Services

Services Provided: The following services are among those currently provided:

Assessment:
A typical upper extremity evaluation will include range of motion and strength testing, and a variety of special tests depending on your area of injury.  Some unique evaluations in hand therapy include sensibility testing, cold stress testing for complex regional pain syndrome, edema measurement, grip and pinch strength, and wound evaluation.

Treatment Services:
A variety of treatment services are provided, including splint fabrication, therapeutic exercise, manual therapy, dominance-retraining, pressure garment fitting, acupuncture, work conditioning, desensitization, wound care and home exercise programs. Pre-operative assessment, splinting , and education are performed by professional therapists.

Modalities:
We offer a variety of modalities in addition to exercise and manual therapy, including continuous passive motion machines, fluidotherapy, laser, ultrasound, TENS, whirlpool, and electrical muscle stimulation.

Conditions Frequently Treated:

Post-Operative Conditions Frequently Treated:


Conditions Frequently Treated

Click on any of the conditions for more info

Rotator Cuff Tendinitis

Rotator cuff tendinitis is an inflammation (irritation and swelling) of the tendons of the shoulder.

Causes:
The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula.
Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation or injury can cause the tendons of the rotator cuff to tear.
The risk factors are being over age 40 and participation in sports or exercise that involves repetitive arm motion over the head.

Symptoms

  • Pain associated with arm movement
  • Pain in the shoulder at night, especially when lying on the affected shoulder
  • Weakness with raising the arm above the head, or pain with overhead activities (brushing hair, reaching for objects on shelves, etc.)

Exams and Tests
A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.
X-rays may show a bone spur, while MRI may show inflammation in the rotator cuff. An MRI can show a tear in the rotator cuff.

Treatment
Treatment involves resting the shoulder and avoiding activities that cause pain. Ice packs applied to the shoulder and nonsteroidal anti-inflammatory drugs will help reduce inflammation and pain.
Physical therapy to strengthen the muscles of the rotator cuff should be started. If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain and inflammation enough to allow effective therapy.
If the rotator cuff has had a complete tear, or if the symptoms persist despite conservative therapy, surgery may be necessary. Arthroscopic surgery can be used to repair some tears and remove bone spurs and inflamed tissue around the shoulder. Some large tears require open surgery to repair the torn tendon.

Outlook (Prognosis)
Most people recover full function after a combination of medications, physical therapy, and steroid injections. For patients with tendinitis and a bone spur, arthroscopic surgery is usually successful in restoring them to their pre-injury level of activity.
People with tears of their rotator cuff tend to do well, although their outcome is strongly dependent upon the size and duration of the tear, as well as their age and pre-injury level of function.

Prevention
Avoid repetitive overhead movements. Develop shoulder strength in opposing muscle groups.

Alternative Names
Swimmer's shoulder; Pitcher's shoulder; Shoulder impingement syndrome; Tennis shoulder; Tendinitis - rotator cuff
Reference


Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part II. Treatment. Am Fam Physician. 2008;77(4):493-497.
Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand - houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.

Causes
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; over activity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.
There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer's cramp - a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity - is not a symptom of carpal tunnel syndrome.

Symptoms

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

Exams and Tests
A physical examination may find:

  • Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
  • Weak hand grip
  • Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel's sign)
  • Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen's test)

Tests may include:

  • Electromyography
  • Nerve conduction velocity
  • Wrist x-rays should be done to rule out other problems (such as wrist arthritis)

Treatment

Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending.

Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Prevention
Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury.
Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.

Tennis Elbow

Tennis elbow is inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow.
There may be a partial tear of the tendon fibers, which connect muscle to bone. The tear may be at or near where these fibers begin, on the outside of the elbow. Also known as lateral epicondylitis

Causes, incidence, and risk factors
The part of the muscle that attaches to a bone is called a tendon. Muscles in your forearm attach to the bone on the outside of your elbow.
When you use these muscles over and over again, small tears develop in the tendon. Over time, this leads to irritation and pain where the tendon is attached to the bone.

