Category: Upper Limb

  • 07
  • Oct
Wrist Sprain
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Brief Outline of Wrist Sprain

Wrist sprains involve injury to the ligaments of the wrist. Such sprains are a common occurrence when the hand is extended to break a fall. Ligaments are necessary for stabilisation of the hand and control of motion. Wrist sprains vary from moderate to severe, with the latter involving complete tearing of the ligaments and instability of the accompanying joint. The injury is common to athletes engaged in football, basketball, skiing, snowboarding, rollerblading, and a variety of other sports in which the hands are vulnerable.

Anatomy and physiology

The eight carpal bones of the wrist are connected together via ligaments – fibrous bands of tissue. Such ligaments also connect the bones of the wrist with the radius, ulna and metacarpal bones. The smooth coordination of these bones required for proper hand movement is impaired when one or more ligaments are injured.

Wrist Anatomy BonesCause of Wrist Sprain Injury

Engaging in sports where falls are common, e.g. in-line skating, snowboarding, cycling, soccer, football, baseball, and volleyball. Lack of protective equipment, including wrist guards. Muscle weakness or atrophy.

Signs and symptoms of Wrist Sprain Injury

Pain with movement of the wrist. Burning of tingling of feeling at the wrist. Bruising or discolouraion of the skin.

Complications if left Wrist Sprain Injury unattended

Moderate to severe wrist sprains left untreated can lead to ongoing deficit of movement and strength in the wrist as well as developing arthritis at the region of the injury.

Orthopaedic Specialist Major in Wrist Sprain Injury, Dr Kevin Yip

Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

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  • 07
  • Oct
Wrist and Forearm Fracture
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Brief Outline of Wrist and Forearm Fracture

Should an person fall on an outstretched wrist, a break or fracture of the wrist or bones of the forearm may result. Activities vulnerable to such injury include running, cycling, skateboarding, rollerblading and other activities in which an outstretched hand may be used to break a fall.

Anatomy and physiology

The wrist consists of a series of radio-carpal and intercarpal articulations. However, most wrist movement occurs at the radio-carpal joint, an ellipsoid joint. The distal surface of the radius and articular disc articulate with the proximal row of carpals: the scaphoid, lunate, and triquestral (triquetrum). Movements are in combination with the intercarpal joints. The intercarpal joints are a series of plane joints, which have articulations between the two carpal row (midcarpal joint), plus articulations between each bone of the proximal carpal row and of the distal carpal row. The distal radio-ulnar joint is immediately adjacent to the radio-carpal joint. A cartilaginous disc separates the distal ulna and radius from the lunate and triquetral bones. Wrist fractures are breaks in one or more of these bones. The two most common wrist fractures are Colles’ fracture, which occurs near the end of the radius, and scaphoid fracture, which involves the scaphoid or navicular, a small bone located on the thumb-side of the wrist that joins the radius.

Wrist Anatomy Bones

Cause of Wrist Fracture

  • A fall onto an outstretched wrist.
  • A blow to the wrist.
  • Extreme twisting of the wrist.

Signs and symptoms of Wrist Fracture

Deformity of the wrist. Pain and swelling. Limited motion in the thumb or wrist.

Wrist Fracture

Complications if left Wrist Fracture unattended

Wrist fractures often fuse naturally, though complications may arise in the untreated fracture leading to limitations of wrist movement and forearm rotation, pronation, and supination. Osteoarthritis may also arise following untreated fractures. Untreated or misdiagnosed scaphoid fractures run the risk of non-union or malunion of fractured bone segments.

Rehabilitation and prevention for Wrist Fracture

Immobilisation with a rigid cast is generally required for such fractures to properly heal, with x-ray follow-ups to analyse improvement. Where surgery is required, wires or screws may be employed to fuse fractured segments.

