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Common Disorders
- Upper limb
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© Donald Budge 2001
UPPER LIMB....elbow, wrist & hand.
THE ELBOW and WRIST
The upper limb carries out a wide variety of tasks sometimes requiring great strength and others great dexterity - or both. This combination exposes the limb to a number of common disorders.
TENNIS ELBOW (Lateral epicondylitis/tendinitis)
Caused by excessive use and subsequent strain of the wrist extensor and supinator muscles, tendons and tendon attachments. Pain usually comes on gradually after the activity starting on the outside of the elbow and radiating down the forearm. It becomes painful to touch and resisted wrist extension with elbow extended will usually cause pain. Deep frictioning, passive stretching coupled with ultrasound and rest will aid recovery.
GOLFER'S ELBOW (Medial Epicondilitis/tendinitis)
Caused by excessive use of the wrist flexors with active pronation as used by golfers or baseball pitchers. The condition and treatment is similar to Tennis Elbow except that treatment is given to the flexors, which are situated on the inside of the elbow.
STUDENT'S or DART THROWER'S ELBOW (Olecranon bursitis)
Refers to inflammation of the bursa located at the olecranon (funny bone). Bursae are sacs lined with synovial membrane which provide a cushion between soft tissue and bone. In this case bone and skin - similar to Housemaid's knee. Treatment involves ice, rest and possibly ultrasound.
TENOSYNOVITIS
Refers to inflammation of the thin inner lining of the tendon sheath caused by over use (repetitive strain injury), or an injury to the tendon itself. Inflammation may also have spread from bacterial infection from surrounding tissue or there may be no obvious cause. When the inflammation subsides, surfaces of both tendon and sheath may be rough such that pain will be perceived on movement of each surface against the other. Treatment comes in the form of massage, nonsteroidal anti-inflammatory drugs or by operation. Using massage, the aim is to smooth out the rough surfaces and free the tissues from adhesions deposited during the healing process. Deep transverse friction applied across the tendon will assist with smoothing out the roughness which is causing the pain. The tendon should be fully stretched during massage. Rest, coupled with deep friction and stretching should gradually allow the patient to return to the activity which initially aggravated the condition - canoeing, sawing, etc.
TRIGGER FINGER (Tenovaginitis)
Refers to inflammation or thickening of the fibrous wall of the sheath that surrounds a tendon coupled with a slight inflammation of the tendon itself. The thumb extensors are another common sight, particularly amongst women. The cause is unknown but the treatment is similar to tenosynovitis. Deep friction is essential and sometimes painful. Treatment can sometimes take up to 3 months.
De QUERVAIN'S TENDINITIS
Refers to a condition which develops gradually and affects the tendons of the muscles abductor pollicis brevis and abductor pollicis longus. Pain on the outside of the wrist will increase on lifting heavy loads or if the thumb is pushed downwards when the thumb is flexed.
GANGLION
A cystic swelling associated with the sheath of a tendon. It usually develops in the wrist although a finger or foot may be affected. The cyst contains a thick fluid derived from the synovial fluid which lubricates tendons and joints. A ganglion may disappear spontaneously, if it does not it can be drained with a syringe. Alternatively pressure may burst the sac and the fluid will be taken up by surrounding tissue.
CARPAL TUNNEL SYNDROME
This condition is characterised by a numbness, tingling and pain in the thumb, index and middle finger that worsens at night. It may be present in both hands and is sometimes accompanied by weakness in the thumb. Carpal tunnel syndrome is a common occupational disease of workers using computer keyboards or playing piano and is sometimes listed under the heading of repetitive strain injury. The condition results from pressure on the medial nerve as it passes to the hand via a gap (carpal tunnel) under a ligament at the front of the wrist. Massage can be employed to help nerve nutrition. Passive movements will help combine with both active and passive stretching until active movement is restored. Frictioning of the retinaculum in carpal tunnel syndrome is also necessary. Rest is important. The hand may require to be splinted. Treatment is likely to be long term. Corticosteroid injections or surgery may be required to relieve pressure on the nerve.
CHILBLAINS
An itchy, purple-red swelling, usually in a toe or finger, caused by excessive constriction of small blood vessels below the surface of the skin in cold weather. Gentle massage will help to improve circulation.