De Quervain’s disease is an inflammation to the tendon of the wrist. You will experience pain at the side of your wrist and the bottom of your thumb.
What causes de Quervain’s disease?
You may get de Quervain’s disease when you use the thumb or wrist too much. It is also commonly known as “mummy’s wrist” as de Quervain’s disease usually happens to mothers who often carries the baby and injured the tendon.
Activities that may cause de Quervain’s disease are:
Wringing out wet clothes.
Hammering.
Knitting.
Lifting heavy objects such as a jug of milk or lifting a baby.
People who are more prone to de Quervain’s disease:
Air-steward and air-stewardess
Waiter and waitress
Parents and Grandparent if they are taking care of a newborn baby
Librarians.
Women are more likely to get de Quervain’s disease more than men. De Quervain’s disease affects people between the age of 30 and 50.
What are the symptoms of de Quervain’s disease?
If you are having de Quervain’s disease, you will feel extreme pain when you try to twist your wrist. The pain is worse if you grab something between your thumb and finger.
The bottom of the thumb or the side of the wrist may get swollen. Moving your thumb or wrist may increase pain. If you ignore, the pain can radiate to your forearm or down to your thumb.
How is de Quervain’s disease diagnosed?
Physically examination will include checking for swelling or tenderness around the base of your thumb.
Finkelstein test will help to diagnose de Quervain’s disease.
How is de Quervain’s disease treated?
The treatment for de Quervain’s disease is to help to reduce the pain and you can resume back to your daily activities pain free.
The term “frozen shoulder” is used to describe a condition characterised by pain and gradual loss of range of motion of shoulder. It occurs in up to 5% of the population and is more common in females. Frozen shoulder affects patients between ages of 40 and 60 years and the non-dominant shoulder is more commonly affected. Up to a third of patients who have a frozen shoulder will develop the same condition in the opposite shoulder.
Pain and stiffness in frozen shoulder is due to inflammation and progressive fibrosis (or scarring) of the capsule of the shoulder joint.
This disorder can be subdivided into primary or secondary frozen shoulder.
Primary Frozen Shoulder
This is a frozen shoulder condition which develops in the absence of any other shoulder condition. There is, however, an association with diabetes and thyroid disease. This is more common than the secondary frozen shoulder.
Secondary Frozen Shoulder
The frozen shoulder progresses through four stages before it starts to improve.
Stage 1
Gradual onset of pain typically referred to the middle of the upper arm. Aching pain is experienced at rest and sharp pain on movement. Patient is unable to sleep on the affected side. This stage lasts less than three months.
Stage 2
“Freezing” stage characterised by increasing pain, especially at night, together with gradual limitation of shoulder motion.
Stage 3
“Frozen” stage where the predominant complaint is stiffness and pain is diminished. Symptoms have been present between 9 to 15 months at this point.
Stage 4
“Thawing” stage where pain is a minimal and gradual improvement is seen in the range of motion.
Treatment for Frozen Shoulder
Before treatment can be instituted, the diagnosis has to be confirmed and secondary frozen shoulder has to be excluded. This involves a history suggestive of the disorder with a physical examination by a healthcare professional to exclude other causes of shoulder pain and stiffness.
The physical examination may also be able to pick up causes of secondary frozen shoulder. Finally X-ray images, and in cases where other associated condition are suspected, an ultrasound scan or MRI scan may be obtained.
The treatment of a frozen shoulder involves several possible modalities.
Physiotherapy
This is the mainstay of treatment. Mobilisation exercises within the limits of pain improve symptoms and function while aggressive stretching is associated with a poorer outcome. The exercises recommended are dependent on the stage of the condition. In the later stages, strengthening exercises are also incorporated.
Oral Anti-inflammatory Medication
Because of the inflammation process involved in this disorder, this class of medication is useful to alleviate the pain component of symptoms and is routinely given.
Manipulation Under Anaesthesia
This procedure also known as MUA. In this procedure, you will be under general anaesthesia while the orthopaedic surgeon tries to move your shoulder to the full range of motion.
By doing this, the scar tissue around the shoulder capsule will break up and release your shoulder capsule. This procedure has a high success rate and many patients has high satisfaction with the result. The advantages of MUA is that it only requires half an hour’s time and there is no cut or wound to your skin.
Surgery
Surgery is an alternative for the patient who has failed non-operative measures. As a guideline, physiotherapy should be instituted for at least four to six months before it can be concluded that the patient has failed this modality of treatment. Surgery involved is an arthroscopic (keyhole surgery) release of the shoulder capsule.
Dos and Don’ts for Frozen Shoulder
Do
Seek medical opinion even if you are sure you have a frozen shoulder as a secondary frozen shoulder possibility needs to be excluded. The outcome of a secondary frozen shoulder, if left neglected, can be quite different from that of a primary frozen shoulder.
Don’t
Ignore a stiff and painful shoulder as appropriate early intervention results in a shorter duration of discomfort and inconvenience.
Aggressively stretch a stiff shoulder as it can result in worsening of the frozen shoulder.
Let our orthopaedic surgeon advise you personally on treatments to frozen shoulder.
Also known as as stenosing tenosynovitis, trigger fingers are painful conditions of the fingers and thumbs where they get stuck in a bent position and then straighten with a “click” or a snap – kind of like a trigger being pulled and released. If a trigger finger is severe, you may find your finger locked in a bent position, unable to straighten.
What happens is the protective covering, the tendon sheath that surrounds the tendon of the affected finger, becomes narrow because of inflammation. This usually happens to people who have work or hobbies that require repetitive gripping actions, though they are more common in women and anyone who has diabetes.