Symptoms

  • Elbow pain that gradually worsens
  • Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting
  • Weak grasp

Signs and tests
The diagnosis is made based on signs and symptoms, because x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.
There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance.

Treatment

  • The first step is to rest your arm and avoid the activity that causes your symptoms for at least 2 - 3 weeks.

If your tennis elbow is due to sports activity, you may want to:

  • Ask about any changes you can make in your technique.
  • Check any sports equipment you're using to see if any changes may help.
  • Think about how often you have been playing and whether you should cut back.

A physical therapist can show you exercises to stretch and strengthen the muscles of your forearm, as well as use of a brace to take the pressure off the muscles.
Your doctor may also inject cortisone and a numbing medicine around the area where the tendon attaches to the bone. This may help decrease the swelling and pain.
If the pain continues after 6 - 12 months of rest and treatment, surgery may be recommended. Talk with your orthopedic surgeon about the risks, and whether surgery might help.

Expectations (prognosis)
Most people improve with nonsurgical treatment. The majority of those who do have surgery show an improvement in symptoms.

Prevention
To help prevent tennis elbow:

  • Apply an ice pack to the outside of the elbow
  • Maintain good strength and flexibility in the arm muscles and avoid repetitive motions
  • Rest the elbow when bending and straightening are painful

References
Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009: chap 19.

Shoulder Impingement

Shoulder impingement simply means that certain structures within the shoulder (typically those structures within the "subacromial space") are being "pinched.” Not everyone who suffers from shoulder impingement presents in the same manner, as different structures may be injured, and varying biomechanics may be leading to the injury. The three most common structures that may be "pinched" are the subacromial bursa, the rotator cuff and the long biceps tendon. Injury to these structures may lead to subacromial bursitis, rotator cuff injuries and biceps tendonitis/tendinopathy.

Shoulder anatomy
The outer layer of the shoulder is primarily made up of the deltoid muscles (anterior, posterior and middle), which move the arm forwards, backwards and upwards. These muscles are what give the shoulder most of its shape. The innermost part of the shoulder is the actual shoulder joint. This is where the humerus (arm) moves on the scapula (shoulder blade), which is attached to the body. More specifically, it is the humeral head ("ball" of the humerus) and the glenoid fossa (shallow "socket" of the scapula). The next layer enveloping the joint, is the capsule, which is comprised of ligaments and the rotator cuff muscle tendons. These muscles originate from the scapula, and insert around the humeral head. They work primarily to hold the shoulder in place, keeping the head centered, and to rotate and lift the arm. The biceps has two main portions, and one of these (the long head) has a tendon that runs over the joint and attaches to the glenoid fossa.

Just above the joint, a part of the scapula sticks out like a shelf. This is called the acromion. This "shelf" is also extended forwards and down by another part of the scapula (the coracoid process) and the ligament between them. The space between the shelf and the shoulder joint is called the subacromial space. With this "shelf" structure in place, when the arm is lifted up and rotated inwards, the subacromial space gets smaller, which in turn may cause some pinching on the shoulder capsule, rotator cuff muscles and the biceps tendon. To protect these from the "pinch", we have a special fluid filled sac called a bursa. This particular bursa is called the subacromial bursa (ie: below the acromion). If the impingement is too great, or too repetitive, injury to the bursa, rotator cuff or biceps tendon may result. This could possibly lead to subacromial bursitis, rotator cuff injuries and biceps tendon pathology.
                                                 

Treatment

As previously stated, shoulder impingement may present itself in different ways, and thus treatment is quite variable and is based on a full assessment of the injury and the individual. This assessment will include a detailed history regarding both the injury and the individual, functional assessment of the affected areas, biomechanical analysis and screening for more serious pathology.  Following the treatment of symptoms, the main goals of treatment are to find out the causative factors, both internal and external, and to correct them by a variety of means.

Wrist Sprains

A sprain is an injury to a ligament. Ligaments are strong bands of connective tissue that connect one bone to another. A wrist sprain is a common injury. There are many ligaments in the wrist that can be stretched or torn, resulting in a sprain. This occurs when the wrist is bent forcefully, such as in a fall onto an outstretched hand.

