Hand, Shoulder and Upper Extremity Surgery
The treatment of musculoskeletal issues is one of our differentiating practices at UF Health Shands Hospital, which is among the region’s top locations for orthopaedic care. The field of hand and upper extremity is one of the many focus areas within the UF Health Orthopaedics and Sports Medicine Institute.
Common causes of pain based on the hand & wrist include the following:
Arthroscopic surgery of the wrist, elbow and shoulder
Arthroscopic surgery is a widely used procedure for various body parts that gives doctors the ability to spot and repair issues without the need for large incisions. This technique is most certainly applied to the wrist, elbow and shoulder.
A tiny camera, or arthroscope, is inserted through a small incision and is connected to a video monitor in the operating room. Making use of this visual, a doctor can examine all tissues (cartilage, bones, tendons and ligaments). If necessary, one to three more small incisions can then be made to insert other instruments and make repairs.
Bursitis
Bursitis in the shoulder refers to an inflamed bursa, which is one of many fluid-filled sacs that serve to lessen friction within your shoulder. Shoulder bursitis is typically accompanied by pain on the outside of the shoulder that can travel down the arm to the elbow or wrist.
The pain is also magnified during activities that force the use of your arm above head level. This condition is usually caused by repeated incidents of minor trauma or a single incident of major trauma.
Elbow bursitis is a form of inflammation that arises in the boney tip of the elbow (olecranon), and more specifically in the thin, fluid-filled sac located there called the olecranon bursa. Oftentimes, the first symptom of bursitis is swelling that limits elbow movement, although there can be other symptoms such as pain, redness and being warm to the touch.
Carpal tunnel syndrome
Those suffering from carpal tunnel syndrome experience pain, numbness and tingling in the hand and arm. This frequently occurring condition stems from a compression of one of the major nerves in the hand, the median nerve.
Prompt treatment of carpal tunnel syndrome helps to avoid permanent damage. Risk factors for the condition are: heredity, performing the same hand/wrist motions over and over for a long span of time and pregnancy. Other health conditions such as diabetes or rheumatoid arthritis can also be triggers.
Although non-invasive treatments are typically fruitful among those with carpal tunnel syndrome, some patients could require surgical decompression. Once a one-inch incision is made in the palm over the carpal ligament, the soft tissue is dissected to the level of the ligament and cut to lessen the pressure on the median nerve.
Learn more about carpal tunnel syndrome.
Dislocation
A shoulder, more specifically the humerus (upper arm bone) and glenoid socket, can be subject to a full dislocation or partial dislocation (subluxation). Like other dislocations, the shoulder variety can be more severe if ligaments, tendons or nerves are damaged in the process. Some individuals experience reoccurring dislocations, which may cause bone damage to the humerus or socket.
Elbow dislocation occurs when the joint surfaces of an elbow are separated. However, that separation can either be complete or partial (subluxation).
This injury tends to occur when the elbow is tasked with absorbing the force from an individual falling onto his/her outstretched hand. This can happen during any type of physical activity or in a car accident when a passenger reaches forward to brace for impact.
Elbow replacement
If an elbow joint is severely damaged and there’s resulting pain or immobility, an elbow replacement surgery can be an option. This procedure serves to replace the elbow joint with artificial joint parts, or prosthetics. These artificial joints, which are made of high-quality metal, are available in varying sizes to fit appropriately.
Those who undergo elbow replacements usually experience their damage from osteoarthritis, rheumatoid arthritis, serious bone fracture near the elbow, serious tissue damage or tears in the elbow, a tumor in or near the elbow or just a stiff elbow. In most cases, this surgery successfully reduces pain.
Elbow stiffness or contractures
A stiff elbow, or an elbow contracture, is marked by limited range of motion. Typically, elbow stiffness manifests from elbow surgery, fractures, dislocations and burns. Pain isn’t typically associated with elbow stiffness.
Flexor tendon repair
Flexor tendons are the tissues in your hand that help control movement in your fingers and thumb, and these essential motions stem from long tendons that extend from the forearm. This movement can be compromised by a deep cut on the palm side of your fingers, hand, wrist or forearm.
Since tendons can only heal with their ends touching, complete tears oftentimes require surgery. The surgeon will choose the best method to approach the repair based on the nature of the tendon tear. Partial tears may not require surgery.
