We use our hands daily — whether to perform simple tasks like washing the dishes or more complex tasks like needlework or playing the piano. Often, hand motion also involves the wrists and elbows, too. That’s why pain or injury affecting the hands, wrists or elbows, can be so debilitating.
The right diagnosis and treatment can help patients get back to normal functioning, with less pain, as soon as possible, according to Dr. Christopher Miskovsky, MD, an orthopedic surgeon on the medical staff of Texas Health Center for Diagnostics and Surgery.
While he specializes in hand, wrist and elbow surgery, Dr. Miskovsky says that most of his patients don’t end up requiring surgery.
“Probably about 90% of what we do is not operating on patients,” he said. “In the majority of cases, we can take care of the orthopedic problem and get the patient back to functioning without having to go through to the operating theater.”1
Some of the common conditions that are associated with upper extremity conditions include distal radius fracture, tennis elbow, carpal tunnel syndrome and arthritis of the hand and thumb. Here’s a brief look at each.
Distal Radius Fracture
Distal radius fractures — broken wrists — are common injuries. The radius is one of the two long bones in the forearm. When a break occurs close to the wrist, it’s called a “distal radius fracture.”2
“These are very common with younger patients who’ve been involved in motor vehicle accidents or injured during football games or soccer games,” Dr. Miskovsky said. “But we also take care of older people, in the 60s, 70s and 80s, who have distal radius fractures from falls in the backyard or the driveway.”
In most cases, Dr. Miskovsky said, doctors can treat the injury with non-surgical treatments. Early intervention is key.
“It's important for patients to be seen and treated early, in an efficient manner, so that they can get the best possible outcome,” he said.3
That doesn’t necessarily mean a trip to the emergency room. Unless the injury is an emergency – for example, with significant bleeding or severe pain — it may be more efficient for patients to call the orthopedic surgeon’s office first, rather than go to an ER.
“Often people will call us immediately after they’ve had an injury, and if we can fit them into the office soon, it saves them an emergency room trip,” Dr. Miskovsky said. “We can usually get them in either the same day or the following day.”
Patients who go to an emergency room with a distal radius fracture typically receive only a splint and a referral to an orthopedic surgeon.
“If we can see the patient first, that can avoid a trip to the ER and an unnecessary delay in their treatment,” he said.
Tennis Elbow
What is tennis elbow? Lateral epicondylitis — or “tennis elbow” — is a painful condition of the elbow. It’s often caused by playing tennis or other racquet sports, but several other sports and activities can also lead to tennis elbow. The condition involves the degeneration (wearing down) or, in some cases, micro-tearing of the tendons that join the forearm muscles on the outside of the elbow.4
“Tennis elbow is an overuse injury, which means that it occurs from repeating the same motions over and over again,” said Dr. Miskovsky. “It's a tendonitis or a small tear in the tendon at the elbow. The more you do, the more you're going to irritate it.”
The first line of tennis elbow treatment: rest.
“We typically advise patients to back off on athletic activities for several weeks, to relieve the pain and relieve the overuse phenomenon that's occurring,” said Dr. Miskovsky.
Other treatments that may help:
• medications (acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen)
• physical or occupational therapy
• a brace on the forearm to help rest the muscles and tendons
• steroid injections
Patients who play racquet sports should also have their equipment checked for proper fit. Stiffer racquets and looser-strung racquets may reduce the stress on the forearm so that the forearm muscles do not have to work as hard.5
Recovery can be slow, but surgery is usually not required.6
“It takes time, but the majority of patients’ symptoms will fully resolve on their own, and they can get back to their full activities,” Dr. Miskovsky said. “Recovery from tennis elbow may take several months to fully heal and fully improve. But in most cases, we don’t recommend surgery.”7
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and forearm.
The carpal tunnel is a literal tunnel in each wrist that lets nine tendons, four ligaments and one nerve pass through it to reach the rest of the hand. (Think of the carpal tunnel as analogous to the fiber optic cables buried underground to deliver internet or cable TV service to your home.)8
Carpal tunnel syndrome occurs when one of the major nerves in the hand — the median nerve — becomes compressed as it travels through the wrist.9
“I'll have patients come in and they'll tell me, ‘I can't sleep,’” said Dr. Miskovsky. “They’ll say, ‘I'm waking up every night because my hands hurt. I get up, I have to shake my hands or walk around in the middle of the night trying to get my fingers to wake up.’”10
In most patients, carpal tunnel syndrome will worsen over time if left untreated. It can lead to permanent dysfunction of the hand, including weakness and loss of sensation in the fingers. For this reason, it is important to diagnose the condition and begin carpal tunnel treatment sooner rather than later.
