Common Hand/Wrist and Elbow Injuries

Carpal Tunnel Syndrome

This is a common condition that I treat in my practice in Los Angeles. It is caused by compression of the median nerve in the wrist by the transverse carpal ligament.

Carpal Tunnel Syndrome can cause numbness, tingling, loss of dexterity in your fingers as well as decreased grip strength. Patients often complain of a feeling of lightening or electricity in their hands, especially in the palm, thumb, index finger, middle finger and part of the ring finger. There is usually no discomfort in the small finger. There can also be pain which awakens the patient. This is called “night pain”. The patient is often awakened at night and has to shake or massage their hands or wrist due to the “night pain”.

Risk factors and possible associations and causes of Carpal Tunnel Syndrome are quite extensive.

1. There are many issues that can be associated with Carpal Tunnel Syndrome. Such as

  • Obesity
  • Previous trauma to the wrist or forearm
  • Kidney Failure
  • Rheumatoid Arthritis
  • Thyroid Dysfunction
  • Menopause
  • Diabetes
  • Poor Ergonomic balance of the workstation
  • Possibly repetitive motion ( ex: assembly line work)
  • Possibly use of vibratory machines

There is no conclusive evidence that playing video games or extensive typing causes Carpal Tunnel Syndrome.

Pregnancy and Carpal Tunnel Syndrome

Gestational Carpal Tunnel Syndrome can occur during pregnancy due to the imbalance of fluids in the body. Retention of fluid can cause excess pressure in the Carpal Canal which can cause Carpal Tunnel Syndrome during pregnancy.

The Carpal Tunnel Syndrome usually improves after the pregnancy.

Preventive Strategies for Carpal Tunnel Syndrome

The scientific data does not have any conclusive evidence or documentation about how to prevent Carpal Tunnel Syndrome. Here are possible strategies that may help you.

1. Use The Try-Angle

  • Do the Gliding Exercises
  • Review the Try-Angle video about Carpal Tunnel Syndrome and exercises.

2. Take exercise and stretch breaks

  • Take a 5 minute break after 60 minutes of continuous work. Get out of your office space or gaming station and stretch and stand up for 5 minutes every hour.

3. Manage Your Posture

  • Be sure that your work and gaming station is ergonomically balanced. ( Insert a YouTube video or ergonomic) Remind yourself with a timer on your computer every 15 minutes to alert you to maintain a straight spine and square shoulders while at your desk.

4. Adjust and Maintain Computer Equipment

  • Be sure to use a keyboard and mouse that ergonomically fit your hands and wrists. The equipment must be comfortable, functional and well maintained.

5. Ambient/ Room Temperature

  • Use The Try-Angle to warm your hands. Keep your work environment warm to minimize discomfort, cramping and even stiffness of your fingers and wrists.

6. Take frequent breaks from typing or texting or using your phone.

Diagnosing Carpal Tunnel Syndrome

Your healthcare provider will confirm a diagnosis of Carpal Tunnel Syndrome after the following:

1. Getting an appropriate history from the patient.
2. Doing a complete physical exam.
3. Ordering ancillary tests, as needed such as an EMG/ NCV or Radiographs of the wrist and sometimes an MRI if a mass or tumor is suspected.

Treatment Options for Carpal Tunnel Syndrome

1. Non-invasive Treatment

  • Rest
  • Occupational Therapy or Physical Therapy
  • Acupuncture
  • Bracing/ Splints ( Night time bracing is critical to prevent hyper-flexion of the wrists while sleeping)
  • Gliding Exercises with the Try-Angle. Doing the Try-Angle Gliding exercises 3 times per day for 3 minutes

Invasive Treatments for Carpal Tunnel

1. Corticosteroid injections.

Often one or two injections are given before more invasive techniques are done.

2. Carpal Tunnel Release Surgery.

This surgery is often done with a mini-open or via endoscopic surgical approach.

