WRIST FRACTURES
If you or your child participate in sports or physical activities, it’s possible you have suffered a wrist fracture at one time or another. This involves breaking one or more of the bones in your wrist. This is a common injury; broken wrists make up one-tenth of all broken bones in the U.S.
It’s important to have these injuries addressed by the team at Ortho Montana so that they heal properly.
WHAT IS A WRIST FRACTURE?
Although your wrist feels solid, it is actually made up of eight small bones along with the two long bones of your forearm. A wrist fracture is when you break or crack one or more of these bones. The most common small bone broken is called the scaphoid; the most common long bone is the radius.
HOW CAN YOU TELL IF YOU’VE BROKEN YOUR WRIST?
After sustaining a wrist injury, these are the telltale signs you may have a wrist fracture:
- Severe pain that worsens when gripping, squeezing, or moving your hand or wrist
- Swelling
- Tenderness
- Bruising
- Obvious deformity
If you think you may have broken your wrist, it’s not something to leave to chance. A delay in diagnosis and proper splinting/care can lead to poor bone healing, decreased range of motion, and decreased grip strength in the future.
COMMON CAUSES OF WRIST FRACTURES
Most wrist fractures are the result of a fall, whether during normal activities or when playing a contact sport or activities such as snowboarding or skateboarding. Car accidents can also often result in broken wrists.
The most common wrist fracture is known as Colles’ fracture. Also known as a “distal radius fracture,” this is a break in the larger of the two bones in your forearm. The bone breaks on the lower end, close to where it connects to the bones of the hand on the thumb side of the wrist.
HOW ARE WRIST FRACTURES DIAGNOSED?
Wrist fractures are straightforward diagnoses for the team at Ortho Montana most cases, all that is needed is a physical examination of the wrist and hand and an x-ray. If we feel more detail is needed, or to see something we cannot see on an x-ray, we may use a CT scan or an MRI for diagnosis.
WRIST FRACTURE TREATMENT
In cases of a “hairline” break in the bone, we won’t have to reposition the bones. But in many broken wrists, the broken ends of the bone aren’t properly aligned or there may be a gap. In these situations, we need to manipulate the pieces back into position. This is called a reduction and can be very painful, so the patient is given either local or general anesthesia prior to moving the bones.
- Immobilization — The majority of these cases require either a splint or cast on the wrist and lower hand. A splint is often used for a few days to a week while the swelling goes down. Then a cast is placed over the wrist and lower part of the hand. The cast can be used for anywhere from 4-8 weeks, depending on the age of the patient and the type of fracture. This will restrict the movement of the broken bone so it can heal. To reduce early swelling and pain with a cast, you should keep your hand elevated above your heart as much as possible.
WHO IS A CANDIDATE FOR SURGERY TO REPAIR A FRACTURED WRIST?
Certain wrist fractures can require surgery. These are situations that could necessitate surgery:
- An open fracture (the bone has broken through the skin)
- A fracture in which the bone pieces move before they heal
- Loose bone fragments that could enter a joint
- Damage to the surrounding ligaments, nerves, or blood vessels
- Fractures that extend into a joint
HOW IS SURGERY PERFORMED TO REPAIR A BROKEN WRIST?
An incision is usually made directly above the break. Often this is for the purpose of reduction, called an open reduction, to fix the alignment. In an open fracture, surgery should be performed urgently. The exposed soft tissue and bone must be thoroughly cleaned and antibiotics started to prevent possible infection.
In wrist fracture surgeries, fixation is usually necessary to hold the bone in the correct position while it heals. These are the typical options:
- Metal pins
- Plate and screws
- External fixator (a stabilizing frame outside the arm with pins down into the bone on both sides of the fracture)
- Combination of techniques
RECOVERY AFTER WRIST FRACTURE SURGERY
These surgeries are quite varied due to the different variations and degrees of the fractures, so there isn’t a “set” course of recovery. Generally, the patient will have moderate pain that lasts from a few days to a couple of weeks. In most cases a combination of ice, elevation of the wrist above the heart, and non-prescription pain medications are sufficient.
Casts must be kept dry, so the patient needs to shower with a plastic bag taped around the area. If the cast becomes wet, it is difficult to dry.
