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Elbow, Wrist, and Hand

Elbow, Wrist, and Hand

Hand/Wrist Conditions:

Carpal Tunnel Syndrome (CTS)

What is it?

Carpal Tunnel Syndrome (CTS) is a common and troublesome condition that interferes with the use of the hand. The carpal tunnel is a passageway in the wrist, composed of bone and the transverse carpal ligament, housing both the median nerve and nine wrist flexor tendons. The median nerve runs from the forearm to the hand and controls important muscles in the hand, giving sensation to many of the digits. In CTS, symptoms occur when there is an increase in pressure on the median nerve as it passes through this narrow tunnel of bone and ligament at the wrist. Compression on the median nerve decreases its ability to function properly, resulting in numbness, tingling, weakness, and pain in the hand and wrist.

What causes it?

Most cases of carpal tunnel syndrome have no known cause. Many things can contribute to the development of this condition:

  • The best evidence suggests that heredity is the most important factor, as carpal tunnels are smaller in some people and this trait can run in families.
  • Hormonal changes related to pregnancy.
  • Age – the disease occurs primarily in older people.
  • Gender – the disease is more common in females.
  • Other medical conditions such as diabetes, rheumatoid arthritis, thyroid gland imbalance, and obesity.

It is important to note that in most cases of carpal tunnel syndrome, there is no single cause.

What are the symptoms?

Compression of the median nerve causes numbness in the thumb, index finger, middle finger, and half of the ring finger. If the median nerve is compressed for an extended period of time, the nerve may lose its ability to power key muscles of the thumb and hand, resulting in a loss of strength and dexterity. The symptoms are often positional, meaning that extreme flexion or extension of the wrist cause symptoms to worsen. The pain, numbness, and tingling of CTS can happen anywhere and anytime, but most often symptoms are worse at night or while driving and you may feel the need to shake the hand to allow it to “wake up”.

How is it diagnosed?

Your doctor will review your symptoms and conduct a physical examination, testing the feeling in your fingers and the strength of the muscles in your hand. Sometimes an x-ray may be used to exclude other causes of wrist pain, such as arthritis. Nerve conduction studies (EMG) may be recommended to evaluate the electrical activity of your muscles and nerves and diagnose your condition.

What are the treatment options?

Treatment usually begins with wrist splints, designed to keep the wrist in a “neutral” position and reduce the pressure in the tunnel. Anti-inflammatory medications are used to reduce swelling and inflammation. Steroid injections into the carpal tunnel may also provide relief of symptoms. A single injection may bring relief for months, or it may need to be repeated. Surgery may be recommended if you have symptoms that persist in spite of nonsurgical treatment, if your symptoms progress and restrict your normal activities of daily living, or if you are at risk for median nerve damage due to a severe case of carpal tunnel syndrome. This surgical procedure is called carpal tunnel release.

What is involved in surgery?

During carpal tunnel release surgery, a cut is made through the ligament that is pressing down on the carpal tunnel. The goal of surgery is to provide more space for the constricted nerve and tendons passing through the tunnel and improve pain and function. The procedure is typically performed in an outpatient setting. Most patients have only a few days of discomfort and are able to use their hand fully within a few weeks after surgery.

If you believe you are suffering from carpal tunnel syndrome and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Trigger Finger

What is it?

Stenosing flexor tenosynovitis, more commonly known as trigger finger, limits finger movement and is characterized by the inability to flex or extend the digit smoothly. The name trigger finger is from the symptom of triggering or snapping. Triggering usually occurs in the index, middle, or ring finger, but can also occur in the thumb or small finger.

The muscles that move the fingers and thumb are located in the forearm, above the wrist. Long tendons, called the flexor tendons, extend from the muscles through the wrist and attach to the small bones of the fingers and thumb. These flexor tendons control the movement of the fingers of thumb. When you bend or straighten your finger, the flexor tendon slides through a tunnel called the tendon sheath, which keeps the tendon in place.

