Tendons are rope-like structures that attach muscle to bone and are covered by a thin soft-tissue layer, called synovium. The synovium lubricates the tendons, enabling them to easily slide through a fibrous tunnel called a sheath. Swelling of the tendons as well as the sheath can cause significant pain and tenderness along the thumb-side of the wrist. De Quervain’s tendinosis occurs when these tendons are irritated or inflamed and is clearly noticeable when forming a fist or grasping something. The exact cause of De Quervain’s tendinosis is unknown, but repetitive hand and wrist movements can worsen the symptoms.

Surgery may be an option when more-conservative treatments don’t relieve pain caused by severe De Quervain’s tendinosis. The goal of surgery is to open the thumb compartment to create more space for the irritated tendons to move within the sheath. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.

Recovery after a surgery, can take several weeks if not months. Each patient is unique and their recover will depend on the treatment method prescribed by the physician. Regardless of the treatment option chosen, once the strength and comfort return individual may return to their normal level of activity.

Dupuytren’s contracture is a hand deformity that develops gradually, over the years. This condition occurs as result of the thickening and tightening of the fibrous layers of tissues under the skin of the palm of the hand and fingers. There is no associated pain with the thickening process, but it can cause the finger to curl inwards. Dupuytren’s contracture occurs more frequently in men than woman and is typically hereditary and may be linked to certain medical conditions such as diabetes and seizures.

Surgery may be an option when the physician confirms that the disease is progressing through routine measurement of the nodules and the thick bands. The goal of surgery is to divide or remove the thickened bands in order to restore motion of the fingers. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.

Recovery after surgery depends on the severity of the contracture and the complexity of the procedure. Specific exercises prescribed by a physical therapist may be helpful in strengthening the hands and movement in the fingers. There will be some swelling and soreness, but elevating the hand above heart level and gently moving the fingers will assist in reducing pain and stiffness in the fingers.

Tendons are rope-like structures that attach muscle to bone and are covered by a thin slippery layer, called synovium. The synovium lubricates the tendons, enabling them to easily slide through a fibrous tunnel called a sheath. When muscles contract, tendons pull on bones, causing the hand to move. Flexor tendons, which are long tendons located in the forearm extend from the muscles through the wrist to the small bones in the fingers. Trigger finger is a condition that occurs when one of the fingers get stuck in a bent position due to inflammation-induced narrowing of the space within the sheath.

Surgery may be an option when conservative, non-operative treatments have been exhausted. The goal of surgery is to widen the opening of the tunnel allowing more space for the tendons to slide through the sheath. This short outpatient procedure can be performed using a “twilight sleep” technique.

The carpal tunnel is a narrow, tunnel-like structure in the wrist, with the carpal (wrist) bones forming the bottom and sides and the transverse carpal ligament, a strong band of connective tissue, forming the top of the tunnel. The median nerve, which controls sensation in the palm side of the thumb, index finger, and long fingers as well as the muscles around the base of the thumb, extends from the forearm to the hand through the carpal tunnel. Carpal tunnel syndrome is a hand an arm condition that occurs when synovium (tissues) surrounding the flexor tendons in the wrist is inflamed and as a result, puts pressure on the median nerve. The swelling of the synovium narrows the already-limited space within the carpal tunnel and crowds the median nerve. Women are more liked to develop carpal tunnel syndrome than men and there are a number of different ailments and conditions contribute to the development of the condition, including heredity, age, medical conditions such as diabetes or thyroid gland imbalance, as well as hormonal changes caused by pregnancy.

Surgery may be an option when more-conservative treatments don’t relieve pain or numbness caused by severe carpal tunnel syndrome. The goal of surgery will be to reduce or eliminate the pressure on the medial nerve by trimming the ligament that is contributing the pressure. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.

Recovery after a surgery, can take several weeks if not months. Each patient is unique and their recovery will depend on the treatment method prescribed by the physician. Full recovery from surgery can take several months at which point the individual may return to their prior level of activity.

