Hand Specialists

Hand Specialists

Hand surgery requires consideration of the entire hand up to the shoulder as an interconnected unit because of its’ unique complexity and intricacy. Whether treating fractures, arthritis, or deformities, a hand surgeon considers the entire hand, wrist, forearm, arm, and shoulder. The hand specialists at Lowcountry Orthopaedics treat conditions involving the bones, tendons, and muscles of the hands, wrist, elbow, shoulder, arm, and forearm.

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Hand, Arm & Shoulder Conditions

Biceps Tendon Rupture

The biceps muscle is in the front of the upper arm. It helps bend the elbow, rotate the forearm, and stabilize the shoulder. The biceps tendons attach the muscle to bones in the shoulder and elbow. Tears of the distal biceps tendon usually completely detach from the bone and pull toward the shoulder. If the biceps tendon is torn at the elbow, you will lose arm strength, especially when turning your arm from palm down to palm up. The torn biceps tendon will not grow back and heal on its own. The main cause of a distal biceps tendon tear is a sudden injury, usually when the elbow is forced straight against resistance. Men over the age of 30 are most likely to tear the distal biceps tendon.

WHAT ARE THE SYMPTOMS?

  • A “pop” at the elbow. Pain is severe and lasts for about 2 weeks.
  • Swelling and bruising in the front of
  • the elbow
  • Weakness in elbow bending and
  • forearm supination
  • A bulge in the upper arm caused by the recoiled biceps muscle
  • A gap in the front of the elbow from the absence of the tendon

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone conditions that may be causing your pain.
  • MRI: to see if the tendons or muscles are damaged.

HOW IS IT TREATED?

  • Surgery: The tendon should be repaired within 4 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, making surgery more difficult.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 90 minutes and you will go home the same day.
  • Your surgeon will make an incision on the front of the elbow.
  • The tendon may be attached with stitches through a hole drilled in the bone or a small metal implant may be used to anchor the tendon to the bone
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • You will have a sling and splint for 2 weeks that you will wear for comfort.
  • You may be converted to a custom splint that you will wear for another 6 weeks.
  • You can begin lifting at 2-3 months after the surgery.
  • Full recovery is expected by 3-6 months after surgery.
Boutonnière Deformity

There are tendons that run on the side and top of the finger that bend and straighten the finger. The tendon on the top attaches to the middle finger bone (the central slip ). Boutonnière deformity is caused by injury to the top (dorsal) side of a flexed middle finger joint. A cut on the top of the finger can sever the tendon from its attachment to the bone. In some cases, the bone actually can pop through the opening. Boutonnière deformities may also be caused by arthritis. Unless this is treated promptly, the deformity becomes permanent.

WHAT ARE THE SYMPTOMS?

  • The finger middle joint cannot be straightened and the fingertip cannot be bent.
  • Swelling and pain on the top of the middle finger joint.
  • The deformity may develop immediately or take up to 3 weeks after the injury.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.

HOW IS IT TREATED?

  • Splints: This keeps the ends of the tendon together as it heals, and allows the end joint of the finger to bend.
  • Occupational Therapy: formal exercises to stretch and increase the range of motion in the finger.
  • Arthritis: Boutonnière deformity caused by arthritis may be treated with oral medications or corticosteroid injections.
  • Surgery: this is an option in severe deformity from rheumatoid arthritis, or if the tendon is cut. If the deformity has not been treated for more several weeks, surgery is less likely to be successful.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 90 minutes (depending on the injury) and you will go home the same day.
  • Your surgeon will make an incision on the top (dorsal) of your finger.
  • At your 2 week follow up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • You will have a splint for 6-12 weeks that will keep the repaired part of the finger from moving, but will allow you to move the very tip of the finger.
  • You will not be able to lift anything with the affected hand for 8 weeks.
  • You may require occupational therapy after surgery to help restore your range of motion and strength.
Carpal Tunnel Syndrome

The median nerve gives sensation to the thumb, index, long, and parts of the ring fingers. In carpal tunnel syndrome, the median nerve is pinched at the wrist, in a tunnel formed by the wrist bones and a ligament. The median nerve can get pinched when tendons that go through the same tunnel get swollen, tissues around the tendons harden, and in hand positions that make the tunnel smaller.