Risks of Carpal Tunnel Release Surgery

  • Bleeding
  • Infection
  • Scarring
  • Pain
  • Nerve Damage
  • Reflex Sympathetic Dystrophy (RSD)
  • Artery/ Vein disruption

Carpal Tunnel Release Post-Op Surgical Considerations

1. Sutures are usually removed 10-14 days after surgery
2. Post- op therapy protocols vary among surgeons

Cubital Tunnel Syndrome (Ulnar Nerve Neuropathy)

1. What is Cubital Tunnel Syndrome? This is entrapment of compression of the Ulnar Nerve along the elbow. The compression can be from soft tissue impingement or from bone impingement.

2. What are the symptoms of Cubital Tunnel Syndrome?

  • Numbness and tingling in the small finger and ring finger.
  • Pain along the inner ( medial) aspect of the elbow
  • Drifting of the small fifer outward
  • Decreased strength in the small and ring finger.
  • Limited pinch and grip strength involving the small and ring finger.

Possible Causes of Cubital Tunnel Syndrome

  • Repetitive motion involving bending of the elbow
  • Trauma to the elbow
  • Excessive leaning directly in the elbow
  • Inappropriate bone development

Diagnosing Cubital Tunnel Syndrome

1. Done by your healthcare via

  • Comprehensive History
  • Comprehensive Physical Exam
  • Possible X-rays (radiographs of the elbow)
  • Possible EMG/ NCV studies
  • Sometimes an MRI of the elbow.

Treatment Options for Cubital Tunnel Syndrome

  • Splinting (especially nigh time splinting of the elbow)
  • Physical Therapy
  • Using the Try-Angle as an accessory device to increase the strength of the upper extremity
  • Acupuncture
  • Steroid Injections
  • Surgery- is the final option

Medial Epicondylitis (Golfer’s Elbow)

This is pain and often swelling along the inner) medial) aspect of the elbow. The pain is often worse with lifting, pushing or pulling activities.

Causes of Medial Epicondylitis

1. Usually due to repetitive motion and overuse of the elbow and forearm muscles.

2. How to diagnose Medial Epicondylitis. This is done by your healthcare provider via the following:

  • History
  • Physical Exam
  • X-rays
  • Ultrasound ( Sometimes)
  • MRI ( Sometimes)

3. Treatment of Medial Epincondylitis

  • Use cold compresses initially 3 times a day for 15 minutes
  • I recommend moist heat to the area (if it progresses ) for 3 times per day for 15 minutes

4. Treatments

  • NSAID’s
  • Bracing
  • Physical Therapy
  • Acupuncture
  • Steroid Injections
  • PRP ( Plasma Rich Protein) injections
  • Use of the Try-Angle to do exercises 3 timer per day for 3 minutes

Lateral Epicondylitis (Tennis Elbow)

1. This is often associated with pain on the lateral (outside) of the elbow.
2. It is often due to tears or inflammatory changes at the tendon insertion area of the ECRB muscle 9extensor Carpi radialis brevis)
3. Tennis elbow affects 3% of the population

List of Some Associates Causes of Tennis Elbow

  • Repetitive Stress
  • Overuse Syndrome
  • Sports ( Racquet and non-racquet sports)
  • Playing a musical instrument.
  • Weight Lifting
  • Gaming
  • Painting
  • Hair/ Nail Artists
  • Cooking/ Food preparation

(5% of patients with tennis elbow are linked to tennis)

Symptoms of Lateral Epicodylitis

  • Pain and discomfort on the lateral or outside of the elbow
  • Difficult or pushing object
  • Pain at the elbow with flexion of the wrist
  • Swelling along the lateral (outside) of the elbow

Diagnosing Lateral Epicondylitis

1. Your healthcare provider will do the following

  • Comprehensive History
  • Complete Physical Exam
  • X-rays (Radiographs of the elbow)
  • Possible Musculoskeletal Ultrasound
  • Possible MRI of the elbow

Treatment Strategies for Lateral Epicondylitis

  • Rest
  • Bracing
  • Exercises with The Try-Angle 3 times per day for 3 minutes
  • Physical or Occupational Therapy
  • NSAIDs
  • PRP Injections or Steroid Injections
  • Surgery is last option