Understanding Carpal Tunnel Syndrome

By: Alan Gotesman, MD

Are you experiencing pain in your hand waking you up at night?  Do you have tingling in the fingers when you are driving or holding your phone? Is it getting difficult for you to manipulate small objects like buttons or clasps? You may have carpal tunnel syndrome. 

Carpal tunnel syndrome occurs when the nerve crossing your wrist is compressed, usually due to swelling of the tendons, which can cause pain and diminished sensation in your hands, particularly the thumb, index, middle and half of the ring finger. Typical symptoms are pain that wakes people up at night that needs to be “shaken out”, numbness and tingling as well as weakness and difficulty performing activities requiring fine manipulation. The diagnosis can usually be made with a detailed history and physical examination but confirmation can be performed with a nerve test called EMG’s that can determine the severity of the nerve compression and rule out other causes.

In milder forms, carpal tunnel syndrome can be treated with bracing, anti-inflammatories and cortisone shots. Once the compression is more severe, releasing the pressure on the nerve can be crucial to relieve the symptoms and prevent permanent nerve damage which can occur with chronic compression of the nerve. Newer minimally invasive techniques are available that allow the procedure to be done through a quarter-inch incision with the assistance of a camera. This technique allows for a quicker recovery process as well as less postoperative discomfort.  Results of surgery are generally excellent with many patients going back to all of their activities within 6-8 weeks.

If you think you may be suffering from carpal tunnel syndrome, the first step is to have an evaluation so schedule your appointment with one of our board-certified specialists today for an evaluation. 

Is the sport you love causing you pain? Understanding Tennis/Golfer’s Elbow

By: Dr. Neal Shuren

Tennis and golf are two of the most popular sports, especially amongst adults. As enjoyable as they are to play, overuse can lead to pain of the elbow, commonly called Tennis or Golfer’s Elbow. Both tennis and golfer’s elbow are very common and affect both men and women, mostly between the ages of 40 to 50 but can occur at any age. It can also arise from activities not related to sports, such as household chores or work that requires repetitive gripping, like painting, but can also occur form a traumatic injury, such as a blow to the elbow.

Symptoms 

Pain with activities such as lifting, gripping and grasping that starts in the elbow but often radiates down the forearm to the hand. 

Diagnosis and Treatment  

The diagnosis of tennis or golfer’s elbow is usually made clinically by a thorough history and physical examination by your doctor. Sometimes your doctor may order different images such as X-Rays or MRIs to rule out other conditions.

Prevention and Treatment

  • Activity Modification 

If the pain is from playing tennis or golf it is often recommended that you be evaluated by a tennis or golf professional to make sure you are using proper equipment and have proper technique. 

  • Rest & Ice

It may be necessary to stop the aggravating activity all together, for a period of time to allow the soft tissues to heal. Try to avoid heavy lifting, pushing, pulling or repeated hand shaking. Using two hands for heavier lifting can help protect the injured arm. Apply ice 2 to 3 times a day for 15 to 20 minutes at a time when the condition first starts or after actively using the arm to help diminish the inflammation.

  • Stretching 

Stretching can help with tendonitis by keeping muscles and tendons flexible and preventing stiffness. It can also help break down scar tissue that may have formed.

  • Physical/Occupational Therapy

Therapy can help in many ways. Initial treatment is aimed at diminishing inflammation and stiffness while subsequent treatment helps strengthen forearm muscles, which can help prevent future episodes from occurring.

  • Medications 

If there are no medical contra-indications, over-the-counter pain medication, like Advil, Aleve or aspirin, can be taken to help reduce inflammation and pain.

  • Bracing

The counter-force brace is a padded strap that can be worn on the forearm, just below the elbow. By putting gentle pressure on the muscles, tension is released on the tendon. Bracing can be used for treatment and can be used to prevent recurrence in the future by wearing for all activities that put a lot of stress on the arm.