Carpal tunnel syndrome can be associated with repetitive wrist use, broken wrist bones, arthritis, thyroid imbalances, diabetes, menopause, and pregnancy

WHAT ARE THE SYMPTOMS?

  • Numbness and tingling in the thumb, index, long, and ring fingers in one or both hands.
  • Sometimes, pain and numbness in the wrist and forearm.
  • Usually, worse at night and can interrupt sleep.
  • Worse with activities that bend the wrist, like driving, writing, and typing.
  • Come and go at first, but will eventually be all the time.
  • In severe cases, the hand muscles shrink and cause a weak grip, and trouble moving the fingers.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • EMG/NCV (Nerve conduction study): to show whether the median nerve is carrying signals normally and the hand muscles are responding to those signals. In carpal tunnel syndrome, signals can be slow or weak.

HOW IS IT TREATED?

  • Braces: wearing these at night keeps the wrist straight and allows the swollen tissues to rest.
  • Anti-inflammatory Medicine: controls swelling in the wrist. These include naproxen, ibuprofen, and meloxicam.
  • Steroid injections: anti-inflammatories injected into the wrist. This can be repeated every 3 months.
  • Carpal Tunnel Release: the goal of this surgery is to prevent symptoms from getting worse, but most patients report resolution of symptoms.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 10 business days after your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 30 minutes and you will go home the same day.
  • There are no restrictions on movement or lifting things.
  • Your surgeon will make a small incision at the palm base and cut the ligament that is pinching the median nerve.
  • The bandage over the incision should be kept clean and dry.
  • At your 2week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • If you are having symptoms in the other hand, you will be given the option to have surgery at your 4-week follow-up.
Cubital Tunnel Syndrome

Symptoms most commonly occur after injury or surgery, but the exact cause is unknown. Other causes include pressure on a nerve, infection, cancer, stroke, or heart attack. One theory is that a “short circuit” in the nervous system causes overactive blood flow and sweat glands in the affected area. It is mostly in the hands but can occur in the arms, legs, and feet.

WHAT ARE THE SYMPTOMS?

  • Stage I may last up to 3 months. Burning and increased sensitivity to touch are common. Swelling and joint stiffness follow, along with increased warmth and redness. There may be faster-than-normal nail and hair growth and excessive sweating.
  • Stage II can last 3-12 months. Swelling is constant and skin wrinkles disappear. Skin temperature becomes cooler. Fingernails become brittle. Pain is widespread, stiffness increases, and the area becomes more sensitive to touch.
  • Stage III occurs after 1 year. The skin of the affected area becomes pale, dry, tightly stretched, and shiny. The area is stiff and there is less hope of getting motion back.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • MRI: to rule out any abnormal soft tissue structures that might be causing your symptoms
  • Nerve Conduction Study: to show if the nerves are carrying signals normally and the muscles are responding to those signals.

HOW IS IT TREATED?

  • Medications: Anti-inflammatories, corticosteroids, anti-depressants, anticonvulsants, opioids, vitamins, and blood pressure medications.
  • Injection Therapy: Injecting a numbing medicine near the affected nerves. This is recommended early in RSD.
  • Biofeedback: Body awareness and relaxation.
  • Therapy: exercise is essential to permanent relief. Physical therapy is important to regain normal use.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • If nonsurgical treatment fails, there are surgical procedures that may help reduce symptoms.
  • Spinal cord stimulator: Tiny electrodes are implanted along your spine and deliver mild electric impulses to the affected nerves.
  • Pain pump implantation: A small device that delivers pain medication to the spinal cord is implanted near the abdomen.
De Quervain's Tenosynovitis

Inflammation of two tendons as they travel through a small tunnel on the thumb side of the wrist. These tendons allow the thumb to move. The tendons normally slide easily through the tunnel, but sometimes they become swollen, causing movement to be painful. It can occur after repeated hand motions like pinching, gripping, wringing, and lifting. It is more common in women and associated with wrist trauma, new parents lifting their baby, pregnancy, diabetes, rheumatoid arthritis, and jobs with repetitive hand and wrist motions.