Fractures
The most common hand and wrist fractures tend to happen as an individual attempts to use an outstretched hand to brace themselves as they fall to the ground. Contact sports (such as football or hockey) and in-line sports (such as skating or snowboarding) are also common culprits, along with car accidents.
Osteoporosis, a condition in which bones become more thin and fragile, is also a frequently seen precursor to bones breaking in the hand or wrist. Timely treatment of hand and wrist fractures can minimize the chance that the bones heal without proper alignment.
There are three common types of shoulder fractures: those linked to the collar bone (clavicle), the top of the upper arm bone (proximal humerus) and the shoulder blade (scapula). When it comes to the first two, clavicle or upper arm bone fractures are susceptible to direct impact. Shoulder blade fractures don’t happen as easily. Most shoulder fractures can be corrected without surgery, but major cases are exceptions.
Elbow fractures can range in severity, from those that heal on their own with good treatment at home to those that require surgery. Whether an operation is needed can depend on whether the fracture was a “low-energy” or “high-energy” injury.
The former refers to those caused by falls from standing or another low-impact occurrence. The latter form of fracture is tied to falls from heights, car accidents or other high-impact event.
Frozen shoulder
As the name implies, frozen shoulder is a condition that can limit range of motion, and sometimes to a great degree. The ailment, also called adhesive capsulitis, happens when the shoulder capsule thickens and stiffens with the onset of thick bands of tissue called adhesions. Oftentimes, the shoulder joint doesn’t have normal amounts of synovial fluid that’s needed for lubrication.
The cause of frozen shoulder is not fully known. Women between the ages of 40 and 60, along with those who have diabetes, are at the greatest risk for frozen shoulder. The condition can take multiple years to recover from.
Ganglion cyst
Ganglion cysts are fluid-filled masses or lumps in the hand or wrist that are non-cancerous and are often harmless. A ganglion cyst emerges from the tissues that surround a joint, such as ligaments, and usually appear on the back of the wrist.
Ganglion cysts can experience an increase in size due to heightened wrist activity and can decrease in size with rest. However, the cause of ganglion cysts is unknown.
Impingement syndrome
Impingement syndrome in the shoulder is a state that is closely linked to shoulder bursitis and rotator cuff tendinitis. It’s often called “swimmer’s shoulder” because of its association with those who habitually perform overhead arm movements like those in swimming, tennis, golf, weight lifting or throwing an object.
The rotator cuff, which is situated between the arm bone and top of the shoulder (acromion), is uniquely surrounded by bone. It’s this arrangement that can cause increased pressure and compression in the rotator cuff as well as hindered blood flow in the capillaries. Without normal blood circulation, the tissues in the tendon unravel and break down.
Infection
Infections tend to follow an injury or wound to the skin as bacteria enters the vulnerable area. There are several different types of infections that can occur in the hand or wrist.
Serious problems can arise from them even after the infection has been treated or cured. Several areas of the hand and wrist can be subject to an infection: skin, nail bed, joint, bone, flexor tendon sheath or end of a finger.
Joint pain and arthritis
Arthritis is marked by inflammation of one or more joints that leads to pain and stiffness. This condition leads to a deterioration of the smooth cartilage that surrounds joint surfaces. Without being able to glide over each other smoothly, the bones rub against each other, which causes irreversible joint damage.
There are three common types of arthritis in the wrist: osteoarthritis, rheumatoid arthritis and posttraumatic arthritis. The two joints in the shoulder can both be impacted by arthritis. The pain increases with activity and decreases with rest. Another symptom is less range of motion and a grinding of the bones, or crepitus, can be felt.
Although elbow arthritis is less common than other areas affected by arthritis, the condition still affects many people. In elbows, that pain can be felt when bending or straightening the elbow. Arthritis of the elbow can be caused by some sort of trauma or injury to the joint.
Although there is no cure for arthritis, there are ways to treat the disease to relieve symptoms and slow advancement.
Loose or foreign bodies
Progressive deterioration of the shoulder joint can lead to loose bodies in the surrounding space. At times, an injury to cartilage can produce small fragments of cartilage or bone that move in a free manner around the shoulder. Generally, these bodies can be a product of trauma, inflammatory conditions and osteoarthritis, among other events.
