Lateral epicondylitis, also known as tennis elbow, is an injury that causes pain on the outside of the elbow. It is due to repeated wrist extension and forearm supination movements. Repeated use of these muscles causes microinjuries to the tendon. If this persists over time, irritation and pain develops on the outside of the elbow.
Although commonly known as tennis elbow, this condition is suffered not only by tennis players but also by anyone who performs work that involves repetitive stretching and flexing movements of the forearm and wrist; for example, professional painters, mechanics, labourers or those who work long hours in front of a computer using a mouse.
Lateral epicondylitis is not a very serious injury, though it can significantly affect your life. Most people improve with non-surgical treatments and the condition can even be cured. Symptoms often persist for several months before the condition is completely cured.
Lateral epicondylitis is characterised by the following symptoms:
This pain does not go away with rest or by applying local cold or taking anti-inflammatories.
Every trauma specialist should perform a thorough evaluation in order to diagnose lateral epicondylitis. Among other procedures, this will include:
Lateral epicondylitis can only be prevented with careful “postural hygiene”. Proper movements during sport and work will ensure that the tendons are not subjected to excessive stress. Resting your elbow well after a busy session can also help prevent epicondylitis. Stretching and preventive massages, as well as elbow pads, are helpful.
Treatment for an injury of this nature should be gradual and depend on the severity of the injury.
Initial recommendations include:
If these measures are not effective, the following will be recommended:
If the above treatments also prove ineffective and you still suffer from the symptoms and pain of epicondylitis, surgery will be the next option. Surgery can be performed with an open incision, or using arthroscopy. Arthroscopy is currently the most commonly-used technique as it gives access to the lesion, with a miniature camera, through two or three small incisions. This technique is minimally-invasive, so recovery is faster and less painful.
Epicondylitis is treated by a trauma specialist, who usually has specific training in the treatment of elbow pathologies.
Other professionals may be involved during recovery from an epicondylitis injury, such as physiotherapists, who will provide practical exercises to restore movement, and orthopaedic surgeons, to repair the tendons in the elbow when other treatment approaches have failed.
A frozen shoulder is a condition that causes pain and stiffness in the shoulder and hence a loss of mobility.
The shoulder joint capsule has ligaments that hold the shoulder bones together; when this capsule becomes inflamed, the bones are not able to move freely in the joint, causing a stiffened, frozen shoulder.
Typically, frozen shoulder treatments help to restore mobility and the functioning of the shoulder after one year; even without treatment, it may improve after two years.
In cases that are treated by surgery, this should be followed with physical therapy for a few weeks or months to prevent the frozen shoulder from returning.
The main symptoms of frozen shoulder are pain, stiffness, and decreased joint mobility.
To make a diagnosis of frozen shoulder, the specialist will ask the patient about their symptoms, examine the shoulder, and they may also require x-rays or, less often, an MRI scan.
There are no specific causes of a frozen shoulder, although there are some risk factors:
Generally, a frozen shoulder cannot be prevented, however, if you have suffered a shoulder injury or have recently had shoulder surgery, you should practise certain exercises to keep the joint mobile and avoid stiffening. If your shoulder does become stiff, you should see a specialist as soon as possible.
Frozen shoulders can be treated with NSAIDs and steroid injections, in addition to physical therapy. It may take a few weeks to see progress, and a few months to achieve a full recovery.
Frozen shoulder surgery is recommended when non-surgical treatment is not effective. In these cases, it is performed by a shoulder arthroscopy, which is done under anaesthesia.
Orthopaedic surgeons treat cases of frozen shoulder.
Shoulder replacement surgery involves removing and replacing the damaged parts of the shoulder (usually the head of the humerus and scapula) with artificial implants. These are either made out of plastic or metal, or sometimes both. These implants are usually held in place using a special cement, or if they allow new bone growth, then cement is not required permanently. Although shoulder replacement surgery is less common than knee or hip replacement surgery, it can be just as effective in relieving shoulder joint pain.
Shoulder replacement surgery will usually be recommended if non-surgical treatments, such as medication or changes in physical activity have not been successful in relieving pain. You can experience shoulder pain for a number of reasons, including:
There are several types of shoulder replacement surgery:
Before surgery, certain medications will need to be stopped. It is also important to prepare your home prior to surgery, to make recovery easier. This includes, moving essential things to low-level shelves and having everything easily available. Before surgery you should wear loose-fitting clothes, with a button down shirt that allows easy removal after surgery. Surgery is performed with either general anaesthetic or regional anaesthetic.
After surgery, you will be given antibiotics to lower the risk of infection. Your arm will be in a sling and will have minimal movement. Patients generally return home after 2-3 days following surgery. Pain medication will be prescribed for the short-term, but will be carefully monitored. Physical therapy is also crucial to a good recvoery, and soon after surgery movement will be possible. Driving is not permitted for two to four weeks following surgery.
Shoulder arthroscopy is a minimally-invasive technique that allows access to and treatment of many injuries and diseases of the various structures that make up the shoulder joint. The joint is accessed through two or three small incisions of less than one centimetre.
Arthroscopy has become the technique of choice for shoulder pathologies, enabling the treatment of difficult-to-access structures of the shoulder by providing a complete view of the inside.
Shoulder arthroscopy is used to treat shoulder problems in people with shoulder pain or limited movement who have not improved with medical and physiotherapy treatment. In the past, shoulder injuries required more complex surgeries and recovery periods were longer.
Specifically, shoulder arthroscopy is used for:
Shoulder arthroscopy is performed in the operating room, with the person in a semi-seated position or on their side, placing the arm to be operated on in a traction and positioning device. The specialist will create two holes and introduce the arthoscopy, in order to see the inside of the shoulder clearly. Once the surgery is complete, the specialist will seal up the holes and apply a compression bandage and a sling.
In addition to sedation, local anaesthetic will be applied to numb the nerves that go to the arm. This makes the postoperative period more comfortable and less painful compared to conventional shoulder surgery. The surgery itself takes between 30 and 90 minutes, depending on the condition being treated.
Normally, after the operation, you will spend one night in the hospital and be discharged the next day. You will also be given some instructions on how to take care of your shoulder to ensure a full recovery.
To prepare for the procedure:
You must not eat or drink in the eight hours before surgery
You are likely to feel discomfort during the first few days after the operation, as well as swelling. However, this will soon subside with the help of medication recommended by the surgeon.
You must also wear a sling to immobilise and rest the operated arm for two to four weeks. You should nonetheless carry out some small exercises such as elbow flexions and extensions, and move the fingers. The specialist will explain how to do this.
It is important to avoid the incisions getting wet until the stitches are removed, which will be 5-10 days after the operation. Once the stitches have been removed, rehabilitation will be necessary, and this can last up to eight weeks. As the rehabilitation progresses you will be able to do more activities, such as driving, and, after two to four months, more strenuous physical exercise.
The alternative to shoulder arthroscopy is an open surgical procedure. However, this involves greater joint invasion and a more complicated postoperative period, with greater pain and longer recovery time.
The rotator cuff is a group of tendons and muscles that keeps the upper arm bone (humerus) in the socket of the shoulder blade. Sometimes the rotator cuff can be torn which causes pain, limited motion and weakness. If the tear is particularly bad or non-surgical methods have failed to repair the rotator cuff, then surgery will be recommended.
Surgery is required if non-surgical methods have failed, or if the tear is very bad. Rotator cuff tears can be partial (just some of the tendon fibres are torn) or full (the tendon is completely torn). The rotator cuff can be torn when playing sports, such as tennis or cricket, or through physical activities, or through general wear and tear over time. Traumatic injury can also tear your rotator cuff as well.
Rotator cuff surgery involves:
Surgery can be performed either:
In the weeks running up to surgery, certain medications will have to be stopped. It is also important to prepare your house so that everything you need during recovery is easily accessible (not on high shelves). On the day of surgery, eating and drinking will have to be stopped, on instruction from your surgeon and care team.
Pain following surgery will be managed with rest and painkillers. You will wear a sling following surgery as well. Throughout recovery you will need to have physical therapy to ensure the rotator cuff heals properly. Movement exercises can begin as soon as a couple of days following surgery. After 6-8 weeks following surgery, active exercise with shoulder movement can be performed, depending on how bad the rotator cuff tear was. You can expect to return to regular activities after several months.
Mr Keith Adrian Borowsky is a leading consultant shoulder and elbow orthopaedic surgeon, based in Maidstone and Chatham, Kent. He qualified in South Africa and has been practising Orthopaedic Surgery for more than thirty years. His broad range experience in orthopaedics spans from having initially worked in the military with war, industrial and sport injuries, and later developed a service as a substantive NHS consultant for upper limb trauma and more common conditions such as frozen shoulder, rotator cuff injury, arthritis requiring joint replacement, tennis elbow and other conditions. He specialises in shoulder and elbow reconstructions and arthroscopies. On the non-operative side he offers ultrasound-guided joint injections and diagnosis.
Mr Borowsky is also firmly committed to research and academia, some of which has been carried out as an honorary senior lecturer at Brighton and Sussex Medical School. At present, his research is focusing on shoulder fractures and the development of a shoulder replacement for this. In this regard, he was awarded a prize for best podium presentation at the British Shoulder and Elbow Society meeting; and has publications in this field in one of the foremost international shoulder journals. In addition to his clinical practice, research and teaching, Mr Borowsky also has more than 25 years of medico-legal experience.
AC joint surgery, also known as acromioclavicular joint surgery, is a type of shoulder operation to treat acromioclavicular joint separation, also known as a separated shoulder. An acromioclavicular joint separation occurs when the clavicle (collarbone) separates from the scapula (shoulder blade). It is not to be confused with a shoulder dislocation as the injury is different. Surgery can involve the use of a screw or suture loop and on some occasions an artificial ligament.
AC joint surgery aims to reconstruct the acromioclavicular joint when non-surgical treatments, such as physiotherapy or medication, have failed. Surgery aims to restore the alignment of the shoulder blade and the collarbone, improving function, mobility and reducing pain. Surgery is usually required for the most severe cases of AC joint injuries as milder injuries can successfully be treated with conservative means.
AC joint surgery can either be carried out arthroscopically or as traditional, open surgery. How it is performed will depend on the severity of the injury. There are various versions of AC joint surgery:
AC joint surgery requires general anaesthesia so you will need to fast for a duration before surgery. It is also important to stop smoking for a period before surgery to aid a better recovery. It is advised that you make arrangements to have someone to take you home from surgery and to have home-support for at least the first few days.