It’s important to regain full motion of your fingers as soon as possible after you get your cast.
Once the cast or splint is removed, it’s likely there will be some stiffness in the wrist. This will generally resolve in a month or two and should continue to improve, but it could take months. If necessary, you may need physical therapy to overcome this and to regain full range of motion.
WHEN CAN I RESUME EXERCISE OR SPORTS AFTER A WRIST FRACTURE?
Most patients will be able to resume exercise that doesn’t involve the arms within 1-2 months after the cast is removed. Return to sports, such as football, skiing, or skateboarding, can usually come from 3-6 months after the injury.
CARPAL TUNNEL SYNDROME
WHAT IS CARPAL TUNNEL?
The carpal tunnel is a narrow, fibrous passage in the wrist that protects the median nerve, which runs down the length of arm and through the wrist into the hand. It controls some hand movement, and sensation in the thumb, index and middle fingers, and half of the ring finger. Irritation or compression of the median nerve within the carpal tunnel can cause tingling and numbness in the fingers, a condition known as carpal tunnel syndrome (CTS).
CARPAL TUNNEL SYNDROME SYMPTOMS
Carpal tunnel syndrome develops gradually, usually beginning as an ache in the wrist that extends up the forearm or down into the hand. As CTS worsens, there may be tingling or numbness in the fingers, or pain radiating through the entire arm. Some people also experience weakness in the hand and arm, and have difficulty grasping small objects. These symptoms are usually most severe when a person first wakes up.
Although most people associate carpal tunnel syndrome with pain and tingling in the fingers, it should be noted that the “pinky” finger is not affected. Anyone experiencing symptoms in the pinky may be suffering from another condition.
RISK FACTORS FOR DEVELOPING CARPAL TUNNEL SYNDROME
In most cases, the causes of CTS remain unknown. In some instances, CTS is the result of genetic predisposition, with some people having atypically small carpal tunnels, making the median nerve more susceptible to irritation. Whether CTS is caused by repetitive motions such as using a computer mouse has not been proven conclusively. Risk factors for CTS include the following:
- Inflammatory conditions (such as arthritis)
- Diabetes
- Obesity
- Fluid retention
- Thyroid disorders
- Kidney failure
- Use of oral contraceptives
- Injury
Symptoms can be triggered by any pressure placed on the median nerve.
DIAGNOSING CARPAL TUNNEL SYNDROME
Carpal tunnel is usually diagnosed through a complete medical history and physical examination. Diagnostic tests such as an electromyogram, which records the electrical activity of nerves and muscles, may be performed.
CARPAL TUNNEL SYNDROME TREATMENT
Often, CTS can be effectively treated by avoiding or modifying the activity that is causing symptoms. Additional treatments may include the following:
- Resting the hands
- Applying cold packs
- Taking anti-inflammatory medication
- Getting corticosteroid injections
- Wearing splints
- Getting physical therapy
More severe cases of CTS, such as those that interfere with normal daily activities or are caused by nerve damage, may be treated surgically by cutting the ligament that is pressing on the median nerve. Either endoscopy or open surgery can be used. Postsurgery, activities known to have caused CTS should be stopped, or performed differently.
DUPUYTREN’S CONTRACTURE
Dupuytren’s contracture is a rare hand disorder caused by a thickening of the layer of fibrous tissue beneath the skin of the palm and the finger(s). This thickening causes tendons to tighten (contract), which makes the finger difficult to extend. As a result, the finger is continually “curled up.” Although more common in men than women, the cause of Dupuytren’s contracture is unknown. However, people who get the condition tend to drink significant amounts of alcohol; have diabetes; smoke; or have seizures similar to those from epilepsy.
SYMPTOMS OF DUPUYTREN’S CONTRACTURE
The symptoms of Dupuytren’s contracture usually come on quite gradually. Symptoms include one or more small nodules that form in the palm. Although tender when they first form, the tenderness often disappears. Nodules can then thicken and contract, forming tough bands of tissue beneath the skin. Eventually, one or more of the fingers may curl toward the palm. Over time, straightening the curled fingers may be difficult, affecting the ability to grasp large objects. Although all fingers can be affected, the two most common are the ring and “pinky” fingers.