The ulnar nerve travels through the cubital tunnel, which is a tunnel-like structure made up of tissues, that runs under the bump of bone, known as the medial epicondyle, located on the inside of the elbow. The spot where the nerve runs under the media epicondyle is commonly referred to as the “funny bone.” The reason why this is a sensitive area for most people, especially when bumped is because the nerve is very close to the skin, and bumping it causes a shock-like sensation. The ulnar nerve provides sensation to the little finger as well as part of the ring finger along with controlling most of the little muscles in the hand that help with detailed movement, and some of the bigger muscles in the forearm that enable a strong grip. Sometimes, the ulnar nerve gets compressed or irritated at the elbow causing pain or numbness in the elbow, hand, wrist, or fingers; this is called cubital tunnel syndrome.

Surgery may be an option when more-conservative treatments don’t relieve pain caused by severe cubital tunnel syndrome, especially if there are signs of any muscle atrophy or “wasting.” The goal of surgery will be to reduce or eliminate the pressure on the ulnar nerve at the elbow. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.

Recovery after a surgery, will usually take several weeks if not months. Each patient is unique and their recover will depend on the treatment method prescribed by the physician and the severity of the initial problem.The tunnel may be widened to relieve pressure on the nerve (decompression) or the nerve may be moved to a different position with less pressure or tension (transposition). Full recovery from surgery can take several months since nerves recover at a slow rate, but once recovered, the individual may return to their prior level of activity.

Elbow dislocations are not very common, but occur when the joint surfaces of the elbow are separated due to an impact on an arm that is partially extended such as in a fall, or in car accidents when the individual reaches forward to cushion the impact of the accident. Dislocations of the elbow are classified as either subluxation, where the joint surfaces are only partially separated, or complete dislocation, where the joint surfaces have completely separated. For either to occur requires that ligaments which hold the bones in place have been injured.

If the elbow dislocation is complex, surgery might be deemed necessary to restore the alignment of the bone and repair any damage to the ligaments. The elbow might need to be protected with an external hinge after surgery to prevent further or repeated dislocation. If the injury involves damage to any nerves or blood vessels, further surgery may be required to repair them. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.

If surgery is deemed necessary for the dislocated elbow, recovery will depend on the severity of the condition and the complexity of the procedure. Full recovery from surgery can take several months before an individual may return to their prior level of activity.

The pointy bone at the back of the elbow is called the olecranon which has a thin sac called the olecranon bursa which overlies it and acts as a cushion between the olecranon and the soft tissues making up the loose skin. A normal olecranon bursa is rather flat; however, if it becomes irritated or inflamed, more fluid will develop in the bursa, resulting in elbow bursitis. Elbow bursitis can occur due to a traumatic event such as a blow to the elbow, or when there is repetitive pressure placed on the elbow (such as plumbers), or an untreated infection at the tip of the elbow.

The treatment for elbow bursitis depends on the cause of the bursitis. If the physician suspects that the development of elbow bursitis is due to an infection, they may recommend draining the bursa fluid with a needle as this will relieve the symptoms. The physician will then test the fluid to identify what the appropriate antibiotic medication is necessary to treat the infection.

If the elbow bursitis is not a result of an infection, it may be treated with an elbow pad to provide cushioning to the elbow, activity modification to avoid movements that cause direct pressure on the affected elbow, or anti-inflammatory medication like ibuprofen or naproxen to reduce swelling and ease pain. If, after three or four weeks, this treatment method fails, the physician may choose to drain the fluid from the bursa and inject cortisone, a powerful steroidal anti-inflammatory medication to relieve pain and swelling. However, symptoms are likely to return with this approach.

If surgery is deemed necessary for the elbow bursitis, recovery will depend on the severity of the condition and the complexity of the procedure. Full recovery from surgery can take three to four weeks where the affected elbow will be placed in a splint. Once the splint comes off, the individual can return to their prior level of activity.

Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of your bones wears down over time. It’s often called a degenerative joint disease where the cartilage experiences a significant amount of wear and tear over a long period of time, generally occurring in individuals over the age of 50. Osteoarthritis typically affected weight-bearing joints such as the hip or the knee and the elbow is the least affected joint as the surfaces of the joints are typically well matched and the stabilizing ligaments are quite strong. However, if an individual has previously dislocated an elbow or fractured one of their bones that forms the elbow joint, they are at a higher risk of developing osteoarthritis of the elbow as the cartilage surfaces may have sustained previous damage.

