Hand, Elbow & Shoulder

Treating hand and wrist injuries and conditions

You use your hands for work and just about every activity of daily living — eating, bathing, dressing, writing, typing, drawing, and more.

When using your hands becomes difficult or even painful because of an injury or condition like arthritis, it's time to seek medical treatment. Bothwell Medical Room’s team of orthopaedic surgeons specialise in hand and wrist injuries, diseases, and deformities.

Hand and wrist surgeons take a conservative approach to treatment, choosing nonsurgical options whenever possible and appropriate. If it's determined that surgery is your best bet to relieve hand or wrist pain or improve mobility and function, your specialist will create a surgical treatment and recovery plan tailored to your individual needs and lifestyle.

Surgical treatments

Whether your hand or wrist pain, numbness or tingling is related to the degenerative effects of arthritis, nerve damage, fracture, dislocation, or something else, surgery may be your best option.

Here are some of the most common orthopaedic surgical procedures performed at Bothwell Medical Rooms to treat hand and wrist injuries and conditions:

Joint surgery for arthritis: 

When joint inflammation caused by arthritis or injury leads to chronic pain and a decrease or complete loss of function in the hands or wrist, joint surgery may help. Orthopaedic hand and wrist surgeons can replace or stabilise affected joints using plastic or metal components. The result is decreased pain, increased function and improved appearance of deformed joints.

Nerve compression surgery: 

When nerves become compressed between the ligaments, tendons and bones in the hands and wrists, the resulting pain and swelling can be debilitating. Surgeons can surgically relieve compression on the nerve that is causing pain, numbness or tingling.

Hand/wrist fracture or dislocation repair:

Severe fractures in the hands or wrists sometimes require surgery. Surgeons implant wires, screws or plates to stabilize and hold pieces of bone in place so they can heal properly.

Carpal tunnel release: 

Carpal tunnel syndrome is characterized by pain, numbness, weakness or tingling in the fingers or hand. The symptoms are caused by pressure on the median nerve in the wrist. Carpal tunnel release is a surgical procedure to cut through the carpal ligament to create more space for the median nerve and nearby tendons.

Trigger finger release: 

Trigger finger is a term used to describe a condition in which the fingers become stuck in place when they're bent and then make a snapping sound or motion when they straighten. It's called trigger thumb when the condition occurs in the thumb. Trigger finger/thumb occurs when the tendons become inflamed. In severe cases, the fingers or thumb may become locked. Surgeons can release pressure on the compressed tendons causing the condition.

Dupuytren's contracture surgery: 

Dupuytren's contracture is a condition in which scar tissue forms under the skin of the palm and fingers as the tissue around the tendons thickens and tightens over time. The scar tissue eventually causes the fingers to contract and pull inward. This sometimes prevents the fingers from fully straightening, which can interfere with proper hand function. Surgical repair includes removing scar tissue to the allow tendons to move properly.

Wrist fusion:

In cases of severe injury or deformity, wrist fusion may be the most appropriate treatment option. The procedure involves removing the wrist joint entirely and fusing together the major bone in the forearm (radius) with the small bones in the wrist (carpal bones) using a metal plate. It limits wrist movement but is effective in relieving pain.

Elbow Pain

Elbow pain is the result of damage to or disease of bone, tendons, ligaments or cartilage around the elbow. The pain or discomfort is often accompanied by other symptoms, such as tenderness, swelling, numbness, visible deformity of the joint or stiffness and loss of motion.

Athletes have an increased risk of developing these problems, but joint-related issues can affect anyone, at any age.

Injuries That Cause Pain in the Elbow

Fractures, dislocations and sprains, which are stretch or tear injuries to the ligaments, can result from falls, twists or blows to the area and cause significant pain.

Tendonitis is another common elbow injury, but occurs after repetitive use and over use.

Tennis elbow is a type of tendonitis in which the outside bony portion of the elbow joint becomes inflamed and painful.

With golfer’s elbow, the opposite occurs, as the inner tendons are injured. The repetitive motions involved in playing sports like tennis or golf, or other repeated motions such as using hand tools or painting, can cause either of these injuries.

Diseases and Conditions That Cause Elbow Pain

Several systemic forms of arthritis, including rheumatoid arthritis, gouty arthritis and psoriatic arthritis, can cause elbow pain and inflammation.

Bursitis is a common cause of elbow pain and swelling. This occurs when fluid collects over the point on the back of the elbow. Bursitis can be caused by repetitive use, trauma, or infection.

Septic arthritis, or an infection of the joint itself, is a rare elbow condition that results in severe pain and stiffness. This is usually only seen in patients with compromised immune systems, due to diabetes, chemotherapy, chronic disease, and intravenous drug users.

In rare cases, a bone tumor may be the cause of pain and other symptoms.

