Orthopedics

I have numbness and pain in the little and ring fingers of my right hand with difficulty buttoning my clothes.
What is the most likely cause of this and is surgery usually necessary?

The most likely diagnosis is ulnar nerve entrapment of the elbow or wrist. Clinical examination and electrodiagnostic testing are necessary to make the diagnosis. Depending on the severity, surgery may be necessary. Weakness is not always correctible, so a prompt evaluation by a hand specialist is recommended.

I am an executive who uses the Blackberry frequently. For 2 weeks I have had pain at the thumb side of my right wrist increased with thumb movement. Any ideas on what this is and how I can get rid of it?

I see this more and more frequently. Overuse of the fingers and thumb while using a Blackberry can lead to problems in the hand or wrist. The most common problem is that with similar symptoms to you: de Quervain's tendonitis of the wrist, also called "Blackberry Thumb". The first treatment would be to rest the hand by stopping the use of your Blackberry which is usually not practical. A steroid injection and a splint are very effective.If conservative treatment fails, surgery may be necessary and is usually a quick recovery. Please consult a hand specialist for a thorough evaluation.

My right hand feels like it is losing circulation as it awakens me at night.
I have to shake it to relieve the problem. What is happening to me?

This sounds like a classic case of carpal tunnel syndrome or a pinched nerve at the wrist. Symptoms start with numbness and tingling in the thumb, index, middle and ring fingers and advance to loss of feeling and weakness in the hand. The first treatment involves the use of wrist splints and modifying one’s work if repetitive in nature. Additional treatment may consist of a cortisone injection. If symptoms persist, surgery is highly effective.

I enjoy pilates and yoga. Recently, I have developed pain at the back of my left wrist predominantly with putting my weight on my fully extended wrist. What could be causing this?

The most likely cause is a ganglion cyst on the back of the wrist that buckles when the wrist is extended leading to increased pain. A careful examination will most likely reveal a tender cyst at the wrist. After an MRI to assess the wrist ligaments and cartilage, surgery is highly successful and can be performed with the assistance of minimally invasive wrist arthroscopy.

I have intense burning pain at the outside of my left elbow increased with lifting objects such as a coffee mug with my elbow fully extended. I have tried Advil with no relief. What is the next step?

This is one of the most common injuries to the elbow and is frequently a result of repetitive forceful gripping. The muscle origin that attaches at the outside of the elbow and extends the wrist develops small tears that has difficulty healing. The tear fills in with inflamed tissue known as lateral epicondylitis, “tennis elbow”. Conservative treatment usually prevails: rest, tennis elbow band, anti-inflammatory medication, and a cortisone injection. While surgery is a last resort, it is highly effective.

I was lifting free weights six months ago and felt a pop and sudden pain and swelling at the outside of my dominant right wrist. I have continued pain and popping in my wrist. Pain is increased with forearm rotation particularly when using a key to enter my home. I have had this looked at by doctor who said nothing is wrong as the x-rays were normal. Can this be fixed?

This is a common wrist injury due to a torquing injury leading to a tear of the trianglular fibrocartilage complex (TFCC). An MR-arthrogram will most likely reveal a tear of the TFCC. It is also important to assess additional ligamentous damage. Following advanced arthroscopic surgery a full recovery usually occurs with a return to the pre-injury level of sporting activities.

My left ring finger started popping about 3 weeks ago. It occasionally locks in a flexed position and is extremely painful when it unlocks. Is this common? What can be done to help?

Trigger finger is one of the most common hand problems. Due to frequent finger use, inflammation develops forming a knot on the flexor tendon. This becomes caught on a band in the palm when flexing the finger leading to triggering.  A cortisone injection may provide long term relief of symptoms. If not, a surgical release under a local anesthetic is an easy cure.

Orthopedic and Neurological Disorders

What is a physiatrist?

A physiatrist is a medical doctor in the specialty of physical medicine and rehabilitation.  Physiatrists go through a four year residency period after medical school and are board certified.

What does a physiatrist do?

Physiatrists are doctors of function.  They treat various diagnoses, including orthopedic and neurological disorders.  Physiatrists are not surgeons and use a variety of non-surgical treatment, such as physical therapy, medications, injections, and complimentary techniques to treat symptoms and ultimately increase function and improve quality of life.

What kind of mattress should I use?

In my opinion, specific brands of mattresses are over-rated.  The most important factor in purchasing a mattress is having a firm, supportive mattress.  Most reputable stores will give a trial period to use the mattress and this is helpful to see if this particular type of mattress works for you.  In addition, if pain wakes you at night or you wake up stiff and uncomfortable in the morning, the position you sleep in may be a factor.  Sleeping on your stomach or back is more likely to produce discomfort because the spine is in a relatives arched position which can inflame the joints of the spine.  Sleeping on your side with a pillow between the legs puts the spine in a much more biomechanically correct position and makes pain less likely.

Is the pain causing damage to my body?

In most cases, no, but it is important to get evaluated by a physician before engaging in rigorous activity if you are concerned.  Most of the time, the pain is just inflammation and as long as it is understood that certain activities may cause discomfort, they can be performed and treated with medication and/or heat/ice.

How can I prevent the pain?

After it is understood what is causing the pain and a diagnosis has been made, the symptoms can be treated.  The best long-term treatment is exercise and strengthening of certain muscle groups to avoid stress on the affected area.  It is important to perform exercises everyday to get ongoing results.  Medications and injections may be used on a short-term basis to manage the symptoms until a long-term program is obtained.

How can I incorporate an exercise program with my busy schedule?

Exercising is not just going to the gym everyday for 2 hours at a time.  It can also consist of a stretching and strengthening program focusing on certain muscle groups that last 15-20 minutes.  This should be a daily routine that can be incorporated anytime throughout the day—I usually tell people to do the exercises first thing in the morning because then they are over and done with and they can get on with their day.  If they go to the gym, Pilates, yoga, etc. then that is icing on the cake, however, the simple stretching program should be part of the daily routine.

Why do I need to go to physical therapy?

Physical therapy is a helpful treatment to manage symptoms, but it is not a cure.  I use therapy as an educational process to learn an exercise program and proper body mechanics.  Once the exercises are learned, they can be incorporated into your daily routine.  Even if pain is not completely relieved after therapy, it does not mean that therapy is a failure.  Therapy is considered successful if the patients are educated and then it is up to the person to make therapy a success by incorporating the practices learned in therapy.

What is an EMG?

An EMG is a test to evaluate nerve function.  It is comprised of two portions:  nerve conduction studies which use little electrical impulses to see if the nerve is conducting the message properly, and the needle examination which uses a little pin to test nerve-muscle communication.  The test can tell where the nerve is pinched and if there is damage or healing going on.  It cannot, however, tell the cause of pain—only if the nerve is functioning properly or not.

How do you feel about supplements such as glucosamine?

In combination with the appropriate treatment program, glucosamine and other supplements such as fish oil can be useful adjuncts to pain relief.  They are generally safe and can be effective; however, they may take up to 3 months of continuous usage before efficacy can be fully assessed.