What Are Elbow Ligament Injuries, Tennis Elbow and Golfers Elbow?

Elbow Ligament Injuries or MCL (Medial Collateral Ligament) injuries occur frequently in athletes who throw. The MCL happens to be a vital stabilizer, particularly during an overhead throwing motion. Recreational athletes, non-throwing athletes, and professional quarterbacks who suffer from these ligament injuries usually do not need surgical intervention. In manual laborers, javelin throwers, or baseball players, the ligament might need to be repaired in order to restore the earlier levels of activeness or athleticism. 

If the Median Collateral Ligament gets torn with an acute pop, an MRI scan with dye injected into the elbow is usually ordered for confirming the diagnosis. If the ligament of a high-level thrower gets torn, it is usually treated surgically. In absence of a pop, a minimum of 12 weeks of non-operative treatment that includes strengthening of muscles around the elbow should be attempted in order to avoid surgery. 

Tennis Elbow and Golfers Elbow are two different kinds of problems. The problem is called Tennis Elbow when the tendon issues occur on the outer side of the elbow. The problem is termed Golfers Elbow when the tendon concerns occur on the inner side of the elbow. The conditions are the same, but the areas are different. Although the tendon problem of Tennis Elbow and Golfers Elbow can be caused by an injury, they are frequently due to overuse of tendons that leads to tendon breakdown, over time. Known as “tendinosis”, this kind of tendon damage means tendon degeneration.

What Are Subscapularis Tears and SLAP Lesions?

The largest rotator cuff muscle is known as the Subscapularis. This muscle has a tendon attachment that is separate from the other rotator cuffs. Subscapularis Tears are tendon tears that result in significant weakness, pain, and often total impairment of shoulder elevation. 

Subscapularis Tears are often part of large rotator cuff tears. Being a vital stabilizer of the biceps tendon, the Subscapularis when torn almost always results in subluxation of biceps tendon.

Subscapularis tendon tears need to be separately looked for intentionally, during an arthroscopic shoulder examination. Fortunately, these tears can be arthroscopically repaired. 

SLAP Lesions or Superior Labral Anterior-Posterior lesions are tears of the labrum adjoining the top portion of the glenoid socket. The labrum is also known as the meniscus of the shoulder. SLAP Lesions result in a detachment of the base of the Long Biceps Tendon as that tendon essentially sources from the top of the labrum. Young overhead athletes, particularly swimmers and throwers, usually suffer from such lesions. 

These lesions can also occur in people from any age-group due to trauma caused by skiing, fall, or motor vehicle accident. A tight shoulder can often pre-dispose to a SLAP lesion in throwers. It is absolutely essential that pitchers allow their throwing shoulder stay stretched. SLAP lesions can be prevented by using the sleeper stretch, on pitchers. Symptoms of these lesions typically are pain, tightness, and soreness in the outside or back of the shoulder. There might be a catching or snapping sensation occasionally. 

What Are Proximal Interphalangeal (PIP) Joint Injuries and Skier’s Thumb?

A PIP or Proximal Interphalangeal Joint is the middle joint of a finger. This joint can be pretty unforgiving, becoming extremely stiff, when injured. There are varying degrees of Proximal Interphalangeal (PIP) Joint Injuries. 

A simple dislocation without any fracture is invariably a stable injury. Splinting a simple dislocation can be counter-productive as it often results in stiffness. This stiffness often becomes so severe within 3 to 4 weeks that nothing less than a surgical procedure is able to restore motion. What is often not realized is that a finger bone heals fast. If a joint bears a fracture that is significant, the injury can essentially turn irreparable within just 3 weeks. This is why a hand surgeon should be consulted quickly after Proximal Interphalangeal (PIP) Joint Injuries. 

Skier’s thumb, which was previously known as Gamekeeper’s Thumb, is an injury whose present principal cause is skiing, resulting in the change in name. This injury is suffered by the Ulnar Collateral ligament of the MP or Metacarpophalangeal Joint of the thumb, which is the sturdy joint that attaches the thumb to the hand. Ligaments are structures functioning as joint stabilizers. Each finger joint has a ligament that stabilizes the joint. 

Skier’s thumb is often the result of a fall onto the thumb, particularly when the thumb is harshly bent back by a ski pole, the ground, or anything that stresses the Ulnar Collateral ligament by pulling the thumb away from the hand.

Painless Surgery Procedures for Hand, Wrist, Elbow and Shoulder

New methods are being employed to restore function and eliminate pain from hand, wrist, elbow and shoulder. Patients are treated without surgery very successfully. These minimally invasive procedures are used for different joint injuries like:

Metacarpophalangeal (MP) Joint and Proximal Interphalangeal (PIP) Joint

Arthroscopy procedure involves use of two small stab wounds to visualize and instrument the MP joint and PIP joint. Finger connects the hand at metacarpophalangeal joint and middle joint of the finger called as proximal interphalangeal joint. For joint pain and inflammation steroid injection is given. But in case of torn ligament or cartilage injury resulting in enormous pain, arthroscopy procedure will not only diagnose the pain but will provide significant relief too.

EPL Tendon Rupture

EPL (extensor pollicis longus) tendon rupture can occur in case of arthritis and bony spur. This tendon holds the thumb and prevents it from falling into the palm. Tendon rupture can be repaired by tendon transfer that uses the nearby tendon to replace with the damaged one. It is one of the quickest outpatient procedures.

