Common Elbow, Wrist & Hand Injuries
Lateral Epicondylitis (Tennis Elbow)
It is caused by strong gripping combined with repetitive motions of the wrist. A wide range of athletes experience this injury, it is not limited to tennis players. Interestingly, golfers seem to get this in their leading elbows, that is, left elbow for right-handed players and vice versa. It is also common in people who’s jobs involve repetitive wrist and elbow motions, such as drivers, factory workers, and even housewives. It is characterized by pain on the outside of the elbow during movements of the wrist (ex. shaking hands or opening doors). Treatment includes ice, rest or a decrease in the activities that irritate the injury, stretching and strengthening the wrist muscles.
Medial Epicondylitis (Golfer’s Elbow)
Medial epicondylitis is caused by repeated medial tension/lateral compression forces. Commonly described for golfers, usually affects the trailing arm, in other words, the right elbow for right-handed golfers, and the left elbow for left-handed golfers. A wide range of athletes experience this injury, it is not limited to golfers alone. Can be characterized by pain on the inside of the elbow during movements of the wrist (eg. shaking hands). Treatment includes ice and rest or a decrease in the activities that irritate the injury.
De Quervain’s stenosing tenosynovitis is a painful inflammation of the tendons of the wrist. It commonly affects patients between 30 to 50 years of age with a strong predilection for women. Repetitive motion of the wrist is a strong risk factor.
Clinical examination usually reveals tenderness just over the tip of the wrist on the side where the thumb is (radial side)
Finkelsteins test is pathongomic of DeQuervains tenosynovitis.
In this test, the patient makes a fist with his/her thumb placed under his/her little finger, and bends the wrist. The patients symptoms are strongly reproduced with this test.
Treatment for early symptoms include rest, activity modification and anti-inflammatory medication. Steroid injections are useful for cases which do not respond to conservative treatment.
Surgery is recommended for difficult cases.
Trigger finger commonly affects patients between 40 to 60 years of age with a predilection for women. It is more common in patients with Rheumatoid arthritis, Diabetes and repetitive strain injuries. Any finger can be affected.
Symptoms develop when a tendon cannot glide in its sheath because of thickening of the A1 pulley over the Metacarpo-phalangeal joint. (Figure 2)
The onset is insidious and usually starts with pain and sometimes a palpable nodule or small lump in palm. As symptoms progress, the patient may complain of “triggering” or “catching” of the finger with flexion and extension. (Figure 1)
Treatment for early symptoms include rest, analgesia and splinting. Steroid injections are useful for cases which do not respond to conservative treatment.
Surgical release is recommended for recalcitrant cases.