Following surgery, it may be necessary to wear a sling to provide support for a few days. You will need to have physiotherapist to ensure a thorough recovery, however, you may have a few weeks between the operation and the start of physiotherapy. Physiotherapy will involve range-of-movement exercises, passive exercises and when your ligaments have healed, you will be given active exercises. Recovery can take a matter of months and requires patience and commitment to physiotherapy.
If the injury is not very severe, surgery should be avoided, and the following measures should help:
Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types of arthritis, but the most common are:
The symptoms of arthritis can be:
This pathology can be a consequence of:
Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.
The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects:
The term “arthroplasty” refers to any surgical procedure to restore the function of a damaged joint, often by replacing them with artificial joints made of chromium, cobalt and titanium, along with high density plastics. The ultimate aim of arthroplasty is to correct deformities, reduce or eliminate pain in the affected areas, and restore mobility. Arthroplasty is commonly performed on the hip, knee, elbow, shoulder, and ankle, among others.
Different types of arthroplasty include:
Arthroplasty is carried out to replace the damaged joint with a healthy one, allowing the patient to live a full and active life with adequate mobility.
Arthoplasty may become necessary due to:
Arthroplasty procedures are carried out under general anaesthetic. The patient’s heart rate, blood pressure, breathing, and blood oxygen are monitored, while the surgeon makes an incision and removes and/or repairs the damaged parts of the joint, before closing the incision with stitches.
The process of placement of the prosthesis will be different depending on the type of joint replacement.
No special preparation is required for arthroplasty, other than notifying the specialist of the possibility of being pregnant and the medication the patient is taking, which may be strong in cases of rheumatic diseases and may need to be stopped or changed prior to the operation.
After the intervention, the patient may feel pain, which is normal in any intervention. In case of pain, the specialist will recommend the best treatment.
During the hospitalisation, specialists will soon begin to move the joint, so that recovery is as effective as possible and the patient regains mobility as soon as possible.
After being discharged from the hospital, the patient must go for rehabilitation for a few months to fully recover the mobility of the joint and also to check that make sure that the prosthesis is functioning properly.
Arthroscopic subacromial decompression is a type of shoulder operation that aims to treat shoulder impingement. Shoulder impingement is a very common cause of shoulder pain and results from when tendons and bones in the shoulder rub against each other on raising your arm. Subacromial decompression is a day case procedure, so you won't have to stay overnight in hospital, and the procedure takes about an hour. It is usually performed as keyhole surgery (minimally-invasive) and uses general anaesthesia.
The operation aims to increase the space between your shoulder blade and the rotator cuff. Not having enough space can cause pain and restrict your movement when you try to raise your arm. Impingement also causes shoulder pain.
This procedure is mostly done using minimally-invasive techniques, and as such it can be done as a day-case. General anaesthesia is required and the surgery usually takes about an hour. You might also have local anaesthesia in the shoulder nerves to ensure you do not feel pain during the procedure. Once anaesthetised, a number of small incisions are made around the shoulder. These are usually no bigger than 5mm in size and normally 2-3 are sufficient. Through these incisions, the surgeon inserts a thin, flexible tube called an arthroscope into the subacromial space of the shoulder joint. The camera on the end of the arthroscope shows its images on a monitor which the surgeon uses to guide their surgical instruments which are inserted through the other incisions. Using these instruments, the surgeon repairs any damaged tendons and reshapes the shoulder blade. Once complete, the instruments are removed and the incisions are closed with stitches.
One of the most important preparatory measures to take is to prepare your home for your recovery, as well as arrangements for getting you home after surgery. This is nearly always a day case procedure meaning you return home the same day, therefore, you will need a friend or family member to pick you up and take you home. It is also wise to have someone stay with you for the first day following surgery. As the procedure uses general anaesthesia, you will have to fast for a duration before the operation.
Pain relief can be given whilst the anaesthesia wears off immediately following surgery and you can return home the same day. You may have to keep your arm in a sling for a few days. A full recovery takes up to four months. During this time you may need over-the-counter painkillers to manage pain. You should also have physiotherapy during this time to help improve shoulder mobility and stability. Patients who do not do manual labour for work can return to work within a few days following surgery.
Some people suffering from shoulder impingement and pain won’t require this form of intervention as they will see improvements from the following treatment options:
The clavicle is the long, thin bone located in the upper chest, between the sternum and the shoulder. Its function is to join the upper limbs with the thorax and keep the shoulders aligned.
Clavicle fracture, or broken collarbone, occurs when the bone is broken. An injury that causes the clavicle to be broken can also cause the clavicle to be dislocated or the neighbouring acromioclavicular joint to dislocate.
If the fracture is mild, the main symptoms are:
If the fracture is more severe you may notice:
A clavicle fracture is almost always caused by a violent impact on the arm extended in a fall or by a fall directly on the shoulder itself. It is more frequent in children, since these bones do not harden until adulthood.
A clavicle fracture requires a physical examination and imaging tests. In the examination, the doctor will ask you how the injury occurred and will examine your shoulder to see if there are any irregularities. An X-ray can determine whether the clavicle has fractured and whether any other damage has taken place.
In many cases, the clavicle can heal with surgical intervention. Treatment involves:
It is important to see the doctor regularly for follow-up scans to check the clavicle is healing in the right way. If the bone does not heal correctly, a large bump can form over the clavicle, and this may take many years to subside.
Surgery is indicated in fractures that involve a displacement of the fractured bone. There are several surgical techniques, including the use of needles that are placed through the skin, the placement of plates screwed to the bone or the placement of a long screw inside the fractured bone. After the procedure, the arm must be placed in a sling for at least a few days, and no daily activities or weight lifting can be carried out for four to six weeks.
Bursitis is the inflammation or painful irritation of fluid-filled sacs called bursas, most commonly affecting the hips, shoulders, elbows, and knees. The function of these sacs is to help the normal movement of the joints and avoid direct friction between them. Bursitis can affect any of the joints in the body.
There are two types of bursitis: acute and chronic. Acute bursitis causes pain, swelling, and warmth in the area of the bursae, and usually happens when the bursae are injured, stretched, or compressed. Chronic bursitis can re-occur and may last for several months, coming in bouts, which can last from a few days to weeks at a time.
The characteristic symptoms of bursitis are pain and inability to carry out certain exercises or movements usual in daily life. The symptoms may appear suddenly or progressively, something that the patient feels through movement or by touch, as the skin surrounding the bursa is more sensitive than usual. The symptoms depend on the affected area, but the most common are:
Bursitis may be caused by repetitive motion in the joint, or repeatedly putting the joint in certain positions which create pressure on the bursae, such as kneeling down for long periods of time (e.g while cleaning). Bursitis can also be caused by trauma or injury, and by other inflammatory conditions such as gout, or arthritis.
Bursitis may be prevented by avoiding repetitive movements which put strain on the bursae. Another preventive measure is to strengthen the muscles that surround the joint or warm up the area with exercises before starting any physical activity.
In most cases the bursitis disappears without applying any specific treatment. The specialist will focus on reducing pain and inflammation to the patient by prescribing anti-inflammatories or corticosteroids.
In case of acute bursitis without infection, the patient should avoid overexertion, limit certain movements and apply ice in the damaged area to reduce swelling. If chronic bursitis occurs, the treatment is similar, although due to the fact that rest is not effective, more aggressive and direct methods such as intensive physiotherapy or corticosteroid injections should be used. In case of infection, the accumulated fluid should be removed and a corticosteroid treatment be followed.
Carpal tunnel syndrome is a condition which causes numbness, tingling, or pain in the hand. It is a common condition which occurs due to compression of the median nerve in the wrist, which runs down the carpal tunnel, a narrow passage on the side of the wrist. The nerve controls movement in the thumb, and fingers except the little finger. Carpal tunnel surgery is indicated in some cases to correct long-lasting cases of carpal tunnel syndrome.
Carpal tunnel syndrome often clears up by itself or with therapy, but in some cases symptoms can go on for a long time, and the condition may get worse. Muscles in the hand and wrist can weaken, and everyday movements such as grasping or gripping may become more difficult to perform. Surgery is indicated in cases of long-lasting carpal tunnel syndrome, when other treatment methods have been explored and been unsuccessful.
Carpal tunnel surgery is usually performed either as open or endoscopic surgery. In open surgery, a larger cut is made, and recovery time is generally longer. In endoscopic surgery, smaller cuts are made and a tiny camera is inserted which helps guide the surgeon as they cut inside the joint and ligament. However, in both cases the ligament around the carpal tunnel is cut, which relieves pressure around the median nerve. After surgery the ligament is brought back together, but the median nerve has more space to pass through, which permanently relieves the compression.
Before surgery, the surgeon will explain exactly what type of procedure they will be performing, and what to expect. Before surgery, medication will be discussed and blood thinning medications must be avoided, as they can increase bleeding during surgery.
The patient should arrange for someone to escort them from the hospital, as they will not be able to drive after the surgery has been performed.
After the operation, the wrist and surrounding area will be sore and painful, with some swelling and stiffness. A bandage is put in place and this will be kept on for 1-2 weeks. Some over-the-counter medications may help with pain relief. During the recovery period, exercises can be done which will be advised by the surgeon. This helps to prevent the fingers from getting stiff, but it is important to avoid straining them.
In the period directly after surgery (2 weeks afterwards), care should be taken, making sure to only perform light tasks and light movements. Return to normal movement can be made slowly, over a period of time. It usually takes around 10-12 weeks for strength to fully return.
Carpal tunnel syndrome is a condition which causes numbness, tingling, or pain in the hand. It is a common condition which occurs due to compression of the median nerve in the wrist, which runs down the carpal tunnel, a narrow passage on the side of the wrist. The nerve controls movement in the thumb, and fingers except the little finger.
Carpal tunnel symptoms normally progress over time, and do not come on suddenly. Usually symptoms start with numbness or tingling in the fingers (except the little finger, controlled by a different nerve) or thumb, which comes and goes. Symptoms can also include pain in the fingers, or even pain in the arm occurring between the hand and elbow. Sometimes symptoms become more apparent at night.
Carpal tunnel syndrome occurs when the carpal tunnel inside the wrist swells and compresses, or squeezes the median nerve. There are certain risk factors, including being overweight, having another illness such as diabetes or arthritis, and doing a job or having a hobby which involves repeatedly bending the wrist or gripping objects hard. Some women also develop carpal tunnel syndrome during pregnancy.
Some measures can be taken to help prevent carpal tunnel syndrome from developing. Firstly, you can take care of your health in general, by maintaining a healthy weight, not smoking, and regularly exercising. You should also exercise your arm, hand, and finger muscles to keep them strong.
Try to avoid activities which place repeated pressure in the same area, and move your hand and wrist in a way that spreads the pressure over a larger area. Regularly switch hands and take breaks if performing tasks which involve a repetitive motion.