As the flexor tendon slides through the tendon sheath, it can become irritated and not glide smoothly. Prolonged inflammation can cause thickening of the tendon and formation of nodules. The tendon sheath may also thicken, causing the opening of the tunnel to become smaller. There are anchors along the tendon referred to as pulleys, which are numbered A1 through A5. With trigger finger, the difference between the diameter of the tendon and the A1 pulley opening causes the tendon to catch, preventing smooth motion of the tendon pulling into the sheath when you try to straighten your finger. You might feel a pop as the tendon suddenly slips through a tight area and your finger will extend quickly.

What causes it?

The cause of trigger finger is unknown. Factors that put people at greater risk for developing it include:

  • More common in women than men.
  • Occurs most frequently in people who are between the ages of 40 and 60.
  • More common in people with other medical conditions such as diabetes and rheumatoid arthritis.
  • May occur after activities that strain the hand.

What are the symptoms?

Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use. Symptoms of trigger finger may include:

  • Pain and stiffness when bending or straightening your finger or thumb
  • A tender lump in your palm
  • Clicking or popping sensation in your finger or thumb joints
  • Locking or catching of the finger or thumb in bent position which may suddenly release, causing the digit to extend quickly.

In severe cases, the finger is locked in a bent position and is not straightened, even with help.

Symptoms tend to be worse after inactivity, such as when you wake up in the morning. As you begin to move your hand and perform daily activities, the fingers will often loosen up.

How is it diagnosed?

Our physicians can diagnose the problem by talking with you about your symptoms and examining your hand. A routine x-ray may be taken to rule out other conditions.

What are the treatment options?

If the symptoms are mild, the problem may be resolved simply with rest and anti-inflammatory medications to relieve pain. A steroid medication may also be injected into the tendon sheath. A single injection may provide long term relief, but in some cases, relief of your symptoms is only temporary and another injection is needed. Injections are less likely to provide permanent relief if you have had the triggering for a long time, or if you have an associated medical problem, such as diabetes. Based on the severity of your symptoms and whether nonsurgical options have failed, surgery may be considered. If your finger is stuck in a bent position, surgery may be recommended to prevent permanent stiffness.

What is involved in surgery?

The goal of surgery is to release the pulley so the tendon can slide through more easily. The surgery is a simple and highly effective surgery that is usually performed in an outpatient setting. A small incision is made and an area along the tendon sheath tunnel is cut to allow the tendon more room to move through it.

If you believe you are suffering from trigger finger and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Dupuytren’s Contracture

What is it?

Dupuytren’s contracture is a disease that can lead to limited use of your hand. It is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. While typically painless, the tightening of this tissue can cause the fingers to curl and make it difficult to straighten them.

What causes it?

The cause of Dupuytren’s contracture is not known, although there are factors that put people at greater risk for developing this condition. These factors include:

  • It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry.
  • It often runs in families (hereditary).
  • It is more common in men than women.
  • It increases in frequency with age.
  • It may be associated with drinking alcohol.
  • It is associated with certain medical conditions, such as diabetes and seizures.

What are the symptoms?

Signs and symptoms usually occur very gradually, but can steadily progress. Dupuytren’s contracture most commonly affects the ring finger and small finger, but can appear in the other fingers as well.

Nodules: One or more small, tender lumps (nodules) form in the palm.

Bands of tissue: The nodules may thicken and contract, forming tough, scar-like bands of tissue under the skin on the palm.

Curled fingers: One or more fingers bend (flex) toward the palm. As the bend in the finger increases, it may become more challenging to straighten your finger. Grasping objects, shaking hands, and putting your hand in your pocket become more difficult as symptoms progress.

Hand pain: Less common, but can be present.

How is it diagnosed?

The doctor will examine your hand and discuss your symptoms. Grip and pinch strength may be tested, along with the feeling in your thumb and fingers. The locations of nodules and bands of tissue will be noted and the range of motion of your fingers may be measured to determine your flexion limitations.

What are the treatment options?

The condition usually progresses very slowly and may not become a problem for years. If the condition progresses, treatment options may include:

Enzyme Injection (Xiaflex, collagenase):

This procedure is performed in the doctor’s office. The enzyme is injected directly into the diseased tissue. During the several hours following the injection, the enzyme works to weaken the contracted tissue. A follow-up visit the day after the injection is standard. Your doctor will inject local anesthetic into the site and perform a manipulation of the affected finger to disrupt the Dupuytren’s cord and improve the flexion contracture.