WHAT ARE THE SYMPTOMS?

  • Pain with gripping, lifting, pinching or making a fist
  • Sometimes, pain and numbness in the wrist and forearm
  • Pain and numbness over the base of the thumb
  • Pain and swelling over the thumb side of the wrist
  • “Catching” feeling when trying to move the thumb
  • Grip weakness

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • Finkelstein test: you will make a fist, and your wrist will be bent towards your small finger. This stretches the inflamed tendons and causes pain in those with tenosynovitis.

HOW IS IT TREATED?

  • Braces: this keeps the thumb straight and allows the swollen tissues to rest.
  • Anti-inflammatory Medicine: controls swelling in the wrist. These include naproxen, ibuprofen, and meloxicam.
  • Steroid injections: anti-inflammatories injected into the side of the wrist. This can be repeated every 3 months.
  • Surgery: the goal is to prevent symptoms from returning, and most patients report resolution of symptoms.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op visit for pricing and scheduling.
  • The surgery will last less than 30 minutes and you will go home the same day.
  • You will be in a splint for 2 weeks that will keep your wrist from moving. After the splint is removed, there are no restrictions on movement.
  • You will not be able to lift with that hand until 4 weeks after surgery.
  • Your surgeon will make a small incision over the thumb side of the wrist and cut the ligament that pinches the tendons.
  • The bandage over the incision should be kept clean and dry.
  • At your 2-week follow-up visit, the sutures and splint will be removed, and you will begin scar massage.
  • If you are having symptoms in the other hand, you will be given the option to have surgery at your 4-week follow-up.
Dupuytren's Contracture

A painless thickening and tightening (contracture) of the fibrous tissue under the skin of the palm that can cause the fingers to curl. These contractures develop gradually over years, and commonly affect the fingers. It often runs in families (hereditary) and is associated with drinking alcohol, diabetes, and epilepsy medications. It is more common in men over 40 years old, and those of Northern European or Scandinavian (Swedish, Norwegian, Finnish) ancestry, which is why it is also called “Viking’s disease”.

WHAT ARE THE SYMPTOMS?

  • Small lumps in the palm that may or may not be painful at first.
  • The lumps form tough bands of tissue under the skin.
  • As the bands contract, the fingers curl towards the palm.
  • Difficulty straightening the finger and grasping objects.
  • Symptoms may also occur on the sole of the foot and the penis.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to make sure the hand bones are normal.
  • Tabletop test: Xiaflex or surgery is appropriate only when you are unable to completely flatten your hand against a tabletop.

WHAT DO I NEED TO KNOW ABOUT XIAFLEX®?

  • This is the first and only injection approved by the FDA to treat Dupuytren’s contracture.
  • It is injected directly into the bands in the palm.
  • During the several hours following the injection, the enzyme dissolves the bands, allowing the finger to straighten.
  • You will return the next day for manipulation of the finger into a fully straightened position.
  • This procedure is performed in the doctor’s office and is associated with less pain and swelling than with surgery.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks after your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 60 minutes and you will go home the same day.
  • There are no restrictions on lifting things, but you will not be able to move the fingers for 1 week.
  • Your surgeon will make a small incision in the palm over the bands and remove them, and send the tissue to a pathologist for further analysis.
  • At your 1-week follow-up visit, the bandage will be removed, your incision will be inspected, and you will begin finger range of motion.
  • You will wear a brace at rest and at night to keep your finger(s) as straight as possible.
  • You will wear a brace at rest for 1 month.
  • If you have a limited range of motion after the surgery, you may need occupational therapy.
Flexor Tendon Injury

A cut on the palm side of your fingers, hand, wrist, or forearm can damage your flexor tendons, which allow your fingers or thumb to move. These tendons are on the palm side and bend the fingers. Like a rubber band, tendons tightly connect the muscle to the bone. If a tendon is cut, the ends will pull far apart, making it impossible for the tendon to heal on its own.