Carpal tunnel syndrome can often be treated at home, as it clears up naturally in a few months, especially if you have it while pregnant. Some recommendations include:
If your symptoms get worse or do not go away, make an appointment to see your doctor. They may prescribe medication, usually in the form of steroid injections, or in more serious cases where carpal tunnel does not go away, they may refer you on to a specialist for surgery.
Surgery usually cures carpal tunnel syndrome, and is done as a day case procedure. After surgery, the hand and wrist will recover after about a period of a month.
Cubital tunnel syndrome (a form of ulnar nerve entrapment or ulnar neuropathy) is a condition in which the ulnar nerve becomes trapped or compressed. This nerve runs from your neck, through the elbow, to your hand, connecting to the little finger and half of the ring finger. It is the largest nerve in the body unprotected by muscle or bone, and due to its relative exposure, it is easy to bump, which may send a strange sensation like an electric shock down your arm (commonly referred to as “hitting your funny bone”). Unfortunately, it is also easy to injure.
There are several places where the ulnar nerve can become trapped and compressed, such as the collarbone and wrist, but the most common place is at the elbow. This is cubital tunnel syndrome.
Cubital tunnel may not be as well-known as carpal tunnel, but it is, in fact, the second most common peripheral nerve entrapment syndrome, and can cause the patient severe discomfort.
Cubital tunnel can cause the following symptoms:
It is often difficult or impossible to pinpoint the exact cause of cases of cubital tunnel syndrome, but there are several things that can put pressure on it:
Prior fractures and dislocations, arthritis, swellings, and cysts around the elbow can all also be risk factors.
Cubital tunnel can often be managed conservatively, with physical therapies, such as:
In some cases, if the pressure on the nerve does not release via other methods, surgery may be required. There are different operations, ranging from simply releasing the source of the pressure to decompress the ulnar nerve to shifting the nerve within the elbow. Most patients respond to surgical intervention, though it is usually a last resort. Full recovery of hand and wrist strength can take several months, and physical rehabilitation may be necessary.
As with any treatment, the doctor will discuss and decide the best course of action for each individual case.
De Quervain syndrome is an inflammation of the tendon sheath (a membrane encasing the joints in the human body) of the tendons that control thumb. This condition causes your thumb to thicken and the tendon sheath to shrink, limiting your articular motion and leading to overall pain in your hand and wrist.
The outlook for this condition is good, unless you neglect it. In this case, you could suffer from trapeziometacarpal osteoarthritis, which is a type of arthritis affecting the base of the thumb.
The main symptom of De Quervain syndrome is pain radiating to the wrist, forearm and thumb areas. You may also notice some swelling.
You will need to do the Finkelstein’s test, which can assess how much pain you are in. During this test you will be asked to close your hand in a fist, clenching your fingers above the thumb and moving your wrist towards your little finger. An ultrasound of your hand can be helpful to determine if there’s any inflammation of the tendons, which could be putting a strain on the synovial sheath.
The main causes for this condition can be associated with the following risk factors:
This condition can be prevented by changing your habits and paying more attention to the onset of the inflammation.
De Quervain syndrome can be treated by following some rules:
For an accurate diagnosis and treatment of De Quervain syndrome, you should see an orthopaedic surgeon.
The elbow is the joint that joins the arm to the forearm, connecting the humerus with the proximal ends of the ulna and radius. It is formed of bone, cartilage, ligaments, and fluid. The muscles and tendons help stabilise the elbow when we move it. Trauma to any of these structures will cause problems in the elbow.
The elbow enables a series of movements for straightening and bending the arm. These include:
Many factors can cause pain in the elbow, whether injured or not. The most common of these are:
Treatment will depend on the cause of the problem. To diagnose any elbow injury, various tests need to be performed: direct arthrography, radiography and nuclear magnetic resonance imaging, among others. Once the diagnosis has been made, the specialist will decide how best to treat the elbow pathology in each case.
Normally, the main measure taken to treat the injured structure is to reduce inflammation, restrict mobility and alleviate pain, weakness and functional disability. This is why it is important, first of all, to administer NSAIDs (anti-inflammatory drugs), to put the arm in a sling, or similar, to limit mobility and to have physiotherapy. Physiotherapy will generally involve cryotherapy (application of cold), electrostimulation (TENS), a passive stretching programme for the pronation and supination muscles (those involved in twisting the forearm), wrist extensions and flexions, together with postural recommendations. Once the pain has subsided, exercises can be carried out to strengthen the muscles of the affected arm.
If the injury is more severe, the specialist may recommend other procedures. These may include elbow arthroplasty, surgery for tennis elbow or, if surgery is not recommended, injections into the joints and soft tissues.
Elbow pathologies are treated by an orthopaedic specialist. There are also orthopaedic surgeons who specialise in elbow problems and therapeutic treatments.
Elbow arthroscopy is a minimally invasive technique. Through small incisions, and with the help of a small camera, the specialist can work inside the elbow joint to diagnose and treat pathologies that were previously more difficult to identify and which required a more aggressive surgical approach.
The surgery is performed under local and regional anaesthetic, numbing only the arm to be operated on. In most cases, it is performed on an outpatient basis and you will be able to go home within a few hours of the intervention.
This technique is used to treat many different elbow pathologies. Elbow procedures are increasingly performed through arthroscopy, either inside the joint or in the surrounding structures (tendons and nerves). The most common indications for this technique are:
Arthroscopy is used to treat various elbow pathologies. To do this, the orthopaedic surgeon will make small incisions to access the injury and visualise the joint. There are many advantages to arthroscopy, as it offers a direct view of the pathology, a more complete understanding and diagnosis, as well as a very precise treatment. Making small incisions is also advantageous, as it reduces postoperative pain, the loss of elbow mobility, the risk of wound infection, and sometimes does not require joint immobilisation after surgery.
A prior evaluation by the traumatologist will always be necessary. The orthopaedic surgeon must have expertise in using this technique to ensure the best possible outcome. In the prior studies, tests will be carried out to evaluate the functionality of the joint and to assess whether arthroscopy will be the most suitable technique. X-rays, MRI scans and mobility studies will be performed.
Arthroscopy is generally a minimally invasive technique, so recovery is faster than with open surgery. In addition, postoperative pain is less and elbow mobility will start to improve a few days after surgery, even the day after in some cases. However, this depends on the individual case, which the specialist will assess, as some injuries require more immobilisation than others.
If you have an elbow injury it is essential that you see a specialist who is well-trained in that particular condition or injury. Arthroscopy of the elbow joint is perhaps the most hazardous due to the potential damage to the surrounding neurovascular structures. The specialist will tell you whether arthroscopy is the best option for you, and will explain other procedures that can be used. These include elbow arthroplasty and other techniques.
The elbow is a complex joint formed by bones, cartilage, ligaments and fluids. The muscles and tendons help to move the joint and if any of these parts suffers any damage, the pains and problems appear.
Elbow pain can occur as a result of:
You should see your GP in the first instance, who is likely to refer you to a specialist rheumatologist for pain management, or possibly an orthopaedic surgeon if surgery is required. As part of your diagnosis, imaging tests (such as an X-ray or MRI) may be required.
The relevant specialist will coordinate your care, which may involve:
If no improvement is seen in the patient's elbow pain, then the following treatments may be required:
Elbow replacement surgery involves replacing and repairing the damaged parts of the elbow joint. This surgery aims to relive pain caused by conditions such as arthritis. The damaged joint is replaced with an artificial joint made from two implants that are attached to the bones. The implants are joined by a metal and plastic hinge. The procedure is similar to hip and knee replacement surgery.
Elbow replacement surgery will be recommended if non-surgical treatments have failed to relieve pain. Pain in the elbow can be caused by:
An incision is made at the back of the elbow, through which the muscles are gently moved to allow access to the joint. Once any scar tissue around the joint has been removed, the implants will be installed. The stems of the implant are placed into the humerus and ulna bones, and kept in place with special cement. Both stems are connected by a hinge. Sometimes a temporary draining tube is placed in the wound where the incision was made, which is removed after the first few days following surgery.
Before surgery certain medications will have to be stopped. It is also important to make sure your home is prepared to allow a smooth recovery, such as placing objects you need on lower level shelves. Surgery is carried out under either general anaesthetic or regional anaesthetic.
After surgery, antibiotics are given to reduce any chances of infection. Pain management medication will be prescribed for the short-term as well as a level of pain is expected during the healing process. During recovery certain exercises that help with mobility and strength need to be carried out. Physcial therapy sessions will help show you how these exercises work.
Lateral epicondylitis, also known as tennis elbow, is an injury that causes pain on the outside of the elbow. It is due to repeated wrist extension and forearm supination movements. Repeated use of these muscles causes microinjuries to the tendon. If this persists over time, irritation and pain develops on the outside of the elbow.
Although commonly known as tennis elbow, this condition is suffered not only by tennis players but also by anyone who performs work that involves repetitive stretching and flexing movements of the forearm and wrist; for example, professional painters, mechanics, labourers or those who work long hours in front of a computer using a mouse.
Lateral epicondylitis is not a very serious injury, though it can significantly affect your life. Most people improve with non-surgical treatments and the condition can even be cured. Symptoms often persist for several months before the condition is completely cured.
Lateral epicondylitis is characterised by the following symptoms:
This pain does not go away with rest or by applying local cold or taking anti-inflammatories.
Every trauma specialist should perform a thorough evaluation in order to diagnose lateral epicondylitis. Among other procedures, this will include:
Lateral epicondylitis can only be prevented with careful “postural hygiene”. Proper movements during sport and work will ensure that the tendons are not subjected to excessive stress. Resting your elbow well after a busy session can also help prevent epicondylitis. Stretching and preventive massages, as well as elbow pads, are helpful.
Treatment for an injury of this nature should be gradual and depend on the severity of the injury.
Initial recommendations include:
If these measures are not effective, the following will be recommended:
If the above treatments also prove ineffective and you still suffer from the symptoms and pain of epicondylitis, surgery will be the next option. Surgery can be performed with an open incision, or using arthroscopy. Arthroscopy is currently the most commonly-used technique as it gives access to the lesion, with a miniature camera, through two or three small incisions. This technique is minimally-invasive, so recovery is faster and less painful.
Epicondylitis is treated by a trauma specialist, who usually has specific training in the treatment of elbow pathologies.
Other professionals may be involved during recovery from an epicondylitis injury, such as physiotherapists, who will provide practical exercises to restore movement, and orthopaedic surgeons, to repair the tendons in the elbow when other treatment approaches have failed.
