigger fingers occur in the thumb as well as the fingers of the hand where, after the hand is clenched, it is hard to straighten one’s finger out without noting a popping sensation. In severe instances, the finger will not straighten out, even after attempts to physically do it.
Diagnosis
Diagnosis of trigger finger is on physical examination and direct visualization with ultrasound.
Treatment
Treatment of a trigger finger is a well-guided injection into the area where the tendon is getting caught, called the A-1 pulley. With an appropriately placed injection into this region, 60% of trigger fingers can be relieved. If trigger fingers injections do not work, a release of the tissue catching on the finger is performed through surgery.
de Quervain’s Tenosynovitis
de Quervain’s Tenosynovitis is pain near the base of the thumb. This area in particular has multiple tendons crossing one point where pain is frequent, and doesn’t resolve with conservative treatments.
Diagnosis
Diagnosis of de Quervain’s tenosynovitis is made with physical evaluation.
Treatment
Initial treatment of de quervain’s tenosynovitis is a cortisone injection. This is effective 75% of the time. Cases that become chronic and fail repeated injections can require surgery to release the tendon.