Needle Aponeurotomy:

This is a minimally invasive procedure performed in the doctor’s office with no incision required. After numbing the hand with a local anesthetic injection, a hypodermic needle is used to puncture and weaken the cords at multiple locations in the palm and finger. Once the cords are weakened, the doctor gently pulls on the finger to straighten it. The entire procedure takes less than an hour and typically results in minimal pain and swelling.

Surgical Procedure:

Surgery may be recommended when the disease is progressing despite nonsurgical treatment or when patients find that their hand function has become significantly limited.

What is involved in surgery?

Surgery involves the thorough removal of contracted tissue by incisions in the palm and finger(s). A zigzag incision is often used to allow for better healing and finger motion. Hand therapy is often helpful during recovery after surgery. Specific exercises can help strengthen your hands and help you move your fingers. Most people will be able to move their fingers better after surgery. With severe contractions, patients may be splinted in extension after surgery.

If you believe you are suffering from Dupuytren’s contracture and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

 

Basal Joint Arthritis

Other names: 1st CMC joint arthritis, arthritis of the thumb

What is it?

The thumb is made up of three highly mobile joints which allow for a high degree of motion. Smooth cartilage covers the ends of the bones and enables them to glide easily in the joint. Over time, the cartilage can wear down in these joints, causing a painful gliding surface and creating a condition commonly known as arthritis. The most common joint affected by this in the hand is the joint at the base of the thumb, otherwise known as the carpometacarpal (CMC) joint. This joint allows the thumb to swivel, pivot, and pinch so that you can grip things in your hand. You can feel for pain in this joint by palpitating it in the fleshy part of the thumb side of the palm, about a centimeter above the wrist joint. It is a common condition, generally considered a normal part of the aging process.

What causes it?

Basal joint arthritis occurs as a result of wear and tear on the joint. Some common factors include age, gender, joint laxity, and previous injury to the joint. Genetics probably has the greatest influence on the condition as the exact cause is unknown.

What are the symptoms?

Pain in the lower part of the thumb is the most common symptom, especially with activities that involve gripping or pinching, such as turning a key or opening a door or jar. Swelling and tenderness may develop at the base of the thumb and you may notice an aching discomfort after prolonged use. You may also experience a loss of strength and limited motion. Over time, a bony prominence or bump may develop over the joint and the thumb may become stiff or deformed.

How is it diagnosed?

In addition to examining your thumb and the way it looks and moves, x-rays are helpful to fully evaluate the joint and the amount of joint destruction.

What are the treatment options?

There is no cure for this type of arthritis (osteoarthritis), so treatments are generally aimed at symptom relief and functional recovery. Many people need no treatment as the symptoms remain tolerable. Anti-inflammatory medications can decrease symptoms, especially before significant activity. Thumb splints are helpful in immobilizing the joint while allowing some hand motion. Because arthritis is a progressive, degenerative disease, the condition may worsen over time. Some patients find relief with steroid injections into the joint. These can be repeated up to three times per year if symptoms return. Eventually some patients with continued pain elect to proceed with surgery, which consists of removing the painful joint and reconstructing the thumb ligaments to relieve pain and restore function.

What is involved in surgery?

The diseased joint is removed and replaced with a tendon graft taken from your wrist or arm. Your thumb will be immobilized in a splint or cast for up to six weeks, to keep the thumb stable while it heals. Once you can move your thumb, your doctor will give you exercises or refer you to a hand therapist to strengthen the muscles and make the joint more flexible. Regaining use of your thumb will take time but most patients are able to resume normal activities.

If you believe you are suffering from basal joint arthritis and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

DeQuervain’s Tenosynovitis

What is it?

DeQuervain’s tenosynovitis occurs when the tendons and tissue around the thumb are irritated or restricted and become inflamed as they pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. As the inflammation and swelling continue, the symptoms worsen and eventually all thumb movement becomes painful.

What causes it?

DeQuervain’s tenosynovitis may be caused by overuse. It is also associated with pregnancy and rheumatoid disease and is more common in middle-aged women.

What are the symptoms?