An elbow fracture is when there is a break in one or more of the three bones that make up the elbow joint. It normally happens after an injury, like a blow to the elbow, a fall, or a twist. The fracture may also be sprained, strained, or dislocated. Fractures can be:
The most common types of fracture are:
Elbow, ulna, and radius fractures are quite common, especially in backward or hand supported falls, or when there is elbow hyperextension. Although it is not a very serious injury, rehabilitation can take time to recover mobility, especially joint movement.
The most common symptoms are:
A snap may be heard at when the fracture happens. If there is a visible change, it may mean that the bones are out of place or the joint is dislocated.
An orthopaedic surgeon will evaluate the injury. They will first check for skin injuries, then see if the patient has less sensitivity. They will also check if there are any mobility issues. The following tests may be carried out:
The most common causes for an elbow, radius, and ulna fracture are a fall, a direct blow to the joint, or a twist. Osteoporosis also increases the risk of an elbow fracture.
Elbow fractures are difficult to prevent. However, it is easy to improve symptoms and pain by following the recommendations given by the specialist. Examples of these tend to include:
Elbow fractures don’t tend to need surgery and are treated with a sling, a cast, or a splint (when there is little risk of the bones moving out of place). Treatment will depend on the patient's age and their daily activities. It is quite common to put a plaster cast on children, as it is unlikely that they’ll have elbow stiffness which is more common in adults. To avoid this, rehabilitation exercises are recommended, along with applying heat, ice, or having massages.
In more serious fractures that are out of place or unstable, surgery may be necessary. The procedure involves replacing and stabilising the bone fragments or removing them. If there is an open fracture and the skin is broken, the wound and bone should quickly be cleaned to avoid the risk of infection.
The specialist who treats elbow fractures is an orthopaedic surgeon, of which there are those who specialise in treating elbows.
The humerus is the longest bone in the arm. It is articulated with the scapula by the shoulder, ulna, and the radius in the elbow joint. The most common injury of this bone is a humerus fracture. This mainly affects the elderly and young people. Humerus fractures can be classified by the area affected: the upper, centre, or lower section.
Recovery will depend on the following criteria:
There are other factors that can slow down recovery:
Humerus fracture symptoms tend to be immediately noticeable, as there is often a loud snap or crack which is often an indication that the arm is fractured. There are other symptoms, including:
If the patient is in a lot of pain and cannot use their arm, medical help should be sought as soon as possible. Delaying diagnosis and treatment can lead to poor healing.
X-rays are used to diagnose humerus fractures. This can help determine the extent of the injury, locate the exact location of the fracture, and see if it has affected a nearby joint. The doctor may order a CT scan in order to get a more detailed image.
There are certain sports and conditions that can increase the risk of fracturing the humerus. These include; basketball, rugby, wrestling, football, hockey, snowboarding, or skiing. Osteoporosis, a condition that weakens the bones, or a fall, even from a short distance, can also cause a humerus fracture.
There are different treatments for a humerus fracture, the one used will depend on the type of fracture. Treatments include:
A traumatologist, or orthopaedic specialist treats humerus fractures.
The shoulder fracture is a break or a crack in the collarbone, in the scapula or the proximal humerus. In the latter case, it would be called fracture of the humerus. Shoulder fractures often result from a sudden force applied on the arm (a serious fall, a lesion when doing sports or a car accident). The most common symptoms of this injury are pain, swelling, tenderness, deformity under the skin, violet colour or skin discoloration, cracking and inability to move the arm. In general, the treatment of a fractured shoulder involves surgery, but we must also take into account the conservative options and minimally invasive surgical options such as arthroscopy.
A frozen shoulder is a condition that causes pain and stiffness in the shoulder and hence a loss of mobility.
The shoulder joint capsule has ligaments that hold the shoulder bones together; when this capsule becomes inflamed, the bones are not able to move freely in the joint, causing a stiffened, frozen shoulder.
Typically, frozen shoulder treatments help to restore mobility and the functioning of the shoulder after one year; even without treatment, it may improve after two years.
In cases that are treated by surgery, this should be followed with physical therapy for a few weeks or months to prevent the frozen shoulder from returning.
The main symptoms of frozen shoulder are pain, stiffness, and decreased joint mobility.
To make a diagnosis of frozen shoulder, the specialist will ask the patient about their symptoms, examine the shoulder, and they may also require x-rays or, less often, an MRI scan.
There are no specific causes of a frozen shoulder, although there are some risk factors:
Generally, a frozen shoulder cannot be prevented, however, if you have suffered a shoulder injury or have recently had shoulder surgery, you should practise certain exercises to keep the joint mobile and avoid stiffening. If your shoulder does become stiff, you should see a specialist as soon as possible.
Frozen shoulders can be treated with NSAIDs and steroid injections, in addition to physical therapy. It may take a few weeks to see progress, and a few months to achieve a full recovery.
Frozen shoulder surgery is recommended when non-surgical treatment is not effective. In these cases, it is performed by a shoulder arthroscopy, which is done under anaesthesia.
Orthopaedic surgeons treat cases of frozen shoulder.
A ganglion cyst is a benign but painful growth, usually on the hand or wrist. The pain often comes on at night, or after constant use of the hand.
Ganglion cysts can vary in size, growing up to three centimetres wide. While the position of the cyst doesn’t tend to change, the size may fluctuate over time, and some go away entirely without treatment.
As previously mentioned, ganglion cysts sometimes go away on their own. If the cyst persists, treatment may be recommended to reduce the size or attempt to remove it completely. Unfortunately if the cyst is removed there is still a chance that it will come back, and you may need further treatment.
Cysts usually form a visible nodule, although in some cases if the cysts are small they may not be noticeable.
Many of them have no symptoms, but if they do press on a nerve, it can cause pain, tingling and muscle weakness.
Usually a ganglion cyst can be diagnosed by your GP with a physical examination. They may use a syringe to draw out fluid from the cyst. In some cases, they might refer you for an ultrasound or MRI to look at the inside of the lump and rule out other potential causes.
The cause of ganglion cysts is unknown. They have been found to be more common in young people between the ages of 15 and 40 and to develop more in women. It is also more likely to be developed by people who use and overload the wrist. People who have arthritis may develop them more easily.
At the moment it is not clear how to prevent ganglion cysts. The best thing to do is to see you doctor early on if you notice anything unusual.
For many people, treatment will not be necessary especially if there is no associated pain. The main job of the GP will be to reassure you that the lump is not caused by anything more serious.
However, if the cyst is causing you pain the GP may recommend treatment. The two main forms of treatment for ganglion cysts are:
Surgery is a more complex treatment and may involve putting your hand in a splint for several days afterwards. However, it tends to result in fewer recurrences of the cyst compared to aspiration.
Inflammatory arthritis is one of the two major sub-categories of arthritis (the other being osteoarthritis), and, as its name suggests, it is characterised by the inflammation it causes in the joints and surrounding tissue. Most forms of inflammatory arthritis are thought to be autoimmune diseases.
There are many different types of inflammatory arthritis, including the following:
The main symptoms of inflammatory arthritis are:
Depending on the type of inflammatory arthritis, other parts of the body might be affected, causing additional symptoms, such as:
The causes of inflammatory arthritis are not fully understood, but most forms are thought to autoimmune. This means that the body’s own immune system mistakenly attacks healthy cells in the body’s tissues, wrongly identifying them as a threat. It is not understood why the immune system turns on the body it should be protecting in this way, but it is believed that genetics are a factor, along with other triggers, which may differ depending on the disease.
While the condition cannot be cured, inflammatory arthritis can be managed and its symptoms relieved. The aim is to improve physical function, reduce long-term complications, prevent further damage to the joints and organs, and send the pain and inflammation into remission.
Inflammatory arthritis treatment depends greatly on the type, the severity, the symptoms that manifest, and the patient involved. Always consult your doctor to discuss the right treatment for your case.
Some common treatments for the various forms of inflammatory arthritis include:
Surgery is an option for severe cases, when the patient’s daily activities, movement, and independence are threatened by their arthritis. Joint replacement can help to restore mobility in the joints and improve quality of life.
Some sports injuries are more easily diagnosed than others. More simple cases such as dislocations, cuts and grazes are diagnosed through seeing or feeling the injury. Cases that are more difficult, such as soft tissue damage, fractures and overuse injuries require an examination. The specialist will examine these the complex ones using X-rays, CT or MRI scans. The doctor will also ask questions about the patient’s medical history to identify any underlying issues. The patient may be referred to a specialist for a correct diagnosis.
The most common sports injuries are:
There are many different methods and tools used by sports medicine specialists to test for injuries. Shoulder (rotator cuff) injuries are best identified by observing and feeling the shoulder joint by using different movements. Injuries usually leave movement limited, therefore pain as a result of a range of movements can diagnose a specific type of injury. Strength tests can also identify any weakness in the joint.
With cartilage tears in the knee, the doctor will apply pressure to see if there is any tenderness above or surrounding the cartilage. The knee may also be flexed and the doctor will listen out for a clicking or popping noise as the knee bends. This is known as the McMurray’s test and is performed when the patient is lying down. Ege’s test involves the patient squatting so that the specialist can check for a popping or clicking noise as the knee bends.
There are several tests that are used to detect a ligament tear or strain in the knee. These include the Lachman test, the anterior draw test and the dial test. Most of these tests involve applying pressure to the knee joint and moving and bending the knee. The extent of the injury is usually determined by the movement or positioning of other parts of the legs and the location of the pain.
Diagnostic testing helps doctors to understand specific sports injuries. These tests include X-rays, CT scans, ultrasound and MRI scans.
Joint injections are a treatment against joint pain that involves the injection of anti-inflammatory drugs and analgesics to improve joint mobility. It is a quick and simple technique, is minimally invasive, and produces longer-lasting effects compared to those obtained through a drug administered orally or intramuscularly.
The median nerve is one of the nerves in your arm, extending into the hand. It is the only nerve which passes through the carpal tunnel, one of the passageways that connects the hand to the forearm.
The median nerve controls the function and feeling in most of the fingers in your hand as well as part of your palm. The only fingers the median does not control is the little finger, and part of the ring finger, which are controlled by the ulnar nerve. The radial nerve is also responsible for some sensation in the hand.
The two most common places for the median nerve to become damaged or compressed are at the elbow and at the wrist.
A number of elbow injuries can affect the median nerve, including a fracture, or dislocation. When the median nerve is compressed at the elbow this is known as Pronator teres syndrome. This is often caused by repetitive turning grasping and twisting of the hand and wrist, often involved in jobs work heavy manual labour, weightlifting, or racket sports. Pronator teres syndrome can also be caused by body abnormalities, a tumour, or scar tissue.
At the wrist, compression is known as carpal tunnel syndrome. This is a common condition which tends to affect women more than men, but the exact cause is unknown.