  • Cortisone Injections

Cortisone injections usually reduce the pain in the arm for an extended period of time but do not always diminish the time it takes for the elbow to fully heal. 

  • Platelet Rich Plasma (PRP)

PRP is a procedure where blood is withdrawn and then is processed to concentrate the platelets so they can be re-injected into the area of tendonitis. This procedure can usually be done in the office. This is a newer technique and research on this treatment modality continues.

  • Surgery

Surgery is the last resort. If conservative treatment fails and symptoms have been present for at least a year then surgery can relieve the pain. The aim of surgery is to remove degenerated or worn out tissue from the tendon and release tension on the tendon. Symptoms can take several months to fully resolve and a small percentage of people may still have some symptoms, even after surgery.

Prognosis 

Most cases of tennis and golfer’s elbow will resolve with conservative care but can take a long time to fully resolve.

If you have been suffering from symptoms of golf or tennis elbow, schedule a consultation with one of our talented physicians for an evaluation and treatment plan. 

Thumb Arthritis

By: Dr. Doron Ilan

Do you have?

  • Pain in thumb and/or wrist with activities that involve gripping, grasping or pinching, such as opening a jar, turning a key, or taking milk out of the fridge
  • Swelling and tenderness at the base of the thumb (fleshy part)
  • An aching discomfort after prolonged use such as writing 
  • Loss of strength in gripping or pinching activities
  • An enlarged, “out-of-joint” appearance
  • Development of a prominence or bump over the joint at the junction of thumb and wrist

If you are experiencing these symptoms, you may have arthritis at the base of your thumb, or “Basal Joint Arthritis”, the wearing out of the cartilage at the joint that allows you to oppose your thumb (the human joint).

Thumb arthritis can start as early as 40 years old and is more frequent in women. With proper diagnosis by an Orthopedic Surgeon/Hand Specialist, you can begin to gain some relief through various treatment options, depending on severity of symptoms and effect on activities of daily living.

Treatment of Thumb Arthritis

  • Initial treatments may involve activity adjustments, rest, bracing, oral or topical anti-inflammation medications, specific exercises and hand therapy.   
  • Most people are successfully managed without surgery but eventually symptoms may no longer respond to treatment and at that point surgery may be considered 
  • There are many conditions that can mimic arthritis (tendinitis, cysts, sprains, joint inflammation, rheumatoid arthritis, Lyme disease, trigger finger, carpal tunnel syndrome) so it is important to see an Orthopedic surgeon/hand specialist to confirm the diagnosis.

Diagnosis is the first step, so reach out to us to schedule your appointment with one of our board-certified doctors today for an evaluation.

Preventing Gardening Injuries

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year.

By: Dr. Doron Ilan

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year. Back injuries, hand lacerations/puncture wounds, infections, overuse tendinitis, bug bites, and heat exhaustion are some of the more common medical conditions seen in recreational gardeners. Here are a few tips to keep you safe this spring and summer.

  • Warm up: One of the most common mistakes is to head straight to the shed and start lifting heavy bags of mulch, soil, and equipment. This can lead to back sprains and muscle strains.  Instead, first, take a 5-10 brisk walk to warm up the muscles, loosen the joints and get the heart rate up a bit.
  • Wear gloves: This will prevent most thorn punctures, blisters, lacerations, and bug bites. It will also protect your skin from pesticides, bacteria, and fungus (often live in soil). A small cut can lead to a major infection. A light long sleeve shirt and long socks or pants can’t hurt either.  Don’t forget the sunscreen and a hat.
  • Hydrate: It is very easy to spend hours gardening without drinking. Bring a bottle of water outside with you and sip regularly
  • Rotate your tasks: Avoid overuse repetitive stress injuries by not spending more than 10-15 minutes in a row doing the same motion. Make sure your gardening activities are varied so that the same muscles are not used repetitively.
  • Use proper equipment
  • Check your skin for ticks after you finish gardening for the day. Lyme disease and other tick-borne infections are very common in our area.