  • The primary symptom is pain felt over the thumb side of the wrist, which may appear suddenly or gradually, and can travel up the forearm. Pain is usually worse when the hand and thumb are in use, especially when forcefully grasping objects or twisting the wrist.
  • Swelling may be present over the thumb side of the wrist.
  • A “catching” or “snapping” sensation may be felt with thumb movement.
  • Pain and swelling may make thumb and wrist movement difficult.

You may notice the symptoms and signs of DeQuervain’s tenosynovitis after many common activities such as knitting, gardening, playing a musical instrument, typing, carpentry, walking your pet on a leash, or even lifting your child.

How is it diagnosed?

Your doctor will examine you and discuss your symptoms. The most sensitive test is Finkelstein’s test, which causes pain at the base of the thumb when the thumb is placed in the palm and the wrist is ulnar-deviated (moved toward the ulnar side of the wrist, the side where the small finger is located). Discussing your symptoms with a hand surgeon will help differentiate this condition from other common hand and wrist conditions.

What are the treatment options?

Activity modifications may be necessary to alleviate symptoms, including using proper lifting technique. Bracing, anti-inflammatory medications and steroid injections can also dramatically decrease the inflammation. Occasionally surgical release of the affected tendons is required to relieve the symptoms if nonsurgical treatment has not been successful, but this is usually reserved for persistent cases.

What is involved in surgery?

The goal of surgery is to open the thumb compartment to make more room for the irritated tendons by cutting the tendon sheath surrounding the inflamed tendons. Pain and symptoms generally improve after surgery, but you may have tenderness in the incision area for several months. Gentle stretching exercises will encourage the thumb tendons to glide easily through the tunnel.

If you believe you are suffering from DeQuervain’s tenosynovitis and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Ganglion Cyst of the Wrist and Hand

What is it?

Ganglion cysts are the most common mass or lump found in the hand. A ganglion rises out of the surrounding tissues of a joint, such as ligaments, tendon sheaths, and joint linings. They are typically round or oval and are filled with a jelly-like fluid. These fluid-filled cysts can develop in many joints of the hand and wrist, including the top and underside of the wrist, the end joint of a finger, and the base of a finger. Size varies and in many cases the cysts grow larger with increased activity.

What causes it?

The cause of ganglion cysts is unknown, although there are factors that put people at greater risk for developing them:

  • They are most common in younger people between the ages of 15 and 40 years of age.
  • Women are more likely to be affected than men.
  • These cysts are common among gymnasts, who repeatedly apply stress to the wrist.

Ganglion cysts that develop at the end joint of a finger, also known as mucous cysts, are typically associated with arthritis in the finger joint and are more common in women between the ages of 40 and 70 years.

What are the symptoms?

Ganglion cysts are not cancerous and, in most cases, are harmless. Most ganglions form a visible lump, but smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms, pain, tingling, and muscle weakness may develop if the cyst puts pressure on the nerves that pass through the joint. The cyst may be tender to touch and you may experience discomfort when pressure is applied.

How is it diagnosed?

Your doctor will discuss your symptoms, including how long the ganglion has been present and whether it changes in size or is painful. X-rays may be used to rule out other conditions.

What are the treatment options?

Many ganglion cysts do not require treatment and a period of simple observation may be sufficient, to ensure that no unusual changes occur. However, if the cyst is painful, interferes with function, or has an unacceptable appearance, there are treatment options available.

Initial treatment of a ganglion cyst is nonsurgical. As activity often causes the ganglion to increase in size and puts additional pressure on the nerves, a wrist brace or splint may be utilized to relieve symptoms. As the pain decreases, your doctor may recommend exercises to strengthen the wrist and improve range of motion.

If the ganglion is causing significant pain or severely limiting activities, the fluid may be drained in a procedure called an aspiration. This procedure is most frequently recommended for ganglions located on the top of the wrist. During an aspiration, the area around the ganglion cyst is numbed, the cyst is punctured with a needle, and fluid is withdrawn. Although this procedure can provide temporary relief, it frequently fails to eliminate the ganglion because the connection to the joint or tendon sheath has not been removed. In many cases, the ganglion cyst returns after an aspiration procedure.