TREATMENT OF DUPUYTREN’S CONTRACTURE
Dupuytren’s contracture cannot be stopped or cured. Because it progresses very slowly, it may not cause problems for years. There is also the chance that, even if nodules form in the palm, they will never progress further. If the condition becomes problematic, both nonsurgical and surgical treatments are available.
Steroid injections are a nonsurgical treatment for the pain caused by nodules. They usually help relieve pain, and may keep the contracture from getting worse. In cases in which fingers are already contracted, XIAFLEX® injections, which contain a mixture of enzymes that helps dissolve thickened tissue, may be used. If Dupuytren’s contracture continues to get worse, surgery may be recommended.
If Dupuytren’s contracture continues to get worse, surgery may be recommended. During surgery, the bands of thickened tissue in the palm are divided or removed to increase finger flexibility. Postsurgery, physical therapy may be required.
HAND ARTHRITIS
The ulnar collateral ligament (UCL) is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm. The UCL is vital to maintaining elbow stability and function. This ligament may be torn as a result of injury or dislocation of the elbow, or damaged by overuse and repetitive movement and stress. If injuries do not heal properly, the elbow may become loose or unstable. Symptoms of a UCL injury include pain on the inside of the elbow, numbness, tingling, and decreased arm and elbow strength. A UCL injury is more common in athletes, especially baseball players, who use their arm constantly in a throwing motion.
Treatment for a UCL injury varies, and initial treatment may include rest, anti-inflammatory medication, and physical therapy. If symptoms persist and do not respond to conservative methods of treatment, surgery to reconstruct or repair the joint, may be necessary. Ulnar collateral ligament reconstruction is a procedure used to repair a torn or damaged UCL ligament. This procedure is commonly referred to as Tommy John surgery, named after the first baseball player to undergo the procedure.
THE ULNAR COLLATERAL LIGAMENT RECONSTRUCTION PROCEDURE
This procedure is performed through an incision that is made on the inside of the elbow joint. During the ulnar collateral ligament reconstruction procedure, the surgeon replaces the torn ligament with a tissue graft. In most cases of UCL injury, the ligament can be reconstructed using one of the patient’s own tendons, commonly taken from the forearm, hamstring, foot, or knee. Sutures are used to secure the tendon graft in position. When the procedure has been completed, the incision is sutured closed and the elbow is bandaged and placed in a splint.
RISKS OF ULNAR COLLATERAL LIGAMENT RECONSTRUCTION
As with any surgical procedure, there are risks associated with ulnar collateral ligament reconstruction, which may include:
- Reaction to anesthesia
- Infection
- Nerve or blood vessel damage
Some patients may continue to experience chronic pain and instability of the elbow, even after surgery.
RECOVERY AND RESULTS
The elbow is immobilized for one to two weeks after surgery. After that time, a physical therapy program will help the individual to regain strength, flexibility and range of motion. Full recovery from an ulnar collateral ligament reconstruction may take from 6 to 9 months.
UCL INJURIES
WHAT IS THE ULNAR COLLATERAL LIGAMENT (UCL)?
The ulnar collateral ligament (UCL) is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm. The UCL is vital to maintaining elbow stability and function. This ligament may be torn as a result of injury or dislocation of the elbow, or damaged by overuse and repetitive movement and stress.
SYMPTOMS OF A UCL INJURY
Symptoms of a UCL injury include pain on the inside of the elbow, numbness, tingling, and decreased arm and elbow strength.
WHO IS AT RISK FOR GETTING A UCL INJURY
A UCL injury is more common in athletes, especially baseball players, who use their arm constantly in a throwing motion.
WHAT HAPPENS IF A UCL INJURY IS LEFT UNTREATED?
If injuries do not heal properly, the elbow may become loose or unstable.
TREATMENT FOR UCL INJURIES
Treatment for a UCL injury varies, and initial treatment may include rest, anti-inflammatory medication, and physical therapy. If symptoms persist and do not respond to conservative methods of treatment, surgery to reconstruct or repair the joint, may be necessary. Ulnar collateral ligament reconstruction is a procedure used to repair a torn or damaged UCL ligament. This procedure is commonly referred to as Tommy John surgery, named after the first baseball player to undergo the procedure.