Symptoms can vary depending on the injury. Compression on the nerve can cause pain, particularly at night, a tingling sensation in your fingers, numbness and weakness in the hand.
Fracture, trauma or dislocation that has caused damage to the nerve can also cause numbness or weakness. You might find it difficult to turn the hand over, grip things, or move the thumb across the palm. If the nerve has been severely damaged this can lead to muscle wastage.
When the median has been damaged by an acute injury at the elbow or wrist (such as a fracture or dislocation), the first line of treatment is to address the initial injury. Soft tissue injury can be treated with compression, applying ice, and keeping the arm elevated. A bone fracture which is unlikely to heal in the correct way, or which is putting pressure on the nerve, may require surgery.
Carpal tunnel syndrome can be treated very easily with carpal tunnel surgery. This is a quick procedure which releases space in the carpal tunnel for the median nerve, and provides immediate relief of symptoms.
Most treatment aims to prevent any further damage. Existing damage to nerves is likely to be permanent and you cannot always regain lost function or strength. Therefore it’s important to see an orthopaedic surgeon as soon as possible if you experience the symptoms above.
A musculoskeletal ultrasound is a diagnostic imaging tool which uses state-of-the-art transducers to help carry on an accurate analysis of muscles and tendons.
A musculoskeletal ultrasound (also known as musculotendinous ultrasound) is a diagnostic imaging tool which uses ultrasound to get a quick diagnosis. The procedure does not use X-rays. This technique allows for an optimal evaluation for muscular structures while distinguishing the anatomical components of the joints and tendons.
This test is useful for evaluating the consequences of traumas which can cause muscle rupture, haematoma, muscle hernia, contracture or tendon damage. As the radiologist moves the tranducer over your body, a real-time image of the muscles and tendons is displayed on the monitor screen, allowing the radiologist to formulate a diagnosis based on the ultrasound image.
Preparation for a musculoskeletal ultrasound involves applying a gel on your skin over the affected area. This gel allows for better contact between the transducer emitting ultrasounds and the skin.
A musculoskeletal ultrasound is a painless procedure unless it is carried out over a highly inflamed area. In that case you might feel a small amount pain.
Cervical pain (neck pain) occurs in the upper part of the spine, in the cervical area. It is a pain usually caused by trauma, illness, progressive deterioration, bad posture or emotional tension. Specifically, this cervical pain can be caused by any anomaly or tension in this area of the spine, both in the muscles, ligaments, discs or nerves, as well as in the vertebrae and in their joints. The symptoms of cervical pain may be of varying degrees, from mild discomfort to acute, sudden and intense pain. It can also become chronic neck pain when it lasts for more than three months, and it is more common in women than in men. In addition, in patients suffering from persistent cervical pain and headaches, consultation with a physician and physiotherapeutic treatment is recommended.
Osteoarthritis is a degenerative conditions that affects the joints, causing them to become stiff and causing pain. Any of the joints in the body can be affected, but it more commonly affects the hips, knees, and small joints in the hands.
It affects women more commonly than it does men, and is the commonest form of arthritis in the UK.
The most common symptoms of osteoarthritis are joint pain, difficulty in mobility, and stiffness or deformity in the joints.
These symptoms vary depending on the patient and intensify in a progressive manner. Joint pain, the most common symptom, appears first with movement and ceases with rest, but as osteoarthritis progresses, the pain may also be present while resting.
The causes of the onset of osteoarthritis are not currently known but there are a number of risk factors associated with it:
To avoid risk factors and therefore prevent osteoarthritis, it is very important to eat a balanced diet, such as the Mediterranean diet, and perform regular moderate exercise, thus avoiding wear and tear of the joints. Avoiding obesity is important as carrying too much weight can be detrimental.
The objective of the treatment is to avoid or reduce pain and improve mobility. To treat osteoarthritis, the medical specialist will recommend the patient a series of exercises to be performed which are adapted to their situation and abilities, often with the help of a physiotherapist.
Pharmacological treatment: In most cases anti-inflammatories or analgesics are prescribed to reduce swelling and therefore pain. Chondroprotective medications may also be prescribed which may slow the progression of the disease.
Surgical treatment: osteoarthritis in very advanced stages may require prosthetic surgery.
Osteoarthritis is a degenerative disease that causes the loss of cartilage that lines the joint surfaces, which leads to the joint space to disappear. The elbow is one of the least affected joints as osteoarthritis generally affects weight-bearing joints, like the knee.
Osteoarthritis in the elbow can cause a variety of symptoms, which can vary from one person to the next. Some symptoms may be stronger than others, but largely, the most common symptoms include:
In the majority of cases osteoarthritis in the elbow is due to simple wear and tear, as the protective cartilage which covers the joints wears down. Injuries that involve a progressive deterioration of the joint can also speed up this process, and the corresponding loss of cartilage. Such wear and tear generates changes in the structure of the elbow.
You can help to prevent osteoarthritis of the elbow by protecting your joints and avoiding repetitive actions wherever possible. Sports, hobbies and jobs which involve repetitive actions or continuous use of the elbow can mean osteoarthritis is more likely to develop.
Osteoarthritis cannot be cured, but it can improve with treatment.
In the initial phase, treatment of osteoarthritis seeks to alleviate the symptoms by means of rest, physical therapy, and the administration of drugs for the pain, but if this fails it is possible to opt for a surgical intervention.
If patients are overweight, losing weight can also help to alleviate the symptoms and pain. Certain special orthopaedic devices may also be used in order to help reduce any strain on the joints.
If treatment is largely unsuccessful, surgery may become an option, but this is generally only offered in a small amount of cases. Surgical procedures performed include arthroplasty, which replaces the affected joint with an artificial joint, or joint resurfacing, where small wears and tears are filled with metallic inserts. Other procedures include arthrodesis, fusing the joint in a permanent position, and osteotomy, in which the orthopaedic surgeon adds or removes a small section of bone.
New, non-surgical procedures are becoming more widely available and popular in the treatment of joint problems, such as PRP (platement-rich plasma) injections. PRP injections consist of blood plasma which has a high concentration of platelets, which speeds along the healing process. As this is a new treatment, it has been shown effective in the short term, but in the long term, its efficacy has not been demonstrated.
An osteotomy is a surgical procedure, carried out using general anaesthesia, that repairs damaged joints by cutting and reshaping the bones.
An osteotomy can be performed on the following joints:
An osteotomy will fix problems experienced in different bones and joints.
Due to the complexity of an osteotomy, a hospital stay will be required. General anaesthesia is used, meaning you are asleep during the operation. The surgeons makes an incision over the area of bone that is being remodelled. Using a special surgical saw, a section of bone will be removed. The cut edges of bone are then secured together with metal hardware or special bone grafts. For a bone graft, a wedge of bone is usually taken from the pelvis, and it is secured with metal hardware.
Before surgery you won’t be able to eat or drink and certain medications will have to be stopped. You will receive special instructions from your specialist.
You can expect to stay in hospital for a couple of nights. Depending on the type of osteotomy performed, crutches are likely to be needed for a couple of months. Full rehabilitation can take up to 6 months. In most cases, physical therapy exercises will be needed to help restore strength, stability and movement to the bones.
An osteotomy is often an alternative to larger surgical procedures, such as hip and knee replacements which are serious operations with very lengthy recovery times, and often revision surgeries too. Discussing your treatment options with your specialist is essential in making a treatment decision.
Rheumatoid arthritis is a chronic and degenerative disease that causes joint inflammation. There are certain areas that this type of rheumatic condition affects more often, they include the wrists, fingers, toes, elbows, shoulders, hips, knees, and ankles. Joint inflammation normally causes pain, deformity, and movement issues, as the cartilage wears out and the bones rub against each other.
The cause for this condition remains unknown and there is no known cure. Damage to the bone and cartilage is irreparable, which is why treatment seeks to relieve pain and disability, as well as avoid permanent joint damage.
Rheumatoid arthritis affects joints on both parts of the body equally. Fingers, wrists, knees, feet, elbows, ankles, hips, and shoulders are the areas that tend to be most affected. The condition starts slowly, and the first symptoms tend to be: mild joint pain, stiffness, and fatigue.
Other symptoms include morning stiffness that lasts longer than one hour. The joints may feel hot, weak, or sensitive and rigid when they are not used for a while. Joint pain is often the same on both sides of the body. Joints may become inflamed. Over time, joints may lose their range of movement and become deformed.
Some of the most common symptoms include:
There is no definitive test to diagnose if a patient has rheumatoid arthritis, but some can help in its indication.
Some of the main tests used to indicate rheumatoid arthritis include:
The causes remain unknown. It is an autoimmune disease which involves genetic factors: a family history of the disease increases chance of developing it. Non-genetic factors also play a big role: such as infections, feminine hormones, smoking, stress, being overweight, and the type of diet you follow.
There is no known way of preventing the disease, however, some risk factors have been identified such as smoking and chronic gum infections, which can really aggravate the condition. This is why it is important to not smoke and maintain good oral hygiene. Having a correct and personalised treatment can help prevent joint damage.
In most cases, this condition requires long-term treatment, which may include:
Different types of medication:
Physiotherapy:
Surgery:
Exercise, education, and nutrition also play an integral role in the treatment of rheumatoid arthritis.
The specialists who treat rheumatoid arthritis are rheumatologists.
Rotator cuff injuries include inflammation, or partial or complete damage of the tendons of the shoulder. The rotator cuff is a group of four tendons that converge and surround the front, back, and top of the head of the humerus. These tendons are individually connected to very important muscles that cover the shoulder blade (scapula). When these muscles contract, they stimulate the rotator cuff tendons, causing the movements of elevation, separation, and internal and external rotation, hence the name "rotator cuff”.
The main injuries to the rotator cuff are tendonitis and tears:
Rotator cuff injuries are painful and can impede mobility, which has an impact on the patient's quality of life.
If the injured rotator cuff is not treated properly, it can cause chronic stiffness and weakness, and can progressively wear away the shoulder joint.
The main symptoms of rotator cuff injuries are:
The orthopaedic surgeon will begin with a physical examination in which he or she will press on different points of the shoulder and move the patient's arm, as well as examining the strength of the arms.
If the physical examination is not conclusive, imaging tests such as an ultrasound, X-ray or MRI may be used.
Rotator cuff injuries can be prevented by avoiding activities that cause them, such as certain sports that involve arm movements (e.g. tennis or cricket). Also, certain jobs that require use of the arms for several hours, such as carpentry or painting. Exercising and strengthening the shoulders and arms is also a good way to prevent injuries.