Hand & Wrist Orthopaedic Specialist

Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore
Book Appointment Online for Wrist & Forearm Fracture Treatment

  • 04
  • Oct
Mallet Finger (Long Extensor Tendon)
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Brief Outline of Mallet Finger

Extensor tendons are vulnerable to injury, lying just below the skin surface directly on the bones of the back of the hand and fingers. Such tendons may be torn apart when a finger is jammed, separating the tendons from their attachment to bone. The injury is common at the start of baseball season, often caused by a ball hitting the fingertip, bending it sharply downard and tearing the extensor tendon. Cuts to the hand or fingers can also damage  the extensor tendons.

Mallet Finger

Anatomy and physiology

Mallet Finger

Extensor tendons are small muscle tendons in the hand and fingers, which provide for delicate movements and hand coordination. They are located on the dorsal aspect of the hand and fingers, allowing the athlete to extend and straighten the fingers and thumb. Extensor tendons attach to muscles in the forearm. When an object hits the fingertip, the forceful flexion of the distal phalanx avulses the lateral bands of the extensor mechanism from its distal attachment.

Cause of Mallet Finger Injury

Cuts or lacerations affecting the extensor tendons. Baseball, volleyball, football, basketball or other object striking the fingertips while the extensor tendon is taut. Jamming the finger against a wall, door or other immovable object.

Signs and symptoms of Mallet Finger Injury

Inability to extend the finger. Bruising, pain, and swelling of the affected finger. Drooping fingertip.

Complications if left Mallet Finger unattended

Left untreated, mallet finger may cause permanent cosmetic deformity in the finger, though often without further complication. Without splinting however, some residual stiffness and loss of finger extension may result.

Treatment for Mallet Finger

Immobilisation with a splint is a conservative method to treat mallet finger. However, for easier and more comfortable method, surgical intervention is advised.

Rehabilitation and prevention for Mallet Finger

Generally, a splint must be worn continuously until the extensor tendon is fully healed. It will often require several months for local swelling and erythema to fully subside. Special care to the fingertips should always be taken in sports involving fat-moving balls, as well as when handling cutting implements.

Long-term prognosis for Mallet Finger

With attention to post-injury care including immobilisation of the injured finger,  most athletes achieve full restoration of movement and appearance of the digit.

Orthopaedic Specialist Major in Mallet Finger, Dr Kevin Yip

Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

Book Appointment Online for Mallet Finger Treatment

  • 01
  • Oct
Hand Metacarpal Fractures
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Brief Outline of Hand Metacarpal Fractures

Breaks or fractures in one or more of the metacarpal bones may result from a variety of events. They are common in football and basketball players. Metacarpals are vulnerable of events. They are common in football and basketball players. Metacarpals are vulnerable to direct force and can be fractured when a closed fist strikes another person or hard object, such injuries being referred to as boxer’s fracture. Metacarpal bones can fracture either at the base, shaft or neck. The most common fracture is of the neck of the fifth metacarpal.

Anatomy and physiology

The five metacarpal bones run between the wrist and the knuckles (which are the heads of the metacarpals). Each metacarpal bone comprises a base, neck and head, (from proximal to distal end). The first metacarpal bone is the shortest and most agile, and connects with the trapezium at the proximal end of the thumb. The other four metacarpals of teh hand connect to the trapezoid, capitate and hamate, and lateral-medial surfaces of metacarpal bones. Each finger has three phalanges, whereas the thumb only has two, making a total of fourteen phalanges. These connect with the heads of the metacarpals, forming the knuckles when the fist is closed.

Metacarpal Fractures

Cause of Hand Metacarpal Fractures

A direct blow to the hand. Falling directly onto the hand. Longitudinal force transmitted through a closed fist when punching.

Signs and symptoms of Hand Metacarpal Fractures

Local pain and swelling. Bruising and deformity of the broken bone or knuckle. Loss of hand movement and function in the affected region.

Complications if left Hand Metacarpal Fractures unattended

Use of hand not properly immobilised following metacarpal fracture may lead to lasting deformity and reduced function as well as possible damage to surrounding nerves, muscles, tendons, blood vessels, and ligaments.

Orthopaedic Specialist Major in Hand Facture, Dr Kevin Yip

Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

Book Appointment Online for Metacarpal Fracture Treatment

  • 29
  • Aug
Pain in Your Shoulders?
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You don’t have to live with it. Most shoulder injuries can be easily treated by medication, physiotherapy and surgery.