THE ULNAR COLLATERAL LIGAMENT RECONSTRUCTION PROCEDURE
This procedure is performed through an incision that is made on the inside of the elbow joint. During the ulnar collateral ligament reconstruction procedure, the surgeon replaces the torn ligament with a tissue graft. In most cases of UCL injury, the ligament can be reconstructed using one of the patient’s own tendons, commonly taken from the forearm, hamstring, foot, or knee. Sutures are used to secure the tendon graft in position. When the procedure has been completed, the incision is sutured closed and the elbow is bandaged and placed in a splint.
RECOVERY FROM UCL RECONSTRUCTION
The elbow is immobilized for one to two weeks after surgery. After that time, a physical therapy program will help the individual to regain strength, flexibility and range of motion. Full recovery from an ulnar collateral ligament reconstruction may take from 6 to 9 months.
RISKS OF ULNAR COLLATERAL LIGAMENT RECONSTRUCTION
As with any surgical procedure, there are risks associated with ulnar collateral ligament reconstruction, which may include:
- Reaction to anesthesia
- Infection
- Nerve or blood vessel damage
Some patients may continue to experience chronic pain and instability of the elbow, even after surgery.
BICEPS TENDONITIS
Biceps tendinosis is a degenerative condition of the two tendons that connect the biceps muscles, the muscles at the front of the upper arms, to the shoulder bones. One of these, the long head biceps tendon, runs from the muscle to the labrum, the layer of cartilage that deepens and cushions the socket to help stabilize the shoulder joint. The condition is usually the result of an athletic injury or due to the natural aging process and can be very painful.
Biceps tendinosis is typically found in patients who have also experienced biceps tendinitis, which occurs when the tendon around the biceps muscle is inflamed. Biceps tendinosis is typically characterized by deep aches and pain within the shoulder, which may worsen when the arm is lifted over the head.
Biceps tendinosis is diagnosed by evaluating the patient’s medical history, the severity of the symptoms and the overall range of motion in the shoulder. Conservative treatments are usually effective for this condition. These may include ice packs to reduce swelling and pain, anti-inflammatory medications, physical therapy, corticosteroid injections and avoiding activities that require overhead motions. If symptoms persist after 3 months of conservative therapies, a biceps tenodesis procedure to relieve pain and restore full function to the arm may be necessary. This surgery is most often performed as part of a more extensive shoulder operation, such as the repair of a rotator cuff.
RADIAL HEAD FRACTURE
The radial head is the top of the radial bone, located just below the elbow. The radius runs from the wrist to the elbow, and fractures in this bone often occur near the top of the bone, or the radial head. A radial head fracture may be caused by a fall or a sports-related injury, and in some cases, a radial head fracture may occur when the elbow has been dislocated. Symptoms of a radial head fracture include elbow pain and swelling, and difficulty bending the elbow. It also may be difficult to move or turn the forearm.
A radial head fracture is diagnosed through a physical examination and the doctor may attempt to move the arm into different positions. X-rays are performed to determine the degree of displacement and the severity of the fracture. CT scans may also be performed, and after a review of these images, an appropriate treatment plan is developed.
Treatment for a radial head fracture varies based on the severity of the fracture but commonly includes medication to control pain and swelling. If the radial head fracture is small, resulting only in cracks to the bone, treatment may only involve using a splint or sling for a few weeks while the bone heals. Severe breaks may require surgery to insert pins or rods to hold the bones together to promote healing. In some cases, arthroscopic surgery may be performed to:
- Repair torn ligaments
- Debride dead tissue
- Remove extra fragments of bone
In severe cases, when the radial head bone has broken into multiple pieces that cannot be put back together for healing, a procedure known as radial head replacement may be performed. During this procedure, the deformed radial head is surgically removed and replaced with a prosthetic radial head. This surgery may be performed to improve long-term function of the elbow. Physical therapy is necessary after all forms of treatment for radial head fractures, and may include exercises to restore muscle strength, range of motion and flexibility.
LATERAL EPICONDYLITIS/TENNIS ELBOW
WHAT IS TENNIS ELBOW?
