Hand, Wrist & Elbow
The wrist consists of the forearm bones, the radius and ulna, and a group of bones called the carpal bones. Problems of the hand and wrist are common and can affect the bones, cartilage, tendons, and nerves. Problems can arise based on active lifestyle, repetitive motion, injury, overuse, or aging.
Your elbow joint is made up of the humerus (upper arm bone) as well as the radius and ulna (forearm bones). Muscles and tendons move the elbow joint while ligaments primarily stabilize the joint. There are many potential causes of elbow pain, including tendonitis (tennis elbow), fractures or other trauma, arthritis, and nerve disorders. In fact, some symptoms such as numbness or tingling in the hand may be due to a problem at the elbow.
Orthopedic Associates of Hartford can help diagnose the cause of your hand, wrist or elbow symptoms and develop a treatment plan. Treatment of these conditions depends on the cause, and non-operative treatment is often successful. Our hand specialists treat a full range of problems of the hand and wrist including arthritis, broken bones, carpal tunnel syndrome, loss of motion, tendon and nerve injuries, as well as other problems. Our elbow specialists have specific training and experience in operative management of complex fractures, arthritis, ligament tears, and nerve disorders.
Common Conditions
Some of the most common hand and wrist problems include:
Arthritis: Involves inflammation of one or more joints and occurs when the cartilage of a joint surface is injured. Arthritis can cause pain, swelling and loss of motion over time. The hand and wrist have multiple small joints that work together to produce motion, including the fine motion needed to thread a needle or tie a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult. Arthritis can occur in many areas of the hand and wrist as well as the elbow, and can have more than one cause. Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.
Bursitis (Elbow): Bursitis is inflammation of a bursa. A bursa is a fluid-filled sac that is found where tendons pass by bony surfaces.
Carpal Tunnel Syndrome: Carpal tunnel syndrome is characterized by numbness or pain in the thumb and first two fingers. It is a common problem for people who use their hands for extended periods of time, such as workers in textile manufacturing, upholstering, assembly line, and in clerical keyboard work. Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist.
Dislocation of Joints: This occurs when one of the two bones that make up a joint separates from the other bone.
Elbow Tendonitis: Inflammation or pain along a tendon. Tendons are the structures that connect your muscles to your bones. Tendons in the elbow that can experience tendonitis are the biceps and triceps tendon, as well as other tendons in tennis elbow and golfer’s elbow.
Fractures: A bone fracture, or break, occurs when the force applied against a bone is stronger than the bone. The bones of the hands and wrists are very small in comparison to the bones of other joints, such as the hips, knees, and shoulders, and a fracture may be caused by a severe strain of a ligament or muscle. Crushing injuries to the hand or wrist also may cause fractures. Older adults are at higher risk of fractures since they lose muscle mass and bone strength as they age.
Nerve Problems (Elbow): Nerve issues occur when nerves around the elbow are inflamed or compressed. This can cause numbness, tingling, or weakness in the forearm or hand.
Sprains and Strains: A sprain is a torn or stretched ligament. A strain is a torn or stretched tendon, which are the tissues that connect muscle to bone. They occur as a result of excessive stress applied during a stretching, twisting, or thrusting action. Sprains and strains can be caused by sports activity or other repeated activity, a sudden twist, or an accidental fall.
Trigger Finger: An inflammation of the tendon of one or more fingers. If you have the condition, it is usually difficult to extend or straighten the affected finger. Occasionally, when trying to open or extend the finger, it will pop or “trigger” into a straight position.
Wrist Ganglion: A small cyst filled with synovial fluid from around the joint. These cysts can usually be seen at the back of the wrist. They are usually painless, but excessive use of the hand or pressure to the ganglion may cause discomfort.