Diagnosing Elbow Symptoms

When diagnosing elbow pain, the consultant will take a medical history to learn about recent injuries and any past issues with the elbow joint. He or she will then examine the arm and joint to determine the location and scope of pain, as well as any swelling or visible deformities of the joint.

The consultant also will test your mobility and range of motion.

Other tests, such as an X-ray or MRI, may be ordered as a further aid in diagnosis.

Treatment recommendations depend upon the particular injury or condition causing the elbow pain, but may include the RICE treatment ― rest, ice, compression and elevation ― immobilizing the affected area with a brace or cast, cortisone injections, physical therapy, pain management, or in rare cases, surgery.

Orthopaedic surgeons can accurately diagnose elbow problems and offer the most appropriate treatment options to restore function and relieve pain.

Contact the experienced professionals at Bothwell Medical Rooms if you are suffering from elbow pain or related symptoms.

Shoulder treatment and surgery

Lingering pain, stiffness, weakness or instability in your shoulder are signs that it may be time to see a doctor. Not all shoulder injuries and conditions require surgery, but some do. Orthopaedic surgeons at Bothwell Medical Rooms can help determine whether nonsurgical treatments might ease your pain or if shoulder surgery offers your best chance at finding relief.

How the shoulder works

One of the most complex joints in the body, the shoulder has the greatest range of motion of any joint.

Its three bones are:

1. Humerus (upper arm bone)
2. Scapula (shoulder blade)
3. Clavicle (collarbone)

As a ball-and-socket joint, the shoulder depends on an elaborate system of muscles, tendons and ligaments for stability and to help it move smoothly and rotate properly.

At the top of the humerus is the ball. It rests on a socket called the glenoid, which is part of the scapula. Soft tissue called labrum surrounds the socket and stabilizes the joint along with the ligaments. The deltoid and rotator cuff muscles in the shoulder allow the humerus to move and rotate in the socket. This lets you raise and rotate your arm. When an acute or chronic injury interferes with the joint's ability to move and rotate, pain, stiffness, weakness and instability can set in.

Causes of shoulder pain

Causes of acute and chronic shoulder pain, stiffness and other symptoms include muscle injuries, arthritis in the glenohumeral joint (shoulder joint) and general wear and tear to the cartilage in the joint. Orthopaedic shoulder specialists treat all types of shoulder injuries and conditions that may be caused by or related to:

• Arthritis
• Bursitis (inflammation around the joint)
• Tendonitis (inflammation of the tendons), including biceps tendonitis
• Fractures or dislocations to the clavicle (collarbone) or other bones that make up the shoulder
• Muscle tears, including rotator cuff tears
• Shoulder impingement that occurs when bones and tendons rub, making it painful to lift your arm

Cartilage in the shoulder lets the bones move smoothly against one another. The degenerative effects of arthritis can break down that cartilage, causing progressive pain, discomfort and even loss of motion.

Finding the right treatment for your shoulder injury or condition starts with an accurate diagnosis. Your doctor may use a variety of medical imaging technologies and in-office exams to identify the exact location and cause of your shoulder pain or irritation.

Medical imaging procedures that may be used to evaluate and diagnose your shoulder injury include:

• X-rays
• MRIs
• CT scans
• Ultrasound

Treatment of shoulder pain

In most cases, your doctor will begin by exploring nonsurgical options such as:

• Physiotherapy
• Injection of an anti-inflammatory medication
• Lifestyle and activity modification

If nonsurgical options don't alleviate your pain or ease your other symptoms, it may be time for shoulder surgery. When possible and appropriate, orthopaedic surgeons at Bothwell Medical Rooms choose arthroscopic outpatient surgery. This is a minimally invasive surgical approach that:

• Allows smaller incisions.
• Results in less scarring
• Reduces the need for pain medication.
• Results in a faster recovery

Orthopaedic shoulder specialists at Bothwell Medical Rooms perform some of the most complex shoulder surgeries, including shoulder revision surgery. Regardless of the type of shoulder surgery you undergo, the goals include reducing pain and improving function.

Types of shoulder surgery performed at include:

• Shoulder arthroscopy to repair tissue inside and around the shoulder or to remove bone spurs.
• Total or partial shoulder replacement or revision surgery to replace the shoulder joint or repair a previous joint replacement.
• Rotator cuff surgery to treat tears and other injuries to the rotator cuff tendon, which connects the muscles that allow your shoulder to rotate.
• Other types of shoulder surgery

Your orthopaedic surgeon will collaborate with your GP to ensure that you receive the best possible care and treatment. Depending on the recommended treatment or surgical approach, your surgeon may also work with a physio, anesthesiologist, orthopedic nurses and others in the hospital to provide personalized care and attention throughout your treatment.