Diseases of the Upper Extremities: Hand and Elbow

Any problem that brings about the onset of discomfort or pain when using the hand and the elbow may entail significant difficulties in carrying out many of the activities of our daily life. These are two coordinated anatomical regions involved in the execution and development of precision tasks, whether these are work related or everyday life activities. For this reason we must make an accurate diagnosis when faced with the onset of painful symptoms in order to plan a treatment aimed at restoring or maintaining functional level.

The treatments we have today are: pharmacological, functional rehabilitation, infiltration and surgery. Within the surgical section, recent developments in arthroscopic techniques in both the elbow and the wrist and hand are particularly striking, allowing not only the direct visualization of the joints but also treatment performed without the need of incisions.

The diseases that most frequently affect the hand and elbow can be grouped as follows, depending on the source of the pain and its location:

Peripheral Nerve

Carpal Tunnel Syndrome CTS (hand): The median nerve, as it passes to the palm, is located in an anatomical conduit that for various reasons can start narrowing or hardening. This causes the onset of discomfort of increasing intensity (from the thumb to the ring finger) as tingling (predominantly nocturnal). That is when surgical decompression of the nerve path has to be assessed to prevent the progression of the lesion.

Ulnar Nerve Entrapment Syndrome (elbow): The ulnar nerve may be subjected to compression by passing through the posterior side of the elbow and to the first 10 cm of the forearm by circulating around the musculature. When this happens, it typically causes the same tingling pain, but in this case, of the ring finger and the little finger; in this situation the need for surgical decompression has to be assessed as well.

Keep in mind that the progressive compression of peripheral nerves may eventually bring with it loss of muscular strength and skin changes that may be irreversible.

Bone and Joints

Osteoarthritis

Osteoarthritis is a disease that can affect any joint in the body. In the hand, the most common location is at the base of the thumb (Rizarthrosis), and it is also very common in the interphalangeal joints of the fingers. Surgical treatment may be indicated when there are no other therapeutic options for good pain control or when it leads to significant functional impairment.

Arthritis

Arthritis is an inflammatory process of one or more joints, which usually requires comprehensive study in order to obtain an accurate diagnosis and adopt an appropriate treatment. For this reason, sometimes the collaboration of other specialties such as rheumatology is required. The most common location of the upper extremity where these processes may appear are the interphalangeal joints of the fingers.

Fractures

The most common upper extremity fracture is the fracture of the distal part of the radius in the wrist joint. It is a fracture that may alter the integrity of the joint and is now increasingly treated surgically. The goal of the treatment is to recover the shape of the radius and its consolidation in order to regain maximum functionality. In those cases, where the articular cartilage is affected by the fracture, the use of arthroscopic techniques may be necessary in addition to conventional surgery.

Other prevalent fractures of the hand are those of the scaphoid bone, the fifth metacarpal and the phalanges of the fingers. The most appropriate type of treatment has to be assessed based on the pattern of each of these fractures.

It is imperative to monitor the patients closely during the first four weeks to control possible displacements.