Cause

Wrist sprains are most often caused by a fall onto an outstretched hand. This might happen during everyday activities, but frequently occurs during sports and outdoor recreation.

Symptoms

Symptoms of a wrist sprain may vary in intensity and location. The most common symptoms of a wrist sprain include:

  • Swelling in the wrist
  • Pain at the time of the injury
  • Persistent pain when you move your wrist
  • Bruising or discoloration of the skin around the wrist
  • Tenderness at the injury site
  • A feeling of popping or tearing inside the wrist
  • A warm or feverish feeling to the skin around the wrist

Sometimes, a wrist injury may seem mild with very little swelling, but it could be that an important ligament has been torn that will require surgery to avoid problems later.

Common Treatment:

  • Bracing: Your doctor may recommend that you use a brace to immobilize your wrist
  • Rehabilitation Exercises: Flexibility, range of motion, and strengthening exercises for the injured wrist.
  • Rest, Ice, Compression, Elevation
  • Over-the-counter pain medications

Prevention


Because wrist sprains usually result from a fall, be careful when walking in wet or slippery conditions. Wrist sprains also occur during sports, such as skating, skateboarding, and skiing. Wrist guard splints or protective tape can be used to support the wrist and prevent it from bending too far backward.
Trigger Fingers

Trigger finger is a condition in which one of your fingers or your thumb catches in a bent position. Your finger or thumb may straighten with a snap — like a trigger being pulled and released. If trigger finger is severe, your finger may become locked in a bent position.
Often painful, trigger finger is caused by a narrowing of the sheath that surrounds the tendon in the affected finger. People whose work or hobbies require repetitive gripping actions are more susceptible. Trigger finger is also more common in women and in anyone with diabetes.
Treatment of trigger finger, also known as stenosing tenosynovitis, varies depending on the severity
Symptoms

  • Finger stiffness, particularly in the morning
  • A popping or clicking sensation as you move your finger
  • Tenderness or a bump (nodule) at the base of the affected finger
  • Finger catching or locking in a bent position, which suddenly pops straight
  • Finger locked in a bent position, which you are unable to straighten
  • Trigger finger more commonly occurs in your dominant hand, and most often affects your thumb or your middle or ring finger. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

Causes

The cause of trigger finger is a narrowing of the sheath that surrounds the tendon in the affected finger. Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath — which in turn is lined with a substance called tenosynovium. The tenosynovium releases lubricating fluid that allows the tendon to glide smoothly within its protective sheath as you bend and straighten your finger — like a cord through a lubricated pipe.
But if the tenosynovium becomes inflamed from repetitive strain injury or overuse or due to inflammatory conditions, such as rheumatoid arthritis, the space within the tendon sheath can become narrow and constricting. The tendon can't glide through the sheath easily, at times catching the finger in a bent position before popping straight. With each catch, the tendon itself becomes irritated and inflamed, worsening the problem. With prolonged inflammation, scarring and thickening (fibrosis) can occur and bumps (nodules) can form.

Risk Factors

  • Repetitious gripping: If you routinely grip an item — such as a power tool or musical instrument — for extended periods of time, you may be more prone to the development of a trigger finger.
  • Certain health problems: You're also at greater risk if you have certain medical conditions, including rheumatoid arthritis, diabetes, hypothyroidism, amyloidosis and certain infections, such as tuberculosis.

Treatment:
Rest

  • Splinting the affected finger in an extended position for up to six weeks. The splint helps to rest the joint. Splinting also helps prevent you from curling your fingers into a fist while sleeping, which can make it painful to move your fingers in the morning.
  • Finger exercises: This can help you to maintain mobility in your finger.
  • Avoiding repetitive gripping: For at least three to four weeks, avoid activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating machinery.
  • Soaking in warm water: Placing your affected hand in warm water, especially in the morning, may reduce the severity of the catching sensation during the day. If this helps, you can repeat the soaking several times throughout the day.
  • Massage:  Massaging your affected fingers may feel good and help relieve your pain, but it won't affect the inflammation.
  • the locked finger. This procedure is most effective for the index, middle and ring fingers.
  • Surgery. Though less common than other treatments, surgical release of the tendon may be necessary for troublesome locking that doesn't respond to other treatments.