Because the nerves are very close to the tendons, a cut may also damage them, causing numbness of the finger. If blood vessels are cut, this requires immediate surgery. Certain sports can cause flexor tendon injuries, like football, wrestling, and rugby. “Jersey finger” is when a player grabs another’s jersey, a finger gets caught, and the tendon is pulled off the bone.

WHAT ARE THE SYMPTOMS?

  • Inability to bend or move one or more finger joints
  • Pain when your finger is bent
  • Numbness in your fingertip

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any fractures or any abnormal bone structures that might be causing your symptoms.

HOW IS IT TREATED?

  • Infection control: if there is an open cut, you will be treated with antibiotics to prevent infection. You will also need to soak the area in half saline and half hydrogen peroxide twice a day. Keep the area covered with a clean bandage at all times.
  • Surgery: In most cases, a cut or torn tendon must be repaired with surgery. Surgery is usually performed as soon as possible to avoid having the tendon ends separating too far, making surgery more difficult. If your injury is restricting blood flow this will require immediate surgery.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 1 week of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 90 minutes depending on the extent of the injury and you will go home the same day.
  • Your surgeon will make a zig-zag incision over the wound to assess the extent of the damage.
  • You will have a splint after surgery that will keep your finger from moving until you begin hand therapy, which is typically recommended.
  • You will not be able to lift anything with the affected hand for 8 weeks.
  • Stiffness is the most common long-term complication.
Ganglion of the Wrist

The most common mass on the wrist and hand. These fluid-filled cysts can quickly appear, disappear, and change size. A ganglion typically grows out of joint tissues out of a joint, like a balloon on a stalk. Inside the balloon is a jelly-like fluid. Ganglion cysts can develop on both the top and underside of the wrist, the end joint of a finger, and at the base of a finger. They vary in size, and in many cases, grow larger with increased wrist activity. With rest, the lump typically becomes smaller. It is not known what causes a ganglion. They are most common between the ages of 15 and 40 years, and women are more likely to be affected. These cysts are common among gymnasts, who repeatedly stress the wrist.

WHAT ARE THE SYMPTOMS?

  • Pain with pressure on the wrist or making a fist
  • Sometimes numbness into the wrist and forearm
  • A swollen area or visible lump

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • MRI: to look at soft tissues like a ganglion.

HOW IS IT TREATED?

  • Braces: allows the swollen tissues to rest.
  • Anti-inflammatory Medicine: controls swelling in the wrist. These include naproxen, ibuprofen, and meloxicam
  • Aspiration: dorsal ganglia may be drained in-office using a needle. Half the time, the cyst will come back.
  • Surgery: the goal is to remove the cyst. The tissue that is removed will be sent to a pathologist to rule out cancer.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op visit for pricing and scheduling.
  • The surgery will last less than 45 minutes and you will go home the same day.
  • You will have a dressing and/or splint for 2 weeks that will keep your wrist from moving. After the splint is removed, the are no restrictions on movement.
  • You will typically not be able to lift with that hand until 4 weeks after surgery. If the cyst is only on your finger, you will be able to lift right after surgery.
  • Your surgeon will make a small incision over the cyst and remove the capsule and the stalk.
  • The bandage over the incision should be kept clean and dry.
  • At your 2-week follow-up visit, the sutures and splint will be removed, and you will begin scar massage.
  • If you are having symptoms in the other hand, you will be given the option to have surgery at your 4-week follow-up.
Kienböck's Disease

When the blood supply to a small bone in the wrist, the lunate, is cut off. If this happens, the bone can die (“osteonecrosis”). Damage to the lunate causes a painful, stiff wrist and can lead to arthritis. Many people think they have a sprained wrist at first, and most have had some trauma to the wrist, such as a fall. Some things may put you more at risk. Some people only have one blood vessel that supplies the lunate, whereas most people have two. Also, if the forearm bones are of different lengths, it can put pressure on the lunate during wrist motions.

In the 1st stage, the blood supply has been cut off. In the 2nd stage, the bone hardens. In the 3rd stage, the dead bone begins to break down, and the other wrist bones may shift. In the 4th stage, the bones around the lunate break down and cause arthritis.

WHAT ARE THE SYMPTOMS?