In some cases, conservative treatment with rest, physical therapy exercises, and the application of ice is enough to treat a rotator cuff injury. In cases where conservative treatment is not enough, pain injections, physical therapy sessions, or surgery to repair the tendon or even a tendon transplant may be prescribed. This intervention can be done either by open surgery or laparoscopy.
An orthopaedic surgeon is the ideal specialist to diagnose and treat rotator cuff injuries. A physiotherapist will also be involved in the treatment and rehabilitation of the injury.
The rotator cuff is a group of tendons and muscles that keeps the upper arm bone (humerus) in the socket of the shoulder blade. Sometimes the rotator cuff can be torn which causes pain, limited motion and weakness. If the tear is particularly bad or non-surgical methods have failed to repair the rotator cuff, then surgery will be recommended.
Surgery is required if non-surgical methods have failed, or if the tear is very bad. Rotator cuff tears can be partial (just some of the tendon fibres are torn) or full (the tendon is completely torn). The rotator cuff can be torn when playing sports, such as tennis or cricket, or through physical activities, or through general wear and tear over time. Traumatic injury can also tear your rotator cuff as well.
Rotator cuff surgery involves:
Surgery can be performed either:
In the weeks running up to surgery, certain medications will have to be stopped. It is also important to prepare your house so that everything you need during recovery is easily accessible (not on high shelves). On the day of surgery, eating and drinking will have to be stopped, on instruction from your surgeon and care team.
Pain following surgery will be managed with rest and painkillers. You will wear a sling following surgery as well. Throughout recovery you will need to have physical therapy to ensure the rotator cuff heals properly. Movement exercises can begin as soon as a couple of days following surgery. After 6-8 weeks following surgery, active exercise with shoulder movement can be performed, depending on how bad the rotator cuff tear was. You can expect to return to regular activities after several months.
A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse.
Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease.
In addition, there are certain situations where a second medical opinion is sought after:
The aims of obtaining a second medical opinion are:
Possible disadvantages of seeking a second medical opinion include:
You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion.
Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.
The shoulder is the part that serves as the link between the arm and the body. It is formed by the union of the ends of three bones: the clavicle, the scapula (shoulder blade) and the humerus, as well as muscles, ligaments and tendons.
The main shoulder joint connects the head of the humerus and the scapula, or shoulder blade, and is called the scapulohumeral joint. It has two joint surfaces (one corresponding to the head of the humerus and the other to the glenoid cavity of the shoulder blade). The head of the arm bone fits into a rounded cavity in the shoulder blade. Both surfaces are covered with cartilage to allow smooth, painless movement.
In addition, a set of muscles and tendons attach to the surfaces of the bones, allowing joint mobility. These include the rotator cuff, formed by four muscles that give mobility and stability to the shoulder.
The shoulder joint has a greater range of motion than all other joints in the body.
The shoulder enables a wide range of movements in the arm, allowing us to write, use cutlery, scratch our back, swim, and play certain sports that require the use of our arms (including basketball, handball, and tennis).
Shoulder pathologies generally fall into 4 categories:
Less frequent are tumours, infection, and nerve-related problems.
The main shoulder pathologies are:
Shoulder pathologies are usually treated by an orthopaedic surgeon, and depending on the injury, a physiotherapist. If the cause of your shoulder problem was osteoarthritis, it is also likely that you will be treated by a rheumatologist.
Shoulder arthroscopy is a minimally-invasive technique that allows access to and treatment of many injuries and diseases of the various structures that make up the shoulder joint. The joint is accessed through two or three small incisions of less than one centimetre.
Arthroscopy has become the technique of choice for shoulder pathologies, enabling the treatment of difficult-to-access structures of the shoulder by providing a complete view of the inside.
Shoulder arthroscopy is used to treat shoulder problems in people with shoulder pain or limited movement who have not improved with medical and physiotherapy treatment. In the past, shoulder injuries required more complex surgeries and recovery periods were longer.
Specifically, shoulder arthroscopy is used for:
Shoulder arthroscopy is performed in the operating room, with the person in a semi-seated position or on their side, placing the arm to be operated on in a traction and positioning device. The specialist will create two holes and introduce the arthoscopy, in order to see the inside of the shoulder clearly. Once the surgery is complete, the specialist will seal up the holes and apply a compression bandage and a sling.
In addition to sedation, local anaesthetic will be applied to numb the nerves that go to the arm. This makes the postoperative period more comfortable and less painful compared to conventional shoulder surgery. The surgery itself takes between 30 and 90 minutes, depending on the condition being treated.
Normally, after the operation, you will spend one night in the hospital and be discharged the next day. You will also be given some instructions on how to take care of your shoulder to ensure a full recovery.
To prepare for the procedure:
You must not eat or drink in the eight hours before surgery
You are likely to feel discomfort during the first few days after the operation, as well as swelling. However, this will soon subside with the help of medication recommended by the surgeon.
You must also wear a sling to immobilise and rest the operated arm for two to four weeks. You should nonetheless carry out some small exercises such as elbow flexions and extensions, and move the fingers. The specialist will explain how to do this.
It is important to avoid the incisions getting wet until the stitches are removed, which will be 5-10 days after the operation. Once the stitches have been removed, rehabilitation will be necessary, and this can last up to eight weeks. As the rehabilitation progresses you will be able to do more activities, such as driving, and, after two to four months, more strenuous physical exercise.
The alternative to shoulder arthroscopy is an open surgical procedure. However, this involves greater joint invasion and a more complicated postoperative period, with greater pain and longer recovery time.
The shoulder consists of the clavicle (collarbone), the scapula (shoulder blade) and the humerus (upper arm bone). The humerus inserts inside the glenoid cavity (socket) of the scapula. It is the joint with the highest range of movement, due to the high number of surrounding muscles. Shoulder dislocations are a common injury in sports and occur when the head of the humerus comes out of the glenoid cavity. This causes a lot of pain and hinders movement of the arm.
After first occurrence of a shoulder dislocation, the probability of a second occurrence decreases with age: it is greater than 80% in people aged under 20 years and below 20% in people aged over 40 years.
There are different types of shoulder dislocation:
Although shoulder dislocations are not very serious injuries, one of the major considerations, apart from pain, is the potential for damage to the ligaments, blood vessels and nerves of the shoulder capsule. An orthopaedic specialist and a physiotherapist evaluate whether these structures have been compromised and also whether the nerves that innervate the various structures have been damaged, given that capsule retractions are very common if not managed early.
Shoulder dislocations are very painful, to the extent that the patient cannot move their arm.
Due to the fact that many nerves insert in the shoulder joint, the injury may be complicated by neurological damage that makes the arm numb and prevents movement.
However, the main damage occurs in the cartilaginous ring located at the end of the joint. Its function is to ensure that the humeral head inserts into the glenoid cavity. Normally, the glenoid cavity and ligaments are damaged. With recurrences of shoulder dislocation, the ligaments gradually become more lax.
First, the specialist takes a full medical history to diagnose every type of injury or dislocation. These data are used to determine the appropriate treatment and the prognosis. In addition, X-ray and CT scans must be done to better observe the injury and any possible effects on vessels or nerves.
In parallel, the specialist must analyse and evaluate the shoulder’s instability. To this end, an orthopaedic assessment may be done. The more orthopaedic tests give a positive result, the lower the probability of a wrong diagnosis.
The usual cause of shoulder dislocations is a traumatic injury, i.e. a forceful impact on the joint that forces it beyond its limits.
Recurrence of shoulder dislocation does not require a forceful impact; rather, a minor movement of the joint may cause muscles holding the joint in place to become more lax.
Shoulder dislocations cannot be prevented. Patients who suffer from repeated shoulder dislocations can however take preventive measures, by being more careful with movements they make and following the specialist’s advice.
Shoulder dislocations are extremely painful, and therefore require prompt attention to reposition the humeral head in its correct position. This requires specific mechanical manipulations that can only be performed by an orthopaedic specialist or a physiotherapist.
In parallel, the patient will receive medication to relieve pain. The specialist places the shoulder in its correct position - as this procedure may be painful, it is sometimes performed in the operating theatre under anaesthesia. Next, the arm is immobilized with a sling. An X-ray and MRI scan must be done to evaluate possible damage to other structures and ligaments.
People who do intense physical activities are more likely to suffer from repeated dislocations. In such cases, surgery with arthroscopy may be recommended to repair the ligaments. This is a minimally invasive intervention, so postoperative recovery will be shorter. Rehabilitation is necessary to restore mobility and strengthen muscles.
Shoulder dislocations are primarily managed by two types of specialists. An orthopaedic specialist determines the diagnosis and the most appropriate treatment for the shoulder dislocation. He determines the injury type and which structures have been damaged, and decides whether an orthopaedic or surgical approach should be used.
A physiotherapist provides non-pharmacological therapy. They contribute to symptom relief via a series of manual exercises and techniques, and the application of hot, cold, light or water.
The shoulder prosthesis is the replacement of the joint with a piece of synthetic material by surgical intervention. This operation is performed in cases where the shoulder joint is severely damaged by osteoarthritis. This technique achieves a reduction of pain and a restoration of mobility. In the shoulder prosthesis a metal piece is attached to the humerus head and a piece of polyethylene to the shoulder blade, both sealed with cement or embedded. There is also the inverted shoulder prosthesis for patients over 60 years old, to recover mobility of the shoulder. In the inverted prosthesis, the receiver is placed in the place of the humeral head, and where the receiver should be located, the humeral head is placed. These prostheses are indicated in cases of massive rupture of tendons, with no possibility of repair, to which certain joint osteoarthritis is associated.
Shoulder replacement surgery involves removing and replacing the damaged parts of the shoulder (usually the head of the humerus and scapula) with artificial implants. These are either made out of plastic or metal, or sometimes both. These implants are usually held in place using a special cement, or if they allow new bone growth, then cement is not required permanently. Although shoulder replacement surgery is less common than knee or hip replacement surgery, it can be just as effective in relieving shoulder joint pain.
Shoulder replacement surgery will usually be recommended if non-surgical treatments, such as medication or changes in physical activity have not been successful in relieving pain. You can experience shoulder pain for a number of reasons, including:
There are several types of shoulder replacement surgery:
Before surgery, certain medications will need to be stopped. It is also important to prepare your home prior to surgery, to make recovery easier. This includes, moving essential things to low-level shelves and having everything easily available. Before surgery you should wear loose-fitting clothes, with a button down shirt that allows easy removal after surgery. Surgery is performed with either general anaesthetic or regional anaesthetic.
After surgery, you will be given antibiotics to lower the risk of infection. Your arm will be in a sling and will have minimal movement. Patients generally return home after 2-3 days following surgery. Pain medication will be prescribed for the short-term, but will be carefully monitored. Physical therapy is also crucial to a good recvoery, and soon after surgery movement will be possible. Driving is not permitted for two to four weeks following surgery.