If your symptoms are not relieved by nonsurgical methods or the ganglion returns after aspiration, surgery may be recommended. This surgical procedure is known as a ganglion cyst excision.

What is involved in surgery?

Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the “root” of the ganglion. However, there is a small chance the ganglion will return even after excision. This procedure is typically done as an outpatient procedure. There may be some discomfort and swelling after surgery, but normal activities can usually be resumed within a few weeks after surgery.

If you believe you are suffering from ganglion cysts and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Elbow Conditions:

 

Cubital Tunnel Syndrome

Other names: Ulnar Nerve Compression, Ulnar Nerve Entrapment

What is it?

Cubital Tunnel Syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow. The ulnar nerve is one of the three main nerves in your arm and travels from your neck down into your hand. It can be constricted in several places along the way and, depending upon where it occurs, the pressure can cause numbness and pain in your elbow, hand, wrist, or fingers. The most common place for the nerve to be compressed is behind the elbow, causing a sharp, tingling sensation that you feel when you hit your “funny bone”. As the ulnar nerve gives sensation to the small finger and to half of the ring finger on both the palm and back side of the hand, you may experience numbness and tingling into these two digits.

What causes it?

In many cases of cubital tunnel syndrome, the exact cause is unknown. The nerve is especially vulnerable to compression at the elbow because it must travel through a narrow space with very little soft tissue to protect it. Cubital tunnel syndrome can result from holding the elbow in a bent position for a long period of time, which puts pressure on the ulnar nerve. This position is common during sleep.

What are the symptoms?

Cubital tunnel syndrome may cause an aching pain on the inside of the elbow. Most of the symptoms, however, occur in your hand. You may experience numbness and tingling in the ring finger or small finger and the sensation that they have “fallen asleep”. Weakening of the grip and difficulty with finger coordination may occur, but these symptoms are typically seen in patients with more severe cases of nerve compression. Often patients suffering from cubital tunnel syndrome have difficulty sleeping at night due to pain and numbness.

How is it diagnosed?

After discussing your symptoms and medical history, your doctor will examine your arm and hand to determine which nerve is compressed, where it is compressed, and check for feeling and strength in your hand and fingers. X-rays may be taken to rule out other conditions. A nerve conduction study (EMG) is often useful to determine how well the nerve is working and help identify where the compression is located.

What are the treatment options?

Nonsurgical treatment options include splinting at the elbow, especially at night, and anti-inflammatory medications. It is recommended that you avoid activities that require you to keep your arm bent for long periods of time and avoid leaning on your elbow or putting pressure on the inside of your arm. If symptoms persist despite nonsurgical treatment, the ulnar nerve is very compressed, or nerve compression has caused muscle wasting, surgery may be recommended.

What is involved with surgery?

Surgery involves releasing the ulnar nerve from the compression (cubital tunnel release) in order to increase the size of the tunnel and decrease pressure on the nerve, or actually moving the nerve (ulnar nerve transposition) to allow more room for the nerve to move behind the elbow. The nerve can be moved to lie under the skin and fat but on top of the muscle (subcutaneous transposition), within the muscle (intermuscular transposition), or under the muscle (submuscular transposition).

If you believe you are suffering from cubital tunnel syndrome and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Tennis Elbow

Other names: Lateral Epicondylitis

What is it?

Tennis elbow, also known as lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Your forearm muscles extend your wrist and fingers. The elbow joint is made up of three bones: the upper arm bone (humerus) and the two forearm bones (radius and ulna). There are two bony bumps located at the bottom of the humerus called epicondyles. The bony bump on the outside of the elbow is called the lateral epicondyle. This is the site where your forearm tendons, often called extensors, attach your forearm muscles to the bone.

What causes it?

This condition is often caused by overuse. Although playing tennis and other racquet sports can cause this condition, several other sports and activities can put you at risk, including repetitive motions such as gardening or painting. Some cases of lateral epicondylitis can occur without any recognized repetitive injury.

What are the symptoms?

The symptoms of tennis elbow develop gradually. People with this condition often complain of pain or burning that radiates from the outside of their elbow into their forearm and wrist that worsens over a period of weeks or months. The onset of tennis elbow is not typically associated with a specific injury, although the symptoms are often worsened with forearm activity such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can develop this condition.