  • A painful and sometimes swollen wrist
  • Stiffness with motion and decreased grip strength
  • Pain on the top and middle of the wrist
  • Pain or difficulty turning the hand up

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: if the lunate has been damaged for a while, it will show changes on X-ray.
  • MRI: if it is early in the disease, an MRI will show changes that may not be seen on X-ray.

HOW IS IT TREATED?

  • Conservative: immobilization with a brace or cast, anti-inflammatory medicines, and physical therapy.
  • Joint leveling: forearm bones can be made the same length by removing a section of one of the bones.
  • Revascularization: removing part of another bone with blood vessels and putting it into the lunate.
  • Proximal row carpectomy: removing the lunate along with two bones on either side.
  • Fusion: nearby wrist bones can be fused together to reduce the pressure on the lunate.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 90 minutes and you will go home the same day.
  • Your surgeon will make an incision on the back (dorsum) of the wrist.
  • You will have a splint after the surgery for 2 weeks, followed by a cast for at least two more weeks, and then you will wear a wrist brace.
  • You can begin lifting 8-12 weeks after surgery.
  • Full recovery is expected by 3 months after surgery.
Mallet Finger

A mallet finger is a deformity caused when the extensor tendon is damaged at the tip of the finger or thumb, and the finger or thumb cannot be fully straightened. When an object strikes the tip of the finger or thumb, the force damages the thin tendon that straightens the finger. The force of the blow may even pull away from a piece of bone along with the tendon.

WHAT ARE THE SYMPTOMS?

  • The finger is painful, swollen, and bruised
  • The fingertip may droop
  • Blood may collect beneath the nail, or the nail can detach from the nailbed.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any fractures or misalignment that might be causing your symptoms.

HOW IS IT TREATED?

  • Splinting: The majority of mallet finger injuries can be treated without surgery. You will wear a brace that holds the last finger joint straight for 6 weeks. After the first 6 weeks, you will wear the splint at night only and will begin range of motion exercises. Although the finger usually regains function and appearance, many patients may not regain full fingertip extension. In general, it is more functionally important to have finger flexion than extension.
  • Surgery: Surgical repair may be considered if the tendon has been cut, or with large fracture fragments or joint misalignment. Surgery can include tightening the stretched tendon tissue, using tendon grafts, or fusing the joint straight.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 60 minutes and you will go home the same day.
  • Your surgeon will make an incision over the top (dorsal) finger. A wire or pin may be inserted through the tip of the finger to hold it straight until the tendon heals..
  • You will have a splint for 6 weeks that will keep your finger end joint from moving. You will be encouraged to work on finger joints that are not injured to prevent stiffness.
  • You will not be able to lift anything with the affected hand for 8-12 weeks.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • You may require occupational therapy after surgery to help restore your range of motion.
Medial Epicondylitis (Golfers' Elbow)

It involves the tendons of the muscles in your forearm that flex your wrist and fingers. Your forearm tendons attach these muscles to a bone on the inside of the elbow. The tendons and muscles usually involved are called the Flexor Carpi Radialis and the Pronator Teres. The tendons may become damaged from overuse and can develop tiny tears which cause inflammation, swelling, and pain. About half of those with medial epicondylitis develop numbness in their ring and small fingers on the same side.

It is more common in people who golf, pitch baseball, bowl, lift heavy suitcases, chop wood, and use chain saws regularly.

It is more common in men and 30-50-year-olds.

WHAT ARE THE SYMPTOMS?

  • Pain or burning on the inner elbow that radiates to the wrist
  • Weakness and/or pain with grip
  • The dominant arm is most often affected

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • MRI: to see if the tendons or muscles are damaged.

HOW IS IT TREATED?