Post-Operative Conditions Frequently Treated:

Rotator Cuff Repairs

Rotator cuff repair is a type of surgery to fix a torn tendon in the shoulder. The procedure can be done with a large ("open") incision or with shoulder arthroscopy, which uses small button-hole sized incisions.

Description

  • The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its "ball and socket" joint and help the shoulder to rotate. The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury.
  • The goal is to attach the tendon back to the bone where it tore off. The tendon is attached with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or material that dissolves over time, and do not need to be removed.
  • There are a few options for repairing rotator cuff tears. Advancements in surgical techniques for rotator cuff repair include less invasive procedures. While each of the methods available has its own advantages and disadvantages, all have the same goal: getting the tendon to heal.
  • The type of repair performed depends on several factors, including your surgeon's experience and familiarity with a particular procedure, the size of your tear, your anatomy, and the quality of the tendon tissue and bone.
  • Many surgical repairs can be done on an outpatient basis and do not require you to stay overnight in the hospital. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.
  • You may have other shoulder problems in addition to a rotator cuff tear, such as osteoarthritis, bone spurs, or other soft tissue tears. During the operation, your surgeon may be able to take care of these problems, as well.
  • The three techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair, and mini-open repair. In the end, patients rate all three repair methods the same for pain relief, strength improvement, and overall satisfaction.

Open Repair

  • A traditional open surgical incision (several centimeters long) is often required if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches the shoulder muscle (deltoid) to better see and gain access to the torn tendon.
  • During an open repair, the surgeon typically removes bone spurs from the underside of the acromion (this procedure is called an acromioplasty). An open repair may be a good option if the tear is large or complex or if additional reconstruction, such as a tendon transfer, is indicated.
  • Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience has led to less invasive procedures.

All-Arthroscopic Repair

  • During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
  • Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
  • All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.

Mini-Open Repair

  • The mini-open repair uses newer technology and instruments to perform a repair through a small incision. The incision is typically 3 to 5 cm long.
  • This technique uses arthroscopy to assess and treat damage to other structures within the joint. Bone spurs, for example, are often removed arthroscopically. This avoids the need to detach the deltoid muscle.
  • Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.

Rotator cuff repair may be recommended for shoulder problems such as:

  • Torn rotator cuff with weakness and pain
  • Pain, especially using the arm overhead
  • A bone spur or inflammation around the rotator cuff

Rehabilitation:
Rehabilitation plays a vital role in getting you back to your daily activities. A rehabilitation program will help you regain shoulder strength and motion.

Immobilization

After surgery, therapy progresses in stages. At first, the repair needs to be protected while the tendon heals. To keep your arm from moving, you will most likely use a sling and avoid using your arm for the first 4 to 6 weeks. How long you require a sling depends upon the severity of your injury.

Passive Exercise

Even though your tear has been repaired, the muscles around your arm remain weak. Once your surgeon decides it is safe for you to move your arm and shoulder, a therapist will help you with passive exercises to improve range of motion in your shoulder. With passive exercise, your therapist supports your arm and moves it in different positions. In most cases, passive exercise is begun within the first 4 to 6 weeks after surgery.

Active Exercise

  • After 4 to 6 weeks, you will progress to doing active exercises without the help of your therapist. Moving your muscles on your own will gradually increase your strength and improve your arm control. At 8 to 12 weeks, your therapist will start you on a strengthening exercise program.