How is it diagnosed?

Your doctor will discuss the location of your symptoms and how they developed, any occupational risk factors, and any sports or repetitive activity participation. You may be asked to try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain.

X-rays, magnetic resonance imaging (MRI), and nerve conduction studies may be recommended to rule out other conditions.

What are the treatment options?

Approximately 80-95% of patients have success with nonsurgical treatment. This can range from rest and anti-inflammatory medications, to physical therapy and bracing, or a steroid injection.

Participation in sports or heavy work activities may be stopped for several weeks to allow your arm time to rest and for the inflammation to decrease. Medications such as aspirin or ibuprofen reduce pain and swelling.

Specific exercises are helpful for strengthening the muscles of the forearm. Ultrasound, ice massage, or muscle stimulating techniques may also be utilized by your physical therapist to improve muscle healing. A band around the proximal forearm (tennis elbow strap) can help control the pain.

A cortisone injection may also be used to lessen the symptoms.

If severe pain persists over many months despite nonsurgical treatment, there are successful surgical approaches.

What is involved in surgery?

Surgery may include repairing the healthy portion of the tendon, removing a portion of the damaged tendon, or releasing the attachment of the affected tendon. Following surgery, your arm may be immobilized temporarily with a splint. After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about two months after surgery. A return to athletic activity is generally considered at 1-2 months after surgery.

If you believe you are suffering from tennis elbow and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Golfer’s Elbow

Other names: Medial Epicondylitis

What is it?

Golfer’s Elbow, also known as medical epicondylitis, is an inflammation of the tendons that join the forearm muscles and causes pain at the inside of the elbow, interfering with grip, lifting, and forceful grasp. The elbow joint is made up of three bones: the upper arm bone (humerus) and the two forearm bones (radius and ulna). There are two bony bumps located at the bottom of the humerus called epicondyles. The bony bump on the inside of the elbow is called the medial epicondyle. This is the site where your forearm tendons, often called flexors, attach your forearm muscles to the bone.

What causes it?

This condition occurs not only in golfers, but also in anyone who performs repeated resisted motions of the wrist. Chronic, repetitive stress and strain to the muscles and tendons of the wrist and forearm may cause this condition.

What are the symptoms?

This condition is characterized by pain and tenderness along the inside of the elbow, along with weakness or difficulty with gripping activities. Twisting motions of the wrist may be particularly painful, such as playing golf, using a screwdriver, or bowling.

How is it diagnosed?

Your doctor will discuss the location of your symptoms and how they developed, any occupational risk factors, and any sports or repetitive activity participation. You may be asked to flex your wrist or pronate your forearm (turning palm down) against resistance to see if you experience pain with these motions.

X-rays or magnetic resonance imaging (MRI) may be recommended.

What are the treatment options?

Nonsurgical treatment is effective for most patients. This can range from rest and anti-inflammatory medications, to physical therapy and bracing, or a steroid injection.

Participation in sports or heavy work activities may be stopped for several weeks to allow your arm time to rest and for the inflammation to decrease. Medications such as aspirin or ibuprofen reduce pain and swelling.

Specific exercises are helpful for strengthening the muscles of the forearm. Ultrasound, ice massage, or muscle stimulating techniques may also be utilized by your physical therapist to improve muscle healing. A band around the proximal forearm (elbow strap) can help control the pain.

A cortisone injection may also be used to lessen the symptoms.

If severe pain persists over many months despite nonsurgical treatment, surgery may be considered.

What is involved in surgery?

Surgery involves excision of the abnormal tissue responsible for the symptoms. During this outpatient procedure, the surgeon detaches the wrist flexor muscles from the elbow, removes the degenerated portion of the tendon, and sews the tendon and muscle back to the bone. Following surgery, your arm may be immobilized temporarily with a splint. After the splint is removed, exercises are started to stretch the elbow and restore range of motion, and eventually you will begin light, gradual strengthening. A return to athletic activity is generally considered at 1-2 months after surgery.

If you believe you are suffering from golfer’s elbow and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.