  • Anti-inflammatory Medicine: controls swelling in the elbow. These include naproxen, ibuprofen, and meloxicam.
  • Steroid injections: anti-inflammatories injected into the side of the elbow. This can be repeated every 3 months.
  • Physical /Occupational Therapy: to strengthen, stretch, and increase your range of motion.
  • Surgical release: the damaged tendon is removed and the bone is scraped to encourage healing

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 45 minutes and you will go home the same day.
  • Your surgeon will make an incision at the inner elbow and remove the damaged tissue.
  • You will have a splint for 2 weeks that will keep your elbow from moving.
  • You will not be able to lift anything with the affected arm for 4 weeks.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage. If you are having symptoms in the other arm, you will be given the option to have surgery at your 4 -week follow-up.
Olecranon Bursitis

Bursa are thin sacs that contain lubrication and that act as cushions between bones and soft tissues. The olecranon bursa lies between the skin and the pointy bone at the back of the elbow (olecranon). Normally, the olecranon bursa is flat, but if it becomes inflamed, it will swell. Elbow bursitis can occur due to trauma, prolonged pressure, infection, rheumatoid arthritis, or gout. Leaning on the tip of the elbow for long periods of time may cause the bursa to swell over several months. This is common in mechanics, plumbers, or HVAC technicians. If an injury at the tip of the elbow breaks the skin, bacteria may get inside and cause an infection. The infected bursa produces fluid, redness, swelling, and pain. If the infection goes untreated, the fluid may turn to pus.

WHAT ARE THE SYMPTOMS?

  • Swelling and pain over the back of the elbow, worse with direct pressure or with bending the elbow.
  • Restricted elbow motion
  • If the bursitis is infected, the skin becomes very red and warm, and you may develop a fever.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures or foreign bodies that might be causing your symptoms. It is common for people with recurrent bursitis to have a bone spur on the tip of the elbow.

HOW IS IT TREATED?

  • Activity modification: Avoid resting your elbow on a hard surface for long periods of time.
  • Elbow pads: to cushion your elbow You should avoid direct pressure to your swollen elbow.
  • Anti-inflammatory Medications: these reduce swelling and pain.
  • Aspiration: only if there is an infection, your doctor might sample the fluid with a needle. You will also be given an antibiotic. If the bursa is not infected, aspiration may actually cause an infection.
  • Surgery: if other treatments do not work, or if there is infection not responding to antibiotics, it may be removed.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 45 minutes and you will go home the same day.
  • Your surgeon will make an incision that curves around the backside of your elbow
  • You will wear a soft bulky dressing that will allow you to move your elbow to avoid stiffness.
  • There are no lifting restrictions after this surgery.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • You may require occupational therapy after surgery to help restore your range of motion.
Tennis Elbow

Damage to the tendons of the forearm muscles that extend your wrist. Tendons are like rubber bands that attach these forearm muscles to a bone on the outside of the elbow. The tendon usually involved is called the Extensor Carpi Radialis Brevis (ECRB). The tendons may become damaged from overuse or injury and can develop tears and scars which cause inflammation, swelling, and pain. Tennis players, painters, plumbers, mechanics, cooks, butchers, and carpenters are commonly affected.

WHAT ARE THE SYMPTOMS?

  • Pain or burning on the outer elbow
  • Weak grip strength
  • Symptoms are worse when holding a racquet, turning a wrench, or shaking hands.
  • The dominant arm is most often affected

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • MRI: to see if the tendons and muscles are damaged.

HOW IS IT TREATED?

  • Anti-inflammatory Medicine: controls swelling in the elbow. These include naproxen, ibuprofen, and meloxicam.
  • Steroid injections: anti-inflammatories injected into the side of the elbow. This can be repeated every 3 months.
  • Physical /Occupational Therapy: to strengthen, stretch, and increase your range of motion.
  • Tenex: A less invasive surgery that uses ultrasound to remove the diseased tissue.
  • Surgical release: the damaged tendon is removed and the bone is scraped to encourage healing.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 45 minutes and you will go home the same day.
  • Your surgeon will make an incision at the outer elbow and remove the damaged tissue.
  • You will have a splint for 2 weeks that will keep your elbow from moving.
  • You will not be able to lift anything with the affected arm for 4 weeks.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • If you are having symptoms in the other arm, you will be given the option to have surgery at your 4-week follow-up.
Thumb Arthritis

The most common type of arthritis that affects the joint at the base of the thumb is osteoarthritis (“wear-and-tear” arthritis). Normally, cartilage covers the ends of the bones and allows them to slide easily in the joint. As the cartilage wears away with use or age, bones rub against each other and become damaged. The joint at the base of the thumb allows the thumb to swivel and pinch. Osteoarthritis usually occurs after 40 years of age but can develop earlier if there has been an injury to the joint.