Following these tips can help minimize your risk, but of course, if you do sustain an injury make sure to get medical attention as soon as possible.  Have a great spring and summer — and enjoy your gardening!

If you do encounter an orthopedic injury while gardening, contact us today to find out what’s wrong and how we can help.

The Most Common Types of Shoulder Pain, Explained

The shoulder is an efficient combination of joints, muscles and tendons that enable a wide variety of movement and range of motion. However, its utility and versatility make the shoulder prone to a variety of injuries and conditions. In fact, shoulder pain will affect up to 70 percent of the population in their lifetime. It can be disabling and result in a host of unwanted consequences.

Below are some of the most common painful shoulder conditions:

Biceps Tendinitis

The biceps tendon is a structure that connects the biceps muscle to the humerus (upper arm bone) bone near the shoulder joint. Biceps tendinitis, a common cause of shoulder pain, is an irritation or inflammation of the upper part of the tendon.

Causes

Often, biceps tendonitis is due to wear and tear. It can also be connected to other shoulder issues, such as instability, shoulder impingement or a rotator cuff injury. It is particularly associated with damage to the rotator cuff tendon.

Repeated motion in work or sport—particularly those activities that require overhead motion, such as construction work, painting, swimming, tennis and baseball—can also cause biceps tendinitis.

Treatments

  • Rest (from overhead activity)
  • Ice
  • Medication
  • Physical therapy
  • Steroid injections

Surgery-If more conservative measures have been exhausted, surgery may be indicated. This may entail biceps tenodesis, which is detaching the tendon from the shoulder socket and reattaching it to the upper arm bone.

Rotator Cuff Tear

The rotator cuff is involved every time you move your shoulder. It helps to stabilize the shoulder. So, it stands to reason that it is a commonly injured area. Rotator cuff tears can either be partial or incomplete (a tear that is frayed), or complete, which entails a tear that goes completely through the tendon.

Causes

There are two main causes of rotator cuff tears. They can occur from an acute injury (such as a fall or other cause of severe twisting motion of the joint). An acute injury can also be caused by the stress of improperly lifting a heavy object.

However, most rotator cuff tears occur due to progressive degeneration (wear and tear) over time. The incidence of tears increases with aging. It is important to determine the cause of a rotator cuff tear since this impacts what treatment is recommended.

Treatments

  • Rest
  • Modified activity
  • Medications
  • Physical therapy
  • Steroid injections

Surgery: If conservative measures have not offered relief or if the tear is severe, surgery may be indicated. This is particularly the case for athletes or those who engage in repetitive overhead movement, since many tears do not heal on their own.

Shoulder Impingement

Shoulder impingement syndrome, which is also sometimes called “bursitis” or “tendinitis”, occurs with the repetitive compression (“impingement”) of the rotator cuff during movement. A thorough and careful examination is the best approach to a personalized diagnosis.

Causes

Shoulder impingement is also the result of repeated overhead activity involving the shoulder. It can also be caused by a shoulder injury. Finally, in some cases, there is no known cause of the condition.

Treatment

  • Rest (from overhead activity)
  • Ice
  • Medication
  • Physical therapy
  • Steroid injections 

Surgery: If other treatments do not provide results, surgery may be indicated to increase the space around the rotator cuff. The procedure, which can usually be done with minimally invasive arthroscopy, allows free movement without the compression or rubbing on the bone and the resulting pain.

Frozen Shoulder

Frozen shoulder, technically called adhesive capsulitis, is a condition causing stiffness, pain and immobility in the shoulder joint. It is due to a thickening and tightening of the shoulder joint capsule which restricts room for movement.

Causes

While the causes are usually unclear and cannot be identified, some people suffer frozen shoulder following a recent injury or fracture to the area which resulted in a need to immobilize the shoulder. In about 10 to 20 percent of cases, it can be caused by diabetes. Other medical problems may put people at risk for frozen shoulder (hypothyroidism, hyperthyroidism, Parkinson’s and cardiac disease).