Lateral epicondylitis, also known as tennis elbow, is an elbow injury that occurs as a result of the overuse of the muscles and tendons of the forearm and elbow. The pain associated with this condition affects the lateral epicondyle, the area where the tendons of the forearm connect with the bony outer portion of the elbow.
CAUSES OF TENNIS ELBOW
The cause of tennis elbow is the repetitive movement, causing the muscle strain injury. This movement causes stress in the tissues resulting in tiny tears in the tendons. As suggested, tennis elbow may occur in tennis players or individuals who participate in certain athletic activities. This injury is not only limited to tennis players, but also people with jobs that involve repetitive motions of the wrist and arm. This could include the following professions:
- Carpenters
- People in construction related trades
- Plumbers
- Cutting ingredients, including meats
- Painting
SYMPTOMS OF TENNIS ELBOW
The symptoms of tennis elbow affect the inside of the elbow, and may include:
- Wrist extension causes pain
- Forearm weakness
- Pain that spreads from the outside of the elbow into the forearm and wrist
Pain may occur when performing even simple tasks such as turning a doorknob or shaking hands.
DIAGNOSIS OF TENNIS ELBOW
At Ortho Montana we diagnose tennis elbow through a physical examination of the arm and elbow, and a review the patient’s medical history. To assess pain, our providers may apply pressure to the elbow and ask the individual to move the arm, wrist and elbow in different ways. Additional diagnostic tests may include:
- X-ray
- MRI scan
- EMG
These tests may be performed to rule out other conditions that may be responsible for causing elbow pain.
TREATMENT FOR TENNIS ELBOW
The initial pain caused by tennis elbow can often be managed with rest, ice and over-the-counter pain medication. In many cases, tennis elbow heals on its own. Cases of tennis elbow that do not respond to conservative measures may require additional treatment that may include:
- Physical therapy
- Corticosteroids
- Exercises
- Forearm brace
Severe, persistent cases of tennis elbow may require surgery. Our providers will sit down with the patient, as surgical procedures may be necessary to remove damaged tissue, remove bone spurs or to split the tendons to alleviate pressure.
MEDIAL EPICONDYLITIS/ GOLFER’S ELBOW
Medial epicondylitis, also known as golfer’s elbow, is a painful condition in which the tendons connecting the forearm to the elbow have become damaged due to injury or overuse. Previously thought to be a form of tendonitis, or inflammation of the tendon, medial epicondylitis is now considered to be a form of tendonosis in which the collagen fibers making up the tendon have deteriorated. Patients with this condition experience pain on the inside of the elbow that may radiate into the forearm. This pain results when the epicondyle puts pressure on the ulnar nerve, a nerve in the forearm. Most often, medial epicondylitis can be treated successfully by simple measures like resting the arm and applying ice. In some cases, however, it requires surgical correction.
While it may be caused by a single injury, medial epicondylitis is usually caused by repetitive gripping, flexing and swinging of the arm. These actions, common in golfers, cause the targeted tendons to stretch and tear. Medial epicondylitis is also frequently diagnosed in baseball pitchers, bowlers, tennis players, swimmers and individuals who do painting, raking or hammering since all of these activities involve similar arm motions. This condition is much more common in men than in women, but much less common in either than tennis elbow.The difference between the two conditions is that tennis elbow occurs on the outside of the elbow while golfer’s elbow occurs on the inside.
SYMPTOMS AND DIAGNOSIS OF MEDIAL EPICONDYLITIS
Symptoms of medial epicondylitis may appear suddenly or gradually. These symptoms may include:
- Pain on the inside of the elbow or forearm
- Weakness or stiffness in the wrists and hands
- Tingling or numbness in the hand or fingers, particularly the ring finger or pinkie
The pain of medial epicondylitis may worsen with certain actions, such as swinging the arm, squeezing the hand, turning a doorknob or lifting something heavy, especially when the palm is facing downward.
DIAGNOSIS OF MEDIAL EPICONDYLITIS
Medial Epicondylitis is diagnosed through physical examination, the use of X-rays and, on occasion, other diagnostic tests such as MRIs or ultrasound.