WHAT ARE THE SYMPTOMS?

  • Pain with gripping or pinching, such as turning a key, opening a door, or snapping your fingers
  • Swelling and tenderness at the base of the thumb
  • Loss of grip strength and motion
  • A large bump over the joint

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to look at the space between the bones in the joints. In arthritic joints, there is little to no spacing.

HOW IS IT TREATED?

  • Conservative treatment: resting the joint, ice, or heat.
  • Braces: A special type of thumb brace can support the joints while still allowing you to use your hand.
  • Anti-inflammatory Medicine: controls swelling. These include naproxen, ibuprofen, and meloxicam. These can be topical (rubbed on the skin) or taken by mouth.
  • Steroid injections: anti-inflammatories injected into the thumb joint. This can be repeated every 3 months.
  • Occupational Therapy: to strengthen, stretch, and increase your range of motion.
  • Surgery: a tendon from the forearm will be put where the arthritic bone at the base of the thumb was removed.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery is outpatient and will last 2 hours.
  • Your surgeon will make an incision at the base of the thumb and forearm.
  • You will have a splint for 2 weeks that will keep your hand from moving, and you will not be able to lift with the affected hand for 8 weeks.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage. You will get a removable custom brace that will be worn for 2 weeks and then as needed after.
  • Full recovery is expected by 3 months after this surgery.
Trigger Finger

The muscles of the fingers and thumb each have tendons, or thin bands of tissue, that allow movement. When you bend or straighten your finger, the tendon slides through a snug tunnel, called the tendon sheath, that keeps the tendon in place. In trigger finger, the tendon becomes irritated as it slides through the tendon sheath tunnel. As it becomes more irritated, the tendon may thicken and form nodules, causing it to become stuck in the tunnel. The tendon sheath tunnel may also thicken, causing the opening to become smaller. Trigger finger is very common, and it happens more in people more who have diabetes and rheumatoid arthritis. It can happen in multiple fingers and on both hands.

WHAT ARE THE SYMPTOMS?

  • A tender lump in the palm
  • Swelling
  • Catching or popping feeling in your finger or thumb joint that is usually worse first thing in the morning
  • Pain when bending or straightening your finger
  • If the lump is forced through the tunnel, it may feel like your finger is dislocating
  • In severe cases, the finger is locked in the bent position

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.

HOW IS IT TREATED?

  • Heat: soaking your hands in warm water can decrease swelling.
  • Splinting: taping your finger to a popsicle stick keeps it from getting suck in the bent position.
  • Anti-inflammatory Medicine: decreases swelling. These include naproxen, ibuprofen, and meloxicam.
  • Steroid injections: anti-inflammatories injected into the tendon sheath. This can be repeated every 3 months but is less likely to work after 2 rounds of injections.
  • Surgical Release: releasing the tight tendon sheath to allow the tendon to move and not become stuck.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks after your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 30 minutes and you will go home the same day.
  • There are no restrictions on movement or lifting things.
  • Your surgeon will make a small incision in the palm under the affected finger and release the first tendon tunnel.
  • The bandage over the incision should be kept clean and dry.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • If you have a limited range of motion after the surgery, you may need occupational therapy.
  • If you are having symptoms in the other hand, you will be given the option to have surgery at your 4-week follow-up.
Ulnar Nerve Entrapment

The ulnar nerve gives sensation to the small and parts of the ring fingers and controls hand muscles for fine movements, and some forearm muscles for a strong grip. In cubital tunnel syndrome, the ulnar nerve is pinched at the elbow, in a tunnel that runs under a bump inside of your elbow, called the medial epicondyle, or “funny bone”.

When your bend your elbow, the ulnar nerve stretches or moves around the medial epicondyle, and can become irritated. Keeping your elbow bent for long periods, repeatedly bending your elbow, a direct blow to your elbow, or leaning on your elbow can cause symptoms. Cubital tunnel can be associated with prior elbow fracture or dislocations, arthritis, and repetitive activities that require the elbow to be bent.