When non-operative treatments have been exhausted and are insufficient to control the symptoms, the physician may recommend an operative approach. The exact procedure will vary based on the extent of damage the osteoarthritis has caused to the elbow joint and the amount of pain the individual is in. Not all individuals are candidates for surgery; therefore options must be discussed extensively with the physician to determine the appropriate operative treatment and procedure.

If surgery is deemed necessary for the osteoarthritis of the elbow, recovery will depend on the severity of the condition and the complexity of the procedure.

A condyle is a rounded prominence at the end of a bone, usually where the bone connects to another bone. An epicondyle is the most prominent part of the condyle where tendons are attached. Epicondylitis is inflammation or damage to the area where the tendon attaches to the bone. The most common types of epicondylitis are “Tennis Elbow” and “Golfer’s Elbow.” “Tennis Elbow,” which is also known as lateral epicondylitis, is an overuse injury to the lateral (outside) area of the epicondyle of the elbow of the humerus, which is the upper arm bone. “Golfer’s Elbow,” which is known as medial epicondylitis, is similar to tennis elbow, but the damage occurs in the medial (inside) area of the epicondyle of the elbow of the humerus. Tennis elbow is an inflammation of the extensor tendon attachment, whereas golfer’s elbow is an inflammation of the flexor tendon attachment. Both of these conditions occur as a result of repetitive strain on the forearm extensor/flexor muscles such as tennis and other racquet and throwing sports, golf, gardening, carpentry, etc. These conditions can also occur due to traumatic events such as a motor vehicle accident in which the tendon attachment is violently stretched.

When non-operative treatments have been exhausted and are insufficient to control the symptoms for more than six to 12 months, the physician may recommend an operative approach. The exact procedure will vary based on the extent of the injury, the individual’s general health, and their need to return to sport or activity that requires extensive use of the involved muscles. Options must be discussed extensively with the physician to determine the appropriate operative treatment and procedure.

If surgery is deemed necessary for the tennis/golfer’s elbow, recovery will depend on the severity of the condition and the complexity of the procedure. The elbow will most likely be placed in a splint following surgery for a couple of weeks. Once the splint is removed, physical therapy to stretch and restore movement in the elbow will be recommended for a few months. The physician will provide instructions for when an individual can return to sport or the prior level of activity which usually takes up to six months after surgery.

When athletes throw at high speed repeatedly in sports such as baseball and football, the repetitive stress on the elbow can lead to a wide variety of overuse injuries. These injuries most often occur at the inside of the elbow as the force is typically concentrated over the inner elbow during throwing. The most common throwing injuries are:

Flexor Tendinitis – Inflammation caused by irritation to the flexor tendons at the point where they attach to the humerus on the inside of the elbow. This condition is aggravated when the individual is throwing, but severe tendinitis can cause pain to occur during rest and sleep as well.

Valgus Extension Overload (VEO) – When an individual throws, the olecranon and the humerus are twisted and pressed against each other. Over time this can result in VEO where the protective cartilage covering the olecranon is worn down and development of bone spurs occurs.

Ulnar Collateral Ligament (UCL) Injury – The most commonly injured ligament in throwers is the UCL where the injuries can range from minor inflammation to a complete tear of the ligament.

Ulnar Neuritis – In throwing individuals, the ulnar nerve is repeatedly stretched to the point of slipping out of position and causing a painful “snap,” which causes nerve irritation, also known as ulnar neuritis. This condition is often characterized by numbness and tingling in the ring and small fingers during, immediately after, or much after throwing activity.

Olecranon Stress Fracture – When muscles are fatigued and are no longer able to absorb shock, the pressure is transferred to the bone causing a small crack called a stress fracture. The olecranon is the most common site of stress fracture for individuals involved in throwing activities.

When non-operative treatments have been exhausted and are insufficient to control the symptoms, and the individual desires to return to his or her prior level of activity, the physician may recommend an operative approach. The exact procedure will vary based on the extent of the injury; options must be discussed extensively with the physician to determine the appropriate operative treatment and procedure.

If surgery is deemed necessary for the throwing injury, recovery will depend on the severity of the condition and the complexity of the procedure. In some cases it may take upwards of nine months to return to competitive throwing activities.​