Do you feel a twinge in your shoulder when you lift up your arm? Or find that you are having trouble stretching your arms backwards? You may be suffering from a shoulder joint injury.

The shoulder joint is made up of three bones – the upper arm bone, shoulder blade and collarbone – along with a combination of muscles and tendons called the rotator cuff.

Rotator Cuff Tear

The joint is one of the most mobile in the human body and prone to injury because of the heavy use of the arm and shoulder.

There are three main causes of shoulder pain:

Rotator Cuff Injuries

Rotator cuff injuries can range from less severe inflammation or partial tears of the cuff, to a complete tear. This can be caused by wear and tear, which is why the Chinese call this type of injury the “50-year shoulder”. People most affected are those who have to constantly life their arms over 90 degrees. Larger tears are also caused by trauma, such as in sports accidents or when you use your arms to break a fall.

Inflammation and smaller tears sometimes heal by themselves without surgery, and treatment for such conditions include non-steroidal anti-inflammatory drugs to bring down the swelling and ease the pain, combines with physiotherapy to strengthen the other rotator cuff muscles. Another option is an injection of anaesthetic into the area, which gives pain relief and brings down inflammation for up to six months. Activity modification is also important in treatment and prevention. This may include physical exercise to strengthen the rotator cuff, and changing the patient’s posture during everyday activities. A cycle of non-operative treatment usually lasts about three to six months.

In more serious tears, or when non-operative treatment is ineffective, surgeries are usually performed using the keyhole procedure, and will attempt to repair any damage to the rotator cuff. “Results are usually very good and most of our patients are able to return their sport in six to seven months.”

Dislocated Shoulder

Dislocated Shoulder

A dislocated shoulder happens when your upper arm bone pops out of the socket in the shoulder that it should fit in. Patients with dislocated shoulder will be in a lot of pain and unable to move the arm. The shoulder joint will also look deformed. After reducing the dislocation, one of the first steps of diagnosis is to undergo X-rays and a scan to find out why the dislocation happened, because in young patients, the chance of it happening again is very high. “We also conduct tests to find out how ‘loose’ the joint is as that will tell us how likely another dislocation is, even if the patient undergoes surgery.”

Not getting proper treatment could lead to more serious consequences. If a dislocated shoulder is not treated properly, the bone that is left out of the joint could damage the surrounding cartilage. Bone loss can occur because of the friction between the joint and the surrounding bone. Once that happens, it will be difficult to fix the problem with just keyhole surgery. Because of this, our orthopaedic specialist, encourages seeking treatment from an orthopaedic specialist for all dislocations.

Frozen Shoulder

Just like its description, a frozen shoulder occurs when a patient cannot move his shoulder in any direction. This is caused by the thickening of the capsule of connective tissue that surrounds the shoulder joint.

Frozen Shoulder

There are three phases:

  1. Freezing
  2. Frozen
  3. Thawing

The first phase is when the range of motion of your shoulder becomes limited and pain arises when you try to move it. In the frozen stage, the shoulder becomes stiffer but the pain decreases, while the thawing stage is when the patient slowly regains the range of motion. The thawing process can take over a year, which is when it becomes disruptive to daily life. Treatment options include physiotherapy, injections and moving the shoulder joint to the full range of motion while you are in anaesthesia to break up the scar tissue and speed up recovery, and keyhole surgery to release the thickened capsule.

Keep Your Shoulders Safe

Shoulder conditions can have a considerable impact on your everyday life, and it is possible to lessen your risk of developing them. Our best piece of advice for protecting your shoulders would be to know your limits. If you know that a certain action is causing damage to your shoulders or making them hurt, stop doing it – activity modification is very important. And for sports enthusiasts, our advice is something we tell the guys we work out with – keep your ego at home when you exercise.

And more importantly, if you are already having shoulder pain, do not ignore it. See a doctor if you have any pain in the shoulder that persists beyond two weeks. There is treatment that can help relieve the pain and prevent it from coming back again. Remember – you don’t have to live with shoulder pain!
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