WHAT ARE THE SYMPTOMS?

  • Numbness and tingling in the ring and small fingers, especially when your elbow is bent.
  • Weak grip and difficult finger coordination.
  • If the nerve is very compressed or has been compressed for a long time, muscle wasting in the hand can occur that cannot be reversed.

WHAT MEDICAL TESTS WILL I NEED?

  • X-Rays: to rule out any abnormal bone structures that might be causing your symptoms.
  • EMG/NCV (Nerve conduction study): to show whether the ulnar nerve is carrying signals normally and the hand muscles are responding to those signals.

HOW IS IT TREATED?

  • Braces: these keep the elbow straight and allows the swollen tissues to rest.
  • Anti-inflammatory Medicine: controls swelling in the elbow. These include naproxen, ibuprofen, and meloxicam.
  • Cubital tunnel release: the ligament “roof” of the cubital tunnel is cut. This increases the size of the tunnel and decreases pressure on the nerve.
  • Ulnar nerve anterior transposition: the nerve may need to be secured if it moves out of place when the elbow moves.

WHAT DO I NEED TO KNOW ABOUT SURGERY?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 60 minutes and you will go home the same day.
  • Your surgeon will make a small incision at the inner elbow and cut the fascia that is pinching the ulnar nerve.
  • You will have a splint for 2 weeks that will keep your elbow from moving. After the splint is removed, the are no restrictions on movement if the nerve was not moved. If the nerve was moved, you will not be able to lift for 4 weeks.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • If you are having symptoms in the other hand, you will be given the option to have surgery at your 4-week follow-up.
Wrist Arthroscopy

A surgical procedure that uses a small fiber-optic camera (arthroscope) to see inside the wrist joint without making large incisions into the muscles. The wrist is a complex joint with eight small bones and many connecting ligaments. Injury or overuse to any of these parts can lead to pain. Arthroscopy can be used to diagnose and treat the cause of pain at the same time. It is minimally invasive, and patients generally experience fewer problems and a more rapid recovery than with open surgery

WHAT CONDITIONS IS IT USED FOR?

  • Wrist fractures. Small pieces of bone may stay in the joint after a bone breaks. Wrist arthroscopy can remove these, align the broken pieces by using pins, wires, or screws.
  • Ligament tears. Ligaments are fibrous bands that connect bones. They provide stability and support to the joints.
  • TFCC tears. The TFCC acts like a cushion on the small finger side of the wrist. Injury to this can cause pain with movement or a clicking sensation.

WHAT WILL HAPPEN BEFORE THE PROCEDURE?

  • X-Rays: to look at the space between the bones in the joints. In arthritic joints, there is little to no spacing.
  • MRI: to see if the ligaments, tendons, or muscles are damaged.
  • Conservative treatment: some people elect to try a wrist brace, anti-inflammatory medicine, steroid injections, and occupational therapy before arthroscopy.

WHAT DO I NEED TO KNOW ABOUT THE PROCEDURE?

  • You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
  • The surgery will last less than 60 minutes and you will go home the same day.
  • Your surgeon will make small incisions in the skin in specific locations around the wrist. The arthroscope is inserted through these incisions and has a small camera that projects images onto a monitor. Instruments at the end of the arthroscope are used to correct any problems.
  • You will have a splint for 2 weeks that will keep your hand from moving. This will be converted into a cast for at least another 2 weeks if there is a ligament repair.
  • You will not be able to lift with the affected hand for 2 weeks. If there is a ligament repair, you will not be able to lift for at least 8 weeks.
  • At your 2-week follow-up visit, the sutures and bandage will be removed, and you will begin scar massage.
  • Complications are unusual but may include infection, nerve injuries, excessive swelling or bleeding, scarring, or tendon tearing. An experienced surgeon, particularly one who specializes in treating the hand, can reduce the likelihood of complications.

Lowcountry Orthopaedics’ Hand Team

Keith Santiago, MD

Keith Santiago, MD

Hand Specialist

Patterson Owings, MD

Patterson Owings, MD

Hand Specialist

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North Charleston, SC 29406

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