Hand and Wrist Disorders: There is a wide range of hand and wrist disorders that may be the result of injury, genetic predisposition, overuse, or other medical conditions. These include:
- Compartment Syndrome
- Dupuytren’s Contracture
- Reflex Sympathetic Dystrophy
- Ulnar Tunnel Syndrome of the Wrist
- deQuervain’s Tendinitis
- Kienböck’s Disease
- Boutonnière Deformity
Symptoms
Hand & Wrist Symptoms
Symptoms associated with hand and wrist pain are varied based on the condition and can vary in intensity from mild to severe. Some possible symptoms may include:
- Dull or burning pain sensation, especially after increased joint use
- Numbness or tingling in different parts of the thumb, finger, hand, or wrist
- Occasional shock-like sensations that radiate from parts of the hand or wrist
- Pain or tingling that may travel up the forearm toward the shoulder
- Weakness and clumsiness in the hand that may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
Elbow Symptoms
Symptoms associated with elbow pain depend on the cause, and vary in intensity from mild to severe. Symptoms may include:
- Intense pain, swelling, or bruising due to an injury
- Morning stiffness of the elbow with persistent aching
- Numbness and tingling of the inner elbow, forearm, as well as the little and ring fingers
- Pain that is worse when grasping or holding an object
- Soreness in the forearm
- Tenderness on the outer bony part of the elbow
How We Diagnose
Medical History and Examination
During your first visit, your orthopedic surgeon will gather information about your general health and ask questions about the extent of your hand, wrist or elbow pain, and how it affects your ability to perform everyday activities. They will want to understand the duration and intensity of your symptoms and what types of actions lead to increased pain.
During the physical examination, your doctor will examine your hands, wrists and/or elbows as well as any other joints you may be experiencing problems with. Your doctor will be looking for areas that have tenderness, pain or swelling, as well as indications the joint may be damaged. Physical tests to assess numbness, weakness, tingling and atrophy will also be conducted.
Depending on the findings of the history and exam, your doctor may order lab tests and imaging tests to help make or confirm a diagnosis.
X-Ray
These images help to determine the extent of damage or deformity in the fingers, hand, wrist, or elbow. X-ray can reveal narrowing of the space between bones, which can be a sign of osteoarthritis, bone spurs, and fractures.
Other Tests
Other tests, such as a magnetic resonance imaging (MRI) scan, CAT scan, or ultrasound may be ordered. These tests can provide more details about internal structures and can show soft tissues, such as cartilage, ligaments, and muscles more clearly than x-ray. For hand injuries, electrophysiological tests may be conducted to measure how well nerves in the hand are working and whether nerve compression may be contributing to your symptoms.
Treatment Options
There are a number of non-surgical and surgical options to restore mobility and reduce pain.
Non-Surgical Options
When it comes to treating elbow pain, there are many options. Medication, both prescription and over-the-counter, is used to treat arthritis and control pain. Common medications are aspirin-free pain relievers, anti-inflammatory drugs, and corticosteroids. Use of heat or cold over joints may provide short-term relief from pain and stiffness. When first-line treatment with anti-inflammatory medication is not effective, cortisone injections may be used. These typically contain a long-lasting anesthetic and a steroid that can provide pain relief for weeks to months. OAH has state of the art ultrasound machines that allow for these injections to be performed in the office setting. Wearing a brace or splint may be recommended to prevent bending in certain directions, it can provide stability and also reduce pressure on nerves. Physical therapy can be used pre- or post-surgery to increase mobility, restore function, minimize pain and reduce pressure on certain joints to help you meet the demands of your normal routine.
Surgical Options
If nonsurgical treatment fails to give relief, surgery is usually discussed. Our surgical team is adept at the most advanced surgical techniques to inspect, diagnose, and repair hand, wrist and elbow problems. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function.
Patient Education
Hand & Wrist Injury Resources
Arthritis of the Hand: What You Need to Know
Ulnar Tunnel Syndrome of the Wrist
The following 3D animations provide useful information about common injuries and conditions affecting the hand and wrist, as well as treatment options.
Carpal Tunnel Release
Ulnar Collateral Ligament Reconstruction (Tommy John Surgery)
Wrist Arthroscopy
Trigger Finger