TREATMENT OF MEDIAL EPICONDYLITIS
There are several simple treatment options for medial epicondylitis. The treatments for medial epicondylitis may include:
- Resting the arm
- Wearing a bandage or splint on the wrist or elbow
- Icing the affected region
- Taking over-the-counter pain relievers
- Doing therapeutic exercises
- Receiving electrical stimulation treatments
- Taking prescribed corticosteroids orally or by injection
- Receiving shock wave treatments of the area
The symptoms of medial epicondylitis may resolve in weeks or may persist for months. As the pain subsides, a physical or occupational therapist may suggest different ways of moving the arm to avoid a recurrence of symptoms. If the condition lasts more than 3 to 6 months, becoming chronic, surgery may be considered.
SURGICAL REPAIR OF MEDIAL EPICONDYLITIS
There are several types of surgery performed to repair medial epicondylitis. Such surgeries may be performed arthroscopically or as open surgery and are normally done outpatient with a local anesthetic. They usually take between 3 and 4 hours to complete. Most patients may return to a relatively normal routine in about 4 weeks, but may have residual discomfort, weakness or numbness for several months following surgery. Post-surgical physical therapy is usually required. Types of procedures used for surgical repair of medial epicondylitis may include:
Tendon Debridement – in which only the affected tissues within the tendon are removed, or debrided
Medial Epicondyle Release or Epicondylectomy and Ulnar Nerve Release – in which the medial epicondyle is removed, allowing the ulnar nerve to glide freely, releasing it from what is known as ulnar nerve entrapment
Ulnar Nerve Transposition – in which the forearm muscles are cut and temporarily disconnected from the epicondyle so that the ulnar nerve can be moved from behind the elbow to in front of it
RISKS OF SURGICAL REPAIR OF MEDIAL EPICONDYLITIS
While the surgical procedures discussed are considered safe, there are potential risks with any surgery which may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Breathing problems
Risks of the specific surgeries discussed may include a condition known as chronic regional pain syndrome, or CRPS. This complication, which is rare, may cause ongoing swelling, pain, skin discoloration and stiffness.
ULNAR COLLATERAL LIGAMENT
The ulnar collateral ligament (UCL) is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm. The UCL is vital to maintaining elbow stability and function. This ligament may be torn as a result of injury or dislocation of the elbow, or damaged by overuse and repetitive movement and stress. If injuries do not heal properly, the elbow may become loose or unstable. Symptoms of a UCL injury include pain on the inside of the elbow, numbness, tingling, and decreased arm and elbow strength. A UCL injury is more common in athletes, especially baseball players, who use their arm constantly in a throwing motion.
Treatment for a UCL injury varies, and initial treatment may include rest, anti-inflammatory medication, and physical therapy. If symptoms persist and do not respond to conservative methods of treatment, surgery to reconstruct or repair the joint, may be necessary. Ulnar collateral ligament reconstruction is a procedure used to repair a torn or damaged UCL ligament. This procedure is commonly referred to as Tommy John surgery, named after the first baseball player to undergo the procedure.
THE ULNAR COLLATERAL LIGAMENT RECONSTRUCTION PROCEDURE
This procedure is performed through an incision that is made on the inside of the elbow joint. During the ulnar collateral ligament reconstruction procedure, the surgeon replaces the torn ligament with a tissue graft. In most cases of UCL injury, the ligament can be reconstructed using one of the patient’s own tendons, commonly taken from the forearm, hamstring, foot, or knee. Sutures are used to secure the tendon graft in position. When the procedure has been completed, the incision is sutured closed and the elbow is bandaged and placed in a splint.
RISKS OF ULNAR COLLATERAL LIGAMENT RECONSTRUCTION
As with any surgical procedure, there are risks associated with ulnar collateral ligament reconstruction, which may include:
- Reaction to anesthesia
- Infection
- Nerve or blood vessel damage
Some patients may continue to experience chronic pain and instability of the elbow, even after surgery.
RECOVERY AND RESULTS
The elbow is immobilized for one to two weeks after surgery. After that time, a physical therapy program will help the individual to regain strength, flexibility and range of motion. Full recovery from an ulnar collateral ligament reconstruction may take from 6 to 9 months.