Reference:


Matsen FA III, Fehringer EV, Lippitt SB, Wirth MA, Rockwood CA Jr. Rotator cuff. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17.
Total Shoulder Replacements

Many people know someone with an artificial knee or hip joint. Shoulder replacement is less common. But it is just as successful in relieving joint pain. Shoulder replacement surgery started in the United States in the 1950s. It was used as a treatment for severe shoulder fractures. Over the years, this surgery has come to be used for many other painful conditions of the shoulder. These include:

  • Osteoarthritis (degenerative joint disease)
  • Rheumatoid arthritis
  • Post-traumatic arthritis
  • Rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
  • Avascular necrosis (osteonecrosis)
  • Failed previous shoulder replacement surgery

The shoulder is a ball-and-socket joint that enables you to raise, twist and bend your arm. It also lets you move your arm forward, to the side and behind you. In a normal shoulder, the rounded end of the upper arm bone (head of the humerus) glides against the small dish-like socket (glenoid) in the shoulder blade (scapula). These joint surfaces are normally covered with smooth cartilage. They allow the shoulder to rotate through a greater range of motion than any other joint in the body.
The surrounding muscles and tendons provide stability and support. Unfortunately, conditions like those listed above can lead to loss of the cartilage and mechanical deterioration of the shoulder joint. The result can be pain. You can have a stiff shoulder that grinds or clunks. This can lead to a loss of strength, decreased range of motion in the shoulder and impaired function. X-rays of the shoulder would show:

  • Loss of the normal cartilage joint space
  • Flattening or irregularity in the shape of the bone
  • Bone spurs
  • Loose pieces of bone and cartilage floating inside the joint

In severe cases, bone-on-bone arthritis may lead to erosion--wearing away of the bone.
Risk Factors
Osteoarthritis is a common reason people have shoulder replacement surgery. Osteoarthritis is sometimes called "wear-and-tear" arthritis. It affects mainly older individuals in all walks of life. Over time, the shoulder joint slowly becomes stiff and painful. Unfortunately there is no way to prevent the development of osteoarthritis.
A severe fracture of the shoulder is another common reason people have shoulder replacements. When the shoulder is injured by a hard fall or car accident, it may be very difficult for a doctor to put the pieces back together. When the head of the upper arm bone is shattered, the blood supply to the bone pieces is interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for a severe shoulder fracture.
Patients with a massive long-standing rotator cuff tear may develop cuff tear arthropathy. In this injury, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.
Avascular necrosis is a condition in which the bone of the humeral head dies due to lack of blood supply. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease and heavy alcohol use are risk factors for avascular necrosis.
Surgery
If nonoperative treatments fail, shoulder replacement surgery may be needed. Shoulder replacements are usually done to relieve pain.
There are several different types of shoulder replacements. The usual total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

  • The components come in various sizes. If the bone is of good quality, your surgeon may choose to use a non-cemented or press-fit humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid component is implanted with bone cement.

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
American Academy of Orthopedic Surgeons. (2007). Shoulder Joint Replacement. http://orthoinfo.aaos.org/topic.cfm?topic=A00094

Dupuytren’s Release

Dupuytren's release refers to a type of hand surgery (fasciotomy or fasciectomy) performed to release abnormal tightening and flexing inward (flexion contracture) of one or more fingers as a result of abnormal connective tissue growth in the palm. The procedures involve making an incision or incisions in the palm of the hand to remove inflamed and contracted connective tissue (fascia) that covers, supports, and separates the tendons of the hand and fingers. These procedures are most often performed to treat Dupuytren's contracture, a hereditary disease in which the bands of connective tissue (fascia) in the palm of the hand (palmar fascia) thicken and form nodules and cords that may extend into the fingers. Increasing tension causes the fingers to relentlessly flex toward the palm (flexion contracture), causing significant functional impairment. Dupuytren's contracture typically affects the ring and little fingers, often bilaterally.
Reason for procedure
This procedure is used to release the abnormal thickening and related tightening (contracture) of the palmar fascia of the hand and fingers that reduce hand function. Surgery is recommended when the contractures hold the fingers at 30° flexion or more or when individuals demonstrate a positive tabletop test in which they cannot simultaneously place both their palm and fingers flat on a tabletop. Specifically, surgical treatment aims to relieve the fixed flexion deformities by releasing (fasciotomy) or removing (fasciectomy) the palmar fascia while preserving the arteries and nerves, correcting joