Orthopaedic surgeon Dr. Megan Wood specializes in the hand, wrist and elbow. Below she outlines the most common injuries to those areas and how to treat nagging problems. This represents a general approach toward patient care and is in no way intended to be used as a definitive treatment plan or for self-diagnosis.
What are the most common hand, wrist, and elbow injuries you see?
The most common hand, wrist and elbow injuries seen in my practice are traumatic injuries to the hand, including finger fractures and wrist fractures, as well as injuries to the forearm and, less commonly, the elbow. These injuries can be from a simple fall, from a more high-level type of activity, sports injury or related to other types of activities.
In addition, I commonly see patients for compressive neuropathy, which includes problems such as carpal tunnel syndrome, cubital tunnel syndrome and other nerve injuries. We also see forms of tendinitis, which can be common in the wrist and elbow. Also, I often see patients with ligament sprains.
How do you treat each of these injuries?
Each condition is treated based on its mechanism. For example, a workup of fractures includes x-rays followed by a determination of the severity of the break. Based on each patient’s injury as well as their health and level of activity, I dictate specific treatment plans. These treatment plans can range from splinting and casting to surgery.
For compressive neuropathies, we aim at activity modification, education of the patient, splinting, occasional corticosteroid injection and surgical decompression of compressed nerves, if needed. This may also include workup with nerve conduction studies.
With regards to tendinitis, again this is dictated by the patient’s activity level. Activity modification, including splinting, is recommended, as well as steroid injections. Many patients are also referred for physical therapy for relief of their injuries.
How can hand and wrist pain best be treated?
There is a multifactorial approach toward each patient. Workup of hand and wrist pain initially begins by examining the patient and their medical history. Based on these findings, each treatment is individually dictated. What works best for an elite athlete may be totally different from treatment for an elderly patient. All treatments are conservatively based initially, but the ultimate plan is dictated by agreement between the physician and the patient, factoring in the patient’s heath, goals and what is medically indicated.
When should I know if it’s best to see a doctor or simply rest my injuries?
It is best to see a doctor if there is any acute injury with concern for possible fracture or significant injury that causes substantial pain, swelling, bruising or discoloration. Initially, x-rays will need to be taken. Occasionally, this can be done at an outside facility on an emergency basis and then evaluated by me for a definitive treatment course. If an injury seems to be related to overuse, we typically recommend that patients try avoiding the offending activity, coupled with a trial period of rest, ice and elevation and use of anti-inflammatories or over-the-counter pain medicine. If it does not seem to respond to this after a period of time, typically a week or two, then medical treatment should be sought.
What are the dangers of carpal tunnel?
Carpal tunnel syndrome occurs when there is long-term pressure of the median nerve at the level of the wrist. Initially, symptoms include numbness and tingling in the fingers or hand. Occasionally, symptoms may migrate all the way up the arms. Typically, patients have symptoms of pain, numbness and tingling for a while before significant long-term damage can occur. However, if carpal tunnel syndrome is ignored for an extended period of time, it can lead to permanent numbness in the fingers, particularly in the elderly. This may or may not be recoverable after surgical decompression. Therefore, it is advisable to seek medical attention for further evaluation with regards to these symptoms to ensure the patient is not suffering from any permanent sensory loss or muscle atrophy.