Treatments

  • Medications
  • Physical therapy
  • Steroid injections

Surgery is rarely required for frozen shoulder. Although recovery can take a long time (up to a couple of years), in the majority of people it resolves on its own with the use of nonsurgical treatments. In the event of surgery, manipulation under anesthesia and/or arthroscopy are performed to release the scar tissue.

If you’re having shoulder pain, contact us today to find out what’s wrong and how we can help.

What Is Frozen Shoulder?

Adhesive capsulitis, a common cause of what is known to most people as frozen shoulder, is a condition that occurs when the capsule that surrounds the ball joint in the shoulder begins to form scar tissue. This scar tissue causes a drastic decrease in mobility (hence the “frozen” aspect), as well as severe pain. Not every frozen shoulder is Adhesive Capsulitis.

What Causes Frozen Shoulder?

It is often unknown what causes frozen shoulder to take hold, but there are several factors that can play a part in the likelihood of a person being diagnosed.

Those factors include:

  • Age and gender- Frozen shoulder typically affects patients between the ages of 40 to 60 years old. It is much more common in women than men.
  • Endocrine disorders- Patients with diabetes are at a particular risk for developing frozen shoulder, but other endocrine abnormalities can also lead to the development of this condition, such as thyroid problems.
  • Shoulder trauma or surgery complications- Patients with a shoulder injury or shoulder surgery can develop a frozen shoulder joint. The risk is even higher when the injury or surgery is followed by prolonged joint immobilization.This is usually not the same as Adhesive Capsulitis, but may be treated in a similar way.
  • Other systemic conditions- Pre-existing conditions like heart disease and Parkinson’s disease have been known to be a factor for people who suffer from frozen shoulder.

What Are the Treatment Options for Frozen Shoulder?

According to the American Academy of Orthopedic Surgeons (AAOS), 90 percent of patients with frozen shoulder improved range of motion and had a decrease in pain due to light and consistent physical therapy.

Exercises that might be incorporated into a physical therapy treatment plan include:

  • External rotation
  • Stand in a doorway, then bend affected arm 90 degrees in order to reach the doorjamb. Keep hand in place while rotating the body. Hold for 30 seconds. Relax and repeat
  • Forward flexion
  • Lie on back with legs straight. Use unaffected arm to lift affected arm overhead until there’s a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat
  • Crossover arm stretch
  • Gently pull one arm across chest just below chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat

In addition to physical therapy and exercise, a physician might prescribe the following:

  • Non-steroidal anti-inflammatory medicines
  • Drugs like Aspirin® and Ibuprofen® can temporarily reduce pain and swelling
  • Steroid injections
  • Cortisone injections are injected directly into the shoulder joint to work as a powerful anti-inflammatory

If symptoms related to frozen shoulder are not relieved through conservative treatment options, then surgery might be recommended, although this is not very common

There are two different procedures that are most commonly used in treating frozen shoulder:

1. Manipulation under anesthesia

During this procedure, the patient is put to sleep, and the shoulder is moved in ways that can stretch and tear the stiff adhesions. This will allow relief from the tension that the adhesions cause and can increase range of motion.

2. Shoulder arthroscopy

In this procedure, a doctor cuts through tight portions of the shoulder capsule. This is done by inserting pencil-sized instruments through very small incisions around the affected area. This method breaks up scarring tissue and allows for increased range of motion and eventual pain relief after recovery.

Sometimes, the two procedures are performed in tandem in order to achieve the best possible results.

What Is the Window of Recovery After a Procedure?

The best possible results are achieved by patients who thoroughly follow their rehabilitation plan. Recovery times vary depending on the severity of a patient’s frozen shoulder, ranging typically from six weeks to nine months.

If the rehabilitation process is followed thoroughly, outcomes are usually very positive. The range of motion is restored, and pain generally becomes non-existent.