Shoulder surgery treats injured shoulders by repairing the muscles, connective tissue, or damaged joints that occur from traumatic injury, or from where the shoulder has been overused. The shoulder is the most flexible joint in the body, allowing the arm to be placed and rotated in many positions in front, above, to the side and behind the body. This degree of movement makes the shoulder susceptible to injury.
The doctor will discuss the medical history of the patient and then examine the shoulder. They will check to see whether it is tender in any area and whether there is a deformity. The strength of the arm will also be tested and the arm will be moved in different directions. Other tests that help with diagnosis include imaging tests, X-rays and MRI scans.
An orthopaedic surgeon will explain certain exercises that are aimed to strengthen the shoulder muscles, which will include wall push-ups and shoulder press-ups. They may also prescribe anti-inflammatory medication.
Tendonitis means the inflammation of a tendon, in which micro tears and areas of necrosis occur. Tendonitis in the shoulder can mainly affect the long portion of the brachial biceps and the muscles of the rotator cuff.
Physical therapy and exercise are usually effective to improve the symptoms and reduce shoulder pain. If these exercises do not work, surgery may be needed, otherwise the tendon may rupture completely.
The symptoms of shoulder tendonitis are:
Tests to diagnose shoulder tendonitis are as follows:
These tests and the detailed study of the patient's medical history usually provide an accurate diagnosis.
The main causes of shoulder tendonitis include:
Shoulder tendinitis can be prevented by following basic exercise guidelines:
Physical therapy is the appropriate treatment for tendonitis of the shoulder. The goal of this is to eliminate shoulder pain and improve joint stability and muscle strength. For this purpose, a series of exercises are performed that consist of mobilising the joint to avoid the loss of movement, deep massage of the affected tendon and stretching. In addition, other techniques can be performed, such as:
Orthopaedic surgeons and physiotherapists are the two types of specialists that treat this condition.
A SLAP tear is a type of shoulder injury. Your shoulder is surrounded by a band of tissue called the labrum to keep the joint stable. The labrum in your shoulder can tear in many ways. A SLAP tear involves the labrum being torn where it connects to your biceps tendon, both at the front or back.
Symptoms of a SLAP tear include:
It’s important to seek medical advice if you are experiencing the symptoms above. Injuries in the shoulder can lead to loss of motion or weakness without treatment.
It can be difficult to diagnose a SLAP tear because there are many other conditions with similar symptoms, including other types of shoulder tear in the rotator cuff such as a supraspinatus tear, or a dislocation.
A clinical diagnosis of your shoulder will include questions about how long you have had the pain for, whether there are certain movements that make the pain worse, and whether you have had similar problems in the past.
In addition to an examination, the GP may recommend:
The most common cause of a SLAP tear is falling on your arm, but other common causes of a tear include shoulder dislocation or something pulling hard on your arm.
Some people will experience a SLAP tear due to repeating the same actions, such as lifting weights or throwing a ball.
You’re also more likely to experience a SLAP tear the older you get, as the labrum becomes less attached.
A SLAP tear can be treated with medication, physical therapy, steroid injections, or surgery:
A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle, which is located at the back of the shoulder.
Symptoms of a supraspinatus tear include:
Usually a tear due to an injury will produce immediate intense pain and weakness in the arm. In cases of a degenerated tear, pain is mild at first and increases gradually over time.
It’s important to seek medical advice if you are experiencing the symptoms above. Injuries in the rotator cuff can lead to loss of motion or weakness without treatment.
A clinical diagnosis of your shoulder will include questions about how long you have had the pain for, whether there are certain movements that make the pain worse, and whether you have had similar problems in the past.
It can be difficult to diagnose a supraspinatus tear because there are many other conditions with similar symptoms, including other types of shoulder tear in the rotator cuff, SLAP tear, or inflammatory conditions such as arthritis.
In addition to an examination, the GP may recommend:
Supraspinatus tear can be caused by lifting something too heavy, falling on your arm, or dislocating your shoulder. However host cases are the result of the tendon wearing down over time, which is known as a degenerative tear.
You’re more likely to be at risk of a supraspinatus tear if:
Daily shoulder exercises can strengthen the muscles in your shoulder and help prevent future injury. A physiotherapist can advise you on what exercises will strengthen the back of the shoulder in addition to other parts of the shoulder.
A supraspinatus tear can be treated with medication, physical therapy, steroid injections, or surgery:
Surface prosthesis is an alternative procedure to total hip or knee replacement more suitable for patients under 65. Surface prostheses preserve a larger amount of the bone and usually last longer than their conventional alternative.
Tendinopathy is an umbrella term for diseases of the tendons. Tendons are fibrous cords of tissue that hold muscles to bone, and in order to do their job, they must be strong and flexible. Despite this, they can be injured due to overuse.
Tendinopathy broadly refers to three varieties of tendon injury, and is often confused with, or used synonymously with them. They are:
All of these conditions increase the risk of a more serious tendon tear, or rupture.
The common symptom of all types of tendinopathy is pain in or around the tendon, most commonly in the place where it attaches to the bone. Other symptoms depend on the type of tendinopathy – for example, tendonitis is characterised by inflammation, including heat, swelling and redness, while tendinosis is a chronic ache, pain or stiffness without much, if any inflammation.
The pain is usually worse during and after activity, and the area around the joint can be stiffer the following day.
There are tendons in many parts of our bodies, and tendinopathy can occur in any of them. It most commonly strikes in tendons such as those in the arms, shoulder, hands, and the Achilles tendon (in the heel).
It is thought that the biggest factor in most tendinopathies is overuse, although there are many theories regarding other possible factors, such as thermal damage and load-induced ischemia. Both sudden bursts of exertion leading to injury and repetitive movements are thought to be the main causes of tendonitis, and obesity is thought to be a risk factor.
In the case of calcific tendonitis, calcium deposits in the tendon are the cause of the inflammation, but why they build up in the first place is not fully understood.
While it is impossible to prevent with 100% certainty, the best way to prevent tendinopathy is to look after your muscles and tendons by not over-exerting yourself, but keeping them strong and flexible by doing exercise. Warming up before exercise and cooling down afterwards by stretching your muscles is also recommended.
The treatment may depend on the kind of tendinopathy, but in most mild cases the RICE therapy is advised:
Painkillers may be prescribed to deal with the pain – particularly NSAIDs if there is inflammation.
In more severe cases, shockwave therapy or even surgery may be necessary.
Tendon injuries, also known as tendinopathies, happen when there is an overload that causes small fibres to tear. When the affected muscles or joints are put under pressure, it causes tendon inflammation which reduces blood flow and can lead to nerve compression. When there is a mild inflammation it is referred to as tendonitis. It is called tendinosis if there is tendon degeneration.
Tendon injuries are common in sports. Injury location will depend on the sport. Some common tendon injuries include:
Tendon injuries do not tend to be a serious condition, providing adequate treatment is given.
Tendon injuries may be:
The symptoms of tendon injuries vary according to their location. There are several common symptoms, including:
A physical examination is normally enough to identify the affected tendon and the seriousness of the injury. However, in some cases the specialist may carry out other tests to have a closer look, these may be an ultrasound or an MRI scan.
Some of the most common causes include:
There are different tips that can be followed to avoid this kind of injury. It is important to take care when lifting heavy loads to avoid pushing the tendon beyond its limit.
A massage or stretching after lifting a heavy load is one way to prevent a tendon injury.
Other things to bear in mind are:
Treatment tends to be conservative, and includes rest and anti-inflammatory measures, depending on the severity of the injury. This may include medications, nutritional supplements, dietary changes, using bandages and manual therapy.
The methods used will depend on the injury location, severity, and how long it has affected the patient. Although there are many different treatments, the most common ones are:
When treatment doesn’t work, surgery may be resorted to instead.
Tendon injuries are normally treated by a sports medicine specialist, an orthopaedic surgeon or a physiotherapist.
Tendonitis (also spelled tendinitis) refers to inflammation of a tendon. It is one of the major sub-types of tendinopathy (tendon disease), along with tendinosis and paratenonitis.
Tendons are thick, fibrous cords of tissue that attach muscles to bones. They are tough, yet flexible, and have evolved to withstand tension. However, they can become injured or strained due to overuse, leading to inflammation.
Common types of tendonitis include:
Tendonitis is related to, and often goes hand-in-hand with tenosynovitis (inflammation of the sheath around the tendon, such as De Quervain syndrome).
Typical symptoms of tendonitis include:
Symptoms occur where the tendon connects to the bone. They may last anywhere between a few days and several months. Without proper treatment, the condition can develop into chronic tendinosis and leaves the patient more susceptible to ruptures in the tendon.
There are two main direct causes of tendonitis:
As we age, our tendons lose their elasticity, and become less flexible and easier to injure or tear.
Other risk factors include jobs involving repetitive movements, sport (particularly “weekend warriors”, who are relatively inactive during the week, but push themselves hard at the weekend), and certain health conditions, like diabetes and rheumatoid arthritis, which seem to go hand in hand with a greater likelihood of developing tendonitis.
Bad posture and not warming up properly before exercise can also lead to tendonitis.
Calcific tendonitis is caused by a build-up of calcium deposits in the tendon. Exactly why this occurs is unknown.
The first line of treatment for mild tendonitis is usually RICE therapy for 2-3 days:
It is recommended that you avoid heat, alcohol and massages for the first few days after injury.
If the injury is severe or lasts longer than a few days, you should see a doctor, who may recommend different treatments, depending on the nature and severity of the tendonitis.
Possible treatments include:
A traumatic injury is a physical injury which occurs suddenly, with a certain degree of severity. These types of injury typically require immediate medical attention and may first be dealt with in A&E, with later referral to a particular specialist if ongoing treatment is needed or rehabilitation is necessary. Major trauma has the potential to be severe, causing disability, or in extreme cases, death. Trauma is the most common cause of death in adults under 40 in the UK.
Trauma can be caused by a variety of external forces which affect the body. Some of the most common causes of traumatic injury include road traffic accidents, falls, violence, sports injuries, and penetration (e,g stab wounds, bullets). In the UK, falls are one of the most common causes of traumatic injury, as the ageing population are more likely to experience a fall. In England and Wales a fall is the most common type of major trauma, overtaking road traffic accidents as the main cause.
In cases of major trauma, where injuries are multiple and serious in nature, the patient will typically be taken to a trauma centre, where multi-disciplinary teams including anaesthetists, orthopaedic surgeons, neurosurgeons, and emergency doctors work to quickly deal with the injuries. Surgery may be immediate, in order to reduce the possibility of disability/death.