The good news: if treated early, carpal tunnel symptoms can often be relieved with simple measures.
“Initially, we put patients in splints when they sleep at night and see if that benefits their symptoms,” said Dr. Miskovsky. “The pain is caused by a compression of the median nerve as it crosses the wrist. If we can relieve pressure with a splint, by simply keeping the patient’s hand in a stable, straight position rather than a bent position when they sleep, then oftentimes people can avoid needing to do anything further.”
If symptoms persist, typically the next step is to perform a nerve conduction study, which can usually be done in an orthopedic surgeon’s office.
“That tells us how bad off the nerve is on the inside,” he said. “That would then dictate whether we can do things like injections or medications, or if we need to consider carpal tunnel surgery.”
Arthritis of the Hand
Many people develop arthritis of the hand as they get older. The most problematic cases typically involve the CMC joint – the base of the thumb. By age 80, some 85% of patients will have arthritis in that joint.
“We wear out our joints over time, and our thumb is the most common joint to wear out,” said Dr. Miskovsky. “At the base of your thumb, you have a saddle joint that can move in about 270 degrees of motion. That's what allows us to function in such a capable way with our hands. But because we use that joint so much, and because there's so much force placed on it when we grip and pull and twist, that joint will often wear out.”11
Typically, the condition can be treated without surgery.
According to Dr. Miskovsky, “We tend to treat arthritis of the thumb with anti-inflammatory medicines, such as Advil and Aleve, with splinting, and with medicated creams applied in the area. Creams tend to work well for arthritis of the hand in general because the joints are directly underneath the skin.”
Steroid injections tend to be very beneficial for hand arthritis, particularly thumb arthritis.
In rare cases, surgery may be required, such as joint replacement surgery, or the removal of the arthritic bone and replacement with the patient’s own tendon tissue.
Patients who are considering joint replacement surgery in the hand, carpal tunnel surgery, or other hand surgery, should see a surgeon, who specializes in hand surgery.
Read more about surgery of the hand here.
The physicians on the medical staff at Texas Health Center for Diagnostics & Surgery in Plano, Texas, provide a wide range of nonsurgical and surgical treatment options for conditions affecting the hand and upper extremities. For more information, please call our THCDS patient navigator at 972-543-1250.
[1] What is a distal radius fracture? Dr. Miskovsky Video: https://www.youtube.com/watch?v=uoaeIf8saxM
[2] Distal Radius Fractures (Broken Wrist). Ortho Info, website of the American Association of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases—conditions/distal-radius-fractures-broken-wrist/
[3] All quotes from Dr. Miskovsky in this Distal Radius Fracture section are from this video: What is a distal radius fracture? https://www.youtube.com/watch?v=uoaeIf8saxM
[4] Ortho Info: Tennis Elbow. https://orthoinfo.aaos.org/en/diseases—conditions/tennis-elbow-lateral-epicondylitis/
[5] Treatments and equipment check recommendations source: Ortho Info, Tennis Elbow (Lateral Epicondylitis) https://orthoinfo.aaos.org/en/diseases—conditions/tennis-elbow-lateral-epicondylitis/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869705/
[7] All quotes from Dr. Miskovsky in the Tennis Elbow section are from this video: What is tennis elbow? https://www.youtube.com/watch?v=m3cl5eipTrE
[8] Anatomy of the Hand and Wrist, Cleveland Clinic. https://my.clevelandclinic.org/health/body/25060-anatomy-of-the-hand-and-wrist
[9] Ortho Info, Carpal Tunnel. https://orthoinfo.aaos.org/en/diseases—conditions/carpal-tunnel-syndrome/#:~:text=Carpal%20tunnel%20syndrome%20is%20a,syndrome%20gets%20worse%20over%20time.
[10] All Dr. Miskovsky quotes in carpal tunnel section are from this video: What is carpal tunnel syndrome and how is it treated? https://www.youtube.com/watch?v=yRXBgD-5CU4&t
[11] Dr. Miskovsky video, Arthritis of the Thumb. https://www.youtube.com/watch?v=WnJbbNMBqvo