   

Flexor Tendon Injuries

Another traumatic event, an injury in flexor tendon could be life-changing event. These flexor tendons are responsible for bending and flexing the thumb and fingers. It is very difficult to repair the cut flexor tendons as there is no space left for giving sutures. They need to be repaired quickly else they die or become irreparable. Surgery is not very painful and works best along with the hand therapy provided after procedure.

Mucous Cysts, Retinacular cysts and Dupytren’s contracture – An overview

Mucous Cysts

Mucous Cysts are a common cause of finger masses, especially over the tiny finger joint that is closest to the tip. These cysts are a kind of ganglion cyst which generally arises due to an underlying arthritis of that particular joint. 

Aspirating the cyst is the initial treatment recommended. This should not be done by the patients or by inexperienced people. The cyst connects itself to the underlying joint; if an infection is likely to occur, it can spread to that joint, eventually resulting in a serious problem. It is crucial to understand that to remove the cyst permanently, the underlying joint should be addressed.  Mucous cyst excision is a procedure which has proven to be very successful.

Retinacular cysts

Tender masses which appear in the palm near the base of a finger are probably the retinacular cysts. These cysts are simply ganglion cysts coming from the finger’s flexor tendon sheath. The cysts often result in pain when the patient grips objects. Luckily, the cysts are benign and treated easily.

Aspiration is generally successful in the treatment of retinacular cysts. But, as for ganglion cysts in another place, as soon as a cyst recurs, further aspirations may not be the effective form of treatment. If there is a recurrence of a retinacular cyst following a successful aspiration, options are to either live with it or get it removed surgically. Surgery is a very quick outpatient procedure.

Dupytren’s contracture

Dupytren’s contracture is a genetic disorder wherein the fascia of the hand tends to contract, making it difficult for the fingers to extend fully. This condition occurs in people of Scandinavian ancestry. Treatment options include Xiaflex and Needle Aponeurotomy. 

The Most Common Syndromes Involving the Hand, Arm and Wrist

There are several kinds of problems that cause pain in the hand, arm, wrist and fingers. Of the lot, carpal tunnel syndrome, pronator syndrome and ulnar tunnel syndrome are quite significant. 

Carpal tunnel syndrome is a condition that involves tingling, numbness etc. of the hand and arm. It is usually caused due to a pinched nerve in the wrist. Several factors contribute to this syndrome including a few underlying health issues, different patterns of hand use and the anatomy of the wrist. Luckily, proper treatment relieves the numbness and tingling, eventually restoring hand and wrist function. 

Pronator syndrome is a nervous system disorder that causes weakness, pain and numbness in the elbow, upper arm and hand. The syndrome is normally caused due to the compression of the median nerve by either muscles or ligament-like structures present in the forearm. Well, if treated appropriately, the symptoms of this particular syndrome generally resolve. In rare cases, surgery may be necessary. However, these days, there are several non-invasive surgeries performed by expert orthopedic specialists. 

Ulnar tunnel syndrome is another condition involving the hand. It occurs owing to the compression of the ulnar nerve at the wrist. Generally, the ring and small fingers become numb. Symptoms are quite similar to cubital tunnel syndrome symptoms because the same ulnar nerve is involved; however, ulnar tunnel syndrome seems to be less common. Ulnar tunnel syndrome is probably caused by a mass like a ganglion cyst or due to the fracture of an adjacent wrist bone. Nevertheless, by resorting to a reliable medical facility, the symptoms can be treated successfully.

Triangular Fibrocartilage Complex - Injury, Signs & Symptoms

The triangular fibrocartilage complex (TFCC) is located in the wrist between the ulnar bone end and the carpals. It is a complex structure and is a major function is stabilising, cushioning and smooth movement at the radioulnar joint of the wrist. It has an extended triangular shape and consists of –

• The triangular fibrocartilage disc.
• Ulna meniscus.
• Ulnar collateral ligament.
• Several carpal ligaments.
• Extensor carpi ulnaris (ECU) tendon sheath.

You can tear your triangular fibrocartilage complex TFCC from various activities like playing sports, fall with an extended arm etc. The TFCC tear can cause pain in the wrist. Other symptoms of this injury include pain on the side of the pinky finger, tenderness on the wrist back. You will experience extreme pain if you bend your wrist sideways. You will also suffer from swelling in the wrist and loss gripping strength. 

In most of TFCC injury, traditional treatment works wonders. This treatment involves adding a splint to your wrist for approximately 4 weeks. After this period a removable splint is added allowing you to move your wrist slowly. Other treatments include anti-inflammatory medication, electrotherapy, mobility and strengthening exercises. 

Another problem that your wrist may suffer is the Kienbock's disease. It is also known as avascular necrosis of the lunate, occurs when the lunate bone in the wrist is damaged due to loss of blood supply. It is a rare and incapacitating disease that can lead to chronic pain and dysfunction. An Australian radiologist Robert Kienböck first mentioned the disorder and thus it got its name after him. 

The National Institutes of Health stated that affected will at first have the feeling of sprain in their wrist. It is progressive disease and hence its symptoms do not fade ways easily. However, the progress of Kienbock's disease is different from patient-to-patient. Initially, the patient suffers from swelling and pain but later the entire mechanism of the wrist is affected.