If the traumatic injury is not life-threatening, it will most likely first be dealt with in A&E, then referred to a specialist doctor if necessary. Surgery may be necessary to treat the injury, followed by physical therapy in many cases in order to achieve rehabilitation.
The specialist treatment will depend on the injury in question. Bone fractures, for example, will be treated by an orthopaedic surgeon/traumatologist, while brain injuries will be treated by a neurosurgeon.
Trigger finger is a condition that affects the tendons that bend the fingers. When the tendon sheath is inflamed, it makes finger extension or flexion difficult. This can cause the fingers to lock or trigger suddenly. The medical term for it is tenosynovitis.
It is not common for trigger finger to spontaneously resolve. If it is not treated, it is likely to be a painful discomfort. If the finger gets trapped, it could cause permanent stiffness.
Trigger finger symptoms may start with discomfort at the base of the finger, which could cause inflammation and swelling. The most common symptoms are:
The diagnosis can normally be made based on the patients’ medical history and symptoms. A physical exam is normally carried out to assess the stiffness and sensitivity of the affected fingers. The doctor may choose to do an ultrasound to check the swelling or they may carry out specific tests if they think it may be related to a different condition.
There is no clear cause for this condition, but it is thought to be related to rheumatoid arthritis, gout, or diabetes. It is more common in women and people aged between 40 and 60 years old. People who regularly carry out activities that require repetitive phalange flexion and extension for long periods of time, or put intense external pressure on a finger, are more likely to be affected by trigger finger.
Tenosynovitis can only partially be prevented. If it is due to an underlying condition (rheumatoid arthritis for example) that causes thickening of the finger tendon sheaths and causes involuntary movements and pain, it should be treated before it causes trigger finger. It may also be caused by a tendon mechanical overload. Certain movements should be avoided, and exercises should be carried out to strengthen the tendons.
Recommendations include:
Trigger finger treatment normally involves alleviating tendon pressure and enabling finger movement without any discomfort. A splint or anti-inflammatory medications are often used. If these treatments don’t work, surgery may be resorted to.
Orthopaedic specialists are devoted to preventing, diagnosing, and treating musculoskeletal conditions such as trigger finger.
Ulnar nerve entrapment is a nerve condition where the ulnar nerve becomes compressed. The ulnar nerve travels from the neck to the hand and is responsible for the function of different muscles of the hand and sensitivity in the ring fingers and little finger. When the ulnar nerve is trapped at the elbow it is called cubital tunnel syndrome.
The main symptoms of ulnar nerve entrapment are:
In cases of severe entrapment, you may feel a loss of sensation in some fingers and the medial edge of the forearm. The symptoms get worse when the elbow is flexed. Left untreated, you might feel weakness in your hand or even notice muscle wastage.
If you have tingling in your other fingers, this may be a sign of carpal tunnel syndrome.
Ulnar nerve entrapment can be caused by:
You are also more likely to experience ulnar nerve entrapment if you repeatedly place strain on the nerve by keeping the elbow bent. This may be due to the way you sleep or your posture at work.
You can help to reduce the chances of trapping your ulnar nerve by:
Ulnar nerve entrapment is first diagnosed with a medical examination. The doctor will ask about your symptoms and examine your arm, carrying out a number of tests to check which may nerve may be compressed and where.
Follow-up tests can include:
The first line of treatment is non-surgical and can include a splint to keep your arm straight at night and anti-inflammatory medication.
If these measures fail to improve symptoms, surgical intervention may be required. Surgery can include:
Surgery is generally effective, though you may need to wear a splint for a few weeks after the operation.
Compression of the elbow nerve is known as cubital tunnel syndrome. It is the erosion of the ulnar nerve that travels from the neck to the hand. It affects motor skills and sensory function of the ring and little fingers. The patient has pain, tingling, numbness or burning and sometimes altering the sensitivity of the medial edge of the forearm and the ring and pinkie fingers. Symptoms worsen by keeping the elbow bent. To treat this condition, the patient can opt for the conservative treatment (making changes in activities, use of splints, rest, stretching and taking vitamin supplements) or ulnar nerve surgery. This surgery decompresses the nerve from above the elbow to the forearm and moves the nerve from behind the elbow to the front. The goal of such surgery is to provide more space to the nerve and tendons, reducing the pressure on the nerve.
Wrist arthrodesis is a surgical intervention that aims to artificially fuse the joints of the hand. It is done under general or local anaesthetic.
Wrist arthrodesis is recommended when joint wear, arthrosis, trauma, malformation or degenerative disease affect the wrist, causing pain or loss of mobility.
Wrist arthrodesis aims to:
Wrist arthrodesis is generally only recommended when conservative measures have failed to relieve the pain in the wrist.
There is no specific preparation required for wrist arthrodesis, but you will have a consultation prior to the procedure to determine whether you are allergic to any anaesthetic.
Arthrodesis involves making a small incision in the back of the wrist to avoid any blood vessels. The damaged cartilage is then removed and a bone graft put in its place. The surgeon fixes a metal plate to the bone graft to hold it in place and fuse it with the surrounding bone. Finally, the wrist is stitched up.
The metal plate remains in the wrist unless it causes further problems.
After the operation you will be given medication to treat any pain caused by the operation. You will also be given advice on any complications to watch out for, bleeding, infection, or nerve injury.
Arthroscopy is a type of laparoscopic (keyhole) surgery, which is used to both diagnose and treat joint problems. It can be used to look inside the joint of the wrist, and there are many techniques employed by various surgeons. Arthroscopy is performed on many parts of the body, and wrist arthroscopy is one of the most common arthroscopic procedures.
Wrist arthroscopy allows the doctor or surgeon to examine the inside part of the wrist joint, including ligaments and the surface of cartilage, which can help them to determine if there is an internal problem in the wrist. The procedure may be performed after an injury, such as a fall, or when the wrist has twisted. There may be some swelling, clicking, or bruising, which can lead a medical professional to believe further investigation is necessary.
Wrist arthroscopy can also help to align wrist fractures, remove (wash away) infection, remove excess joint lining from conditions such as inflammatory arthritis, and remove ganglions (a fluid-filled swelling).
An arthroscope is a small camera which is fixed to the end of a long, narrow tube. This tube is inserted into the body through a small cut made in the back of the wrist joint. The camera allows the surgeon to see inside the wrist joint, through direct projection on the screen in front of them. Further cuts can be made to allow the surgeon to see inside different areas of the wrist joint. This also allows the surgeon to repair the ligament if necessary.
Usually there is no specific preparation the patient needs to do before the procedure. It is advisable to arrange transport or to arrange for someone to help the patient get home after the procedure. The patient must give their medical history and tell the surgeon which kinds of medicine they are taking, and they will be advised accordingly which they are able to continue with. Blood-thinners must be temporarily avoided before surgery (common blood thinners are ibuprofen and aspirin). These details will all be discussed pre-surgery so the patient is always aware what is expected of them.
After the procedure, the wound is closed with stitches, and a bandage is placed around the wrist which limits motion. This allows for faster recovery, as it will protect the wrist area and support helps to relieve pain. As arthroscopy is ususally performed as a day-case procedure, there is not normally an overnight stay in hospital. The patient can go home the same day, and is advised to keep their wrist elevated for a few days after surgery in order to minimise swelling. Cold packs can help with swelling too.
Some patients may need to wear a splint which will provide them with support. If a dressing is applied, it may need to be changed and correct aftercare advice will be given by the healthcare provider. Physical therapy or specific hand exercises may be advised to help the patient regain the full range of motion.
A broken wrist or wrist fracture is when one or more of the bones in the wrist is cracked or broken. The most common type of wrist fracture is called a Colles’ fracture (or distal radius fracture). This type of break is a break in the larger of the two bones in the forearm. The bone usually breaks at the end where it connects with the hand and thumb. Wrist fractures occur through impact – either through playing sports, having fragile bones (osteoporosis) or falling down.
It is essential to treat a wrist fracture as not doing so could risk the bones healing incorrectly, which may cause problems in the future.
An X-ray will determine the type of fracture. Sometimes a CT scan or MRI will be carried out as well to give the specialist more detail of any potential damage to soft tissue and blood vessels.
The main causes of a wrist fracture are car accidents, sports injuries and falls.
Although you cannot prevent unforeseen events, there are measures that can help reduce the chances of injury.
You can improve your bone strength by eating a healthy diet with enough calcium and vitamin D. Exercising frequently and being sure to do weight-bearing exercises too. Stop smoking.
To avoid falls it is advised to wear practical shoes (not high-heels or platforms). Move any tripping hazards. Make sure your vision is fine, or your glasses prescription is correct.
When playing sports, make sure protective gear is being used.
If the bones are misaligned, they will need to be reset so that they heal in the correct position. This can be painful, so anaesthesia can be given. A cast will be needed for up to 8 weeks, depending on how bad the fracture is.
To manage any pain, over-the-counter pain medication can be taken.
An orthopaedic surgeon is the specialist that will treat wrist fractures.
There are many types of surgical procedures that can be performed on the wrist, depending on the injury or condition being treated. These include both open and minimally invasive surgery on the bones, tendons, ligaments, and nerves in the wrist. As is often the case, surgery is usually only recommended by your doctor in serious situations, or when more conservative treatment has not worked.
There are many things that can happen to your wrist that can warrant surgery. Generally, these are either injuries to the bones, ligaments, or nerves, or serious medical conditions that cause pain or affect the patient’s quality of life. Surgery may be recommended for the following:
In most cases, the doctor will only advise surgery if other treatment options have failed.
Different types of wrist surgery involve different things:
e-Consultation is a private messaging and video conference service that allows contact with leading specialists at the time you choose, from any place.
The majority of people who develop frozen shoulder do so for no known reason at all. Although the condition is usually self-limiting and the tightness in the shoulder spontaneously resolves to a large extent, it may take up to two years for the shoulder to heal. Mr Keith Borowsky talks to us about frozen shoulder and if a frozen shoulder could signal an underlying condition.
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Rotator cuff tears can occur naturally with age, with a 40% chance that a tear will occur when you’re 80 years of age or older (often asymptomatic). They also occur as a result of an injury. We asked shoulder and elbow surgeon Mr Keith Adrian Borowsky about rotator cuff tears and their recovery.
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Despite its name, tennis elbow is not just experienced by tennis players. In fact, tennis elbow, which is actually called lateral epicondylitis is a common condition caused by repetitive wrist extension and forearm supination movements. Over time, these movements cause micro-injuries to the tendons, resulting in what we know as tennis elbow. Mr Keith Adrian Borowsky, a leading shoulder and elbow surgeon, answers our questions about tennis elbow.
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