Hand and upper extremity

Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other activities. To do these activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.

In 2006, approximately 7.5 million people went to the doctor's office for a shoulder problem, including shoulder and upper arm sprains and strains. More than 4.1 million of these visits were for rotator cuff problems. Most problems in the shoulder involve the muscles, ligaments, and tendons, rather than the bones. Athletes are especially susceptible to shoulder problems. In athletes, shoulder problems can develop slowly through repetitive, intensive training routines. Some people will have a tendency to ignore the pain and "play through" a shoulder injury, which only aggravates the condition, and may possibly cause more problems. People also may underestimate the extent of their injury because steady pain, weakness in the arm, or limitation of joint motion will become almost second nature to them.

What are the most prevalent hand and upper extremity conditions?

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men. The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb, index finger, and long fingers. The nerve also controls the muscles around the base of the thumb. The tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons. Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers. This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve.

Dupuytren's Contracture

Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex). Dupuytren's contracture is more common in men than in women.

Ganglion (Cyst) of the Wrist

Ganglion cysts arise from the capsule of a joint or the sheath of a tendon. They can be found at different places on the wrist. A ganglion cyst that grows on the top of the wrist is called a dorsal ganglion. Others are found on the underside of the wrist between the thumb and your pulse point, at the end joint of a finger, or at the base of a finger. Most of the time, these are harmless and will often disappear in time.

Rotator Cuff Injuries

The rotator cuff is one of the most important components of the shoulder. It is comprised of a group of muscles and tendons that hold the bones of the shoulder joint together. The rotator cuff muscles provide individuals with the ability to lift their arm and reach overhead. When the rotator cuff is injured, people sometimes do not recover the full shoulder function needed to properly participate in an athletic activity.

Shoulder Impingement

Impingement is caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade, called the acromion. Impingement problems can occur during activities that require excessive overhead arm motion. Medical care should be sought immediately for inflammation in the shoulder because it could eventually lead to a more serious injury.

Shoulder Instability

Sometimes, one of the shoulder joints moves or is forced out of its normal position. This condition is called instability, and can result in a dislocation of one of the joints in the shoulder. Individuals suffering from an instability problem will experience pain when raising their arm. They also may feel as if their shoulder is slipping out of place.

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other sports and activities can also put you at risk. Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

Trigger Finger

Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight. Trigger finger is a condition that affects the tendons in your fingers or thumb.

How are hand and upper conditions treated?

There are many nonsurgical treatment options, including exercise, rest, bracing or splinting, anti-inflammatory medication, occupational or physical therapy, and steroid injections. Some conditions may require surgical treatment.

Source: AAOS Research Department