Non-surgical treatment options for a loose body in the shoulder are limited. Anti-inflammatory drugs and physical therapy can assist with symptoms and physical therapy. However, a permanent solution to those symptoms requires removal of that foreign body, which can be done with an arthroscopic procedure.
Loose bodies of bone and cartilage can cause elbow pain, stiffness or locking of the elbow. Removal of these loose bodies can be done with a minimally invasive technique.
Nerve grafting and reconstruction
If a patient suffers a nerve injury that leads to total loss of muscle function or feeling, a nerve graft can be performed. This is a surgical technique in which a portion of unrelated nerve is used to substitute or bridge a damaged section of nerve.
Grafts are chosen from nerves that are either deemed expendable or at least not as much of a priority when compared to the function being restored at the graft’s location.
Rotator cuff tear
There are two main causes for rotator cuff tears: injury and degeneration. Meanwhile, there are two different types of tears: partial (or incomplete) tear and a full-thickness (or complete) tear. If the shoulder is left untreated or still utilized, partial tears can become full-thickness tears due to fraying.
Non-surgical treatments such as rest, nonsteroidal anti-inflammatory medication and physical therapy can lessen pain and boost function in the shoulder.
For surgical treatments, some of the considerations revolve around the severity of the tear and how long the symptoms have persisted. The operation can be accomplished with a large incision or with shoulder arthroscopy, which uses smaller incisions.
Separation
Unlike a shoulder dislocation, a shoulder separation doesn’t involve the shoulder joint. Rather it refers to the AC joint, which is where the collarbone meets the highest point of the shoulder blade.
Separations usually stem from a fall squarely onto the shoulder that can tear ligaments and cause a bump. The severity of the tear and size of the bump can both vary from case to case, but even those with a larger bump often make a 100 percent recovery.
Shoulder replacement
Severe shoulder pain that restricts movement in the arm could be one reason to have a shoulder replacement. This operation involves replacing the bones of the shoulder joint with artificial joint parts. A shoulder replacement can be classified as “partial” or “total” based on whether one or both bones in this ball and socket joint must be replaced.
The limiting shoulder pain that causes replacement can stem from conditions such as osteoarthritis, rheumatoid arthritis, a tumor or a badly broken bone or torn tissues.
Tendinitis
Tendinitis occurs when the thick tissue connecting muscle to bone, or tendon, becomes inflamed or irritated. Tendinitis causes pain and tenderness just outside a joint, but the condition can be assuaged with rest, physical therapy and medications.
While tendinitis can develop in any tendon, it’s more frequently seen around the wrists, elbows, shoulders, knees and heels. Specific types of tendinitis include: tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder and jumper’s knee.
Tendon or ligament injury
Tendons or ligaments are among the most frequent soft tissues to suffer injuries, and those in the hand or wrist are also in danger. In particular, wrists — along with ankles and knees — are most susceptible to sprains.
Setbacks to a tendon or ligament in the hand or wrist can either be acute injuries or overuse injuries. Sprains, strains, contusions (bruises), tendinitis and bursitis are among the types of injuries that can be sustained in these body parts.
Whether an elbow sprain is mild or severe depends on whether it’s a small tear or complete tear. Sprains are usually accompanied by pain, swelling, tenderness, bruising and restricted movement.
Tennis or golfer’s elbow (epicondylitis or tendinitis)
Tennis elbow is characterized by pain or soreness on the outside (lateral) part of the lower arm near the elbow, while golfer’s elbow is felt on the inside (medial) part. This condition is caused by repetitive use of a particular tendon that attaches a muscle to a bone in the elbow, eventually leading to tears in the tendon.
The specific motion that leads to tennis elbow is a constant twist of the wrist that is continuously practiced in tennis or other racquet sports. Golfer’s elbow is usually tied to golf, baseball or other throwing sports, as well as weight training.
Torn labrum
Shoulder joints can experience tears in the glenoid, which is a shallow socket in the shoulder blade. Helping to stabilize the joint is a soft fibrous tissue rim called the labrum.
A glenoid labrum tear can occur above (superior) or below (inferior) the middle of the glenoid socket. A SLAP tear occurs above the middle of the socket, while possibly affecting the biceps tendon. A Bankart tear occurs below the middle of the socket, while possibly affecting the inferior glenohumeral ligament.