How would you know you have trigger fingers?
Most of the time, trigger fingers or thumbs happens more frequently in your dominant hand, and mostly affects the thumb, index or ring finger. Sometimes, more than one finger is affected at the same time, and sometimes fingers on both hands may be involved. Triggering incidents are usually more often in the morning, or firmly gripping an object or when you bend and straighten the affected finger.
The common tell-tale signs and symptoms of trigger finger, in progression from mild to severe:
Stiffness in the finger, especially in morning or after periods of rest
A clicking and snapping sensation as you bend and straighten your finger
A “bump” (nodule) that is sensitive or tender at the base of the affected finger
Finger “catches” or “locks” frequently, followed by suddenly popping straight again
Finger becomes locked in a bent position, and you’re unable to straighten without pain
When you should see a doctor?
If you find that you have any of the signs above, for example, stiffness, tenderness at the base of your finger or catching in your finger joints, visit your doctor as soon as you can so that he or she can review your symptoms and do a physical evaluation of your hand. If you find that your finger joint is hot and swollen, get medical care as soon as you can, as those signs indicate possible infection.
What are the main causes of trigger fingers?
The culprit is the narrowing of the tendon sheath that surrounds the tendon in the affected finger. Tendons are thick, fibrous cords that attach muscles to bones; and each tendon is surrounded by a tendon sheath, which is lined with a substance called tenosynovium. This functions as a disperser of the lubrication which allows the tendon to glide smoothly in the protective sheath as you bend and straighten your finger, like a rope through a lubricated container.
But if the tenosynovium becomes inflamed often or for long periods, the space inside the tendon sheath becomes tight, making it difficult for the tendon to glide. The “catch” is when the tendon kinks in a bent position before popping straight . Every time the tendon kinks and snaps, the tendon becomes more irritated and inflamed, further worsening the problem. If the problem is prolonged and more inflammation occurs, the tendon can develop scars and thicken (fibrosis), and cause the tender bumps (nodules) to form.
Testing and diagnosing trigger fingers
It often doesn’t require in-depth or elaborate testing to confirm diagnosis of trigger finger. Usually your doctor will make the diagnosis based on your medical history and a hand physical exam. During the physical exam, your doctor will ask you to bend or straighten your finger, check the base of your finger for tender bumps / nodules, how smooth your finger move, and look out for the evidence of joint catching.
Treatment for trigger fingers
Avoiding repetitive gripping. For at least four to six weeks, avoid activities that require repetitive gripping or any forms of movements or activities that aggravate the problem, repeated grasping or the prolonged use of vibrating hand-held machinery.
Splinting. Your doctor may require you to wear a finger extension splint for up to six weeks to protect the injury and allow the tendon and the tendon sheath to heal. It’s especially useful to prevent you from bending your finger when you sleep, which is often painful enough to wake you up.
Finger exercises. Protected exercises – Be seated comfortably, with your hand supported. Use your unaffected fingers to bend the affected finger joints without causing the joint to click and snap. Repeat for five minutes. Gently massage the nodule at the base of your finger for five minutes. You may be referred to a hand therapist who will teach you protected mobilisation exercises to maintain mobility in your finger.
Anti-inflammatory injection. Another faster and effective way is to inject anti-inflammatory medication to the affected tendon sheath. The medicine will help to reduce the inflammation and swelling of the tendon sheath gradually.
Surgery. If your trigger finger is severe and does not respond well to conservative treatment. Surgery – trigger finger release may be another option. It is a minor day surgery and it is done under local anaesthesia.
See a doctor to treat your trigger finger
If you find that preventive or self-management measure aren’t working, see a doctor as soon as possible. Prompt medical attention can mean the difference between a quick recovery and a lifetime of suffering. And, by all means, be sure the doctor you choose is familiar with these disorders.
Who are at risk for trigger fingers?
There are three main risk factors:
Repeated gripping – if your work or hobbies require you to routinely grip objects, such as power tools or musical instruments for a prolonged duration, you may be more prone to trigger fingers.
Certain health problems – you have higher risks if you have certain medical problems such as rheumatoid arthritis, diabetes, amyloidosis, and certain infections.
Gender – trigger fingers are more prevalent in women than in men.
psUpper LimbComments Off on Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome
How is Carpal Tunnel Syndrome Diagnosed?
A physical examination help determine if the syndrome are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome.
What are the Causes?
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture. It can also be caused by medical conditions such as diabetes, arthritis, pregnancy and obesity.
What are the Treatments?
Treatments for carpal tunnel syndrome should begin as early as possible under a doctor’s direction. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling. Surgery is recommended if symptoms last for more than 6 months. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.
psUpper LimbComments Off on Tennis Elbow or Medial Epicondylitis
What is Tennis Elbow or Medial Epicondylitis?
Tear in the Tendon Causing Tennis Elbow
Tennis elbow is characterized by soreness or pain on the outside of the upper arm near the elbow. There may be a partial tear of the tendon fibers which joins the muscle to bone near their point of origin on the outside of the elbow.
How is Tennis Elbow or Medial Epicondylitis Diagnosed?
The diagnosis is made based on signs and symptoms given that x-rays usually appears normal. There will often be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.
What are the Causes?
This injury is due to repeated motions of the wrist or forearm. The injury is typically associated with tennis playing, hence the name “tennis elbow.” However, any activity that involves repetitive twisting of the wrist for example, using a screwdriver can lead to this condition.
What are the Treatments?
Treatments include heat therapy, local injection of cortisone and numbing medication, physical therapy and shockwave therapy to break up scar tissue which promotes healing and increases blood flow to the afflicted area.
