Hand

Q. I hear that arthritis most commonly affects the joints of the hand, particularly in women. As a woman, what can I do to avoid this?

A. While there are many different types of arthritis that exist, the most commonly recognized and the umbrella under which most fall, include osteoarthritis and rheumatoid arthritis. Rheumatoid arthritis is generally hereditary and can be effectively treated, though difficult to avoid if there is family history that predisposes a patient to the disease.

Osteoarthritis affects the vast majority in some way at some point in their lives. It is most often the result of a previous injury or trauma and it may accompany other forms of arthritis such as rheumatoid. And the simple wearing down of joints over a lifetime of use can also result in osteoarthritis.

While according to recent statistics approximately 90 percent of women and 80 percent of men between the ages of 75 and 79 suffer from osteoarthritis in their hands, there are some things that can be done to reduce these numbers in the future and at least postpone the debilitating affects of joint degeneration, if not deter it.

Including:

• Avoid repetitive tasks that require the same constant motion, which may stress the joints and surrounding tissue.
• Avoid activities that place the hands at risk for injury – such as catching and throwing sports, contact sports, etc.
• Have any injury to the hand thoroughly examined and properly treated.
• Maintain a diet rich in nutrients for bone and joint health.
• Maintain an optimal level of physical fitness. Muscle helps to maintain bone density, which diminishes more quickly in women as they age, making them more vulnerable to fractures and dislocations - creating unstable joint environments and deterioration.
• Discuss lifestyle choices and concerns with an orthopedic specialist for individual-specific preventative recommendations.

Q. I read a lot about problems with the thumb joint. Why are there so many problems associated with the thumb?

A. The thumb is capable of a broad range of motion - able to attain a greater range of movement in many directions compared to the fingers, easily rotating 90 degrees compared to the average 45 degrees of the other fingers as a result of the surface shapes of the two bones which comprise it. It is controlled by nine distinct muscles, which depend on the three major hand nerves to function.

Utilizing muscles arranged around the first metacarpal, the joint at the base of the thumb is able to rotate and oppose the fingers, which easily enables grasping and pinching. And a band of fibrous tissue connecting the bones at the base of the thumb, called the ulnar collateral ligament, helps control thumb movement - preventing it from pointing excessively away from the hand.

A common form of arthritis affecting the hand is arthritis of the thumb, or basilar joint arthritis. This is so common because the unique range of motion that the thumb can achieve and the large role it plays in everyday activities and sports predisposes it to injury. Injury to this joint can create instability and prompt a host of degenerative conditions, which, if not carefully monitored and properly treated, can ultimately lead to arthritis and joint deterioration. Read more.

Wrist

Q. I recently sustained a wrist fracture and am afraid that I'll be wearing a cast for a while. What is the standard procedure for treating a wrist fracture?

A. The manner in which a wrist fracture is handled depends in large part on the type of fracture, the location of the fracture, the affected carpal bone(s) and any associated ligament damage that may exist.

Though, it is commonly recognized in orthopedics today that long periods of casting and the forced immobilization it traditionally promotes yields less successful results than that which short periods of casting and early immobilization can achieve. The treatment option allowing for the earliest possible movement of the affected area is the preferable treatment.

Cast treatment is most effective for an incomplete fracture that does not span completely across the bone. These nondisplaced fractures have shown to heal well if placed in a cast fairly soon after the fracture was incurred.

Those fractures, which are complete and have any degree of displacement have a lower success rate than incomplete nondisplaced fractures - and sometimes do not heal at all. Surgical reduction and other methods of fixation may be considered depending on your particular circumstances. Read More.

Q. I have a scaphoid fracture and hear that this particular bone can cause problems and should be given careful attention. Why is that and what is special about this bone?

A. The scaphoid bone is one of the strongest and most difficult bones to break in the wrist, yet it accounts for nearly 60 percent of all wrist fractures. It is almost always the result of an extreme force.

The scaphoid bone, which is shaped like a cashew and located on the thumb side of the wrist, near the lower arm bones, requires special attention because of the vulnerable location of its blood supply. The blood supply for a scaphoid bone enters from the top. Since most fractures occur in the middle or lower portion of the bone, the supply is interrupted and fails to reach the injury and promote adequate healing.

An undetected scaphoid fracture that results in an interrupted blood supply, can lead to avascular necrosis. Avascular necrosis can cause the bone to crumble and the wrist joint to be destroyed. Early detection and proper care of the scaphoid bone will ensure adequate healing and joint preservation.

Forearm and Elbow

Q. What is the difference between tennis elbow and golfer's elbow?

A. Both caused by overstressing the tendons around the elbow, tennis elbow affects the lateral or outer portion of the elbow and is also called lateral epicondylitis. Golfer's elbow affects the medial or inner portion of the elbow an is referred to as medial epicondylitis.

Lateral epicondylitis or tennis elbow results from the overuse of the muscles and tendons of the forearm and elbow. While it got its name because five in 10 recreational and professional tennis players suffers from the condition, the average man and woman between the ages of 40 and 60 is far more likely to suffer from the condition doing everyday activities - painting with a brush or roller, using a chain saw or hand tools, pruning shrubs, lifting children up and down. Read More.

Medial epicondylitis or golfer's elbow is caused by an excessive and repeated force used to bend the wrist towards the palm. This occurs in such activities as pitching a baseball, swinging a golf club or serving a tennis ball. Read More.

Q. I hurt my elbow while either working in the yard or playing ball with my son over the weekend. How do I know if it is something serious that should be checked out, or if the pain will just go away if I wait a bit?

A. The elbow joint is vulnerable to degeneration ultimately leading to arthritis, if an injury or condition creating an unstable joint environment is not detected early enough and properly corrected. It is always advisable to have pain around such a joint thoroughly assessed by a doctor.

Some of the most common problems affecting the elbow include:

• Lateral Epicondylitis, or Tennis Elbow
• Medial Epicondylitis, or Golfer's Elbow
• Bursitis of the Elbow
• Fractures and Dislocations
• Biceps and Triceps Tendon Ruptures
• Cubital tunnel Syndrome
• Arthritis

Q. My doctor is recommending that I have elbow replacement surgery. Are there any alternatives to this?

A. Generally when elbow replacement is recommended it is only after all other less invasive treatment options have been explored (anti-inflammatory medication, arthroscopy, synovectomy, arthroplasty) and joint stability and pain reduction is not achieved. Once severe deterioration begins within the elbow joint, it threatens the integrity of surrounding bone and tissue - ultimately creating a more severe problem. Elbow replacement surgery replaces the painful damaged joint surfaces with artificial ones. All damaged tissue and bone is removed, and the joint is stabilized, restoring function and relieving pain.

Today new technology and advances in joint replacement of the small bones and joints of the hand, wrist, and elbow are yielding superior results and dramatically reducing recovery times. Refined implants seamlessly mimic natural elbow movement, allowing for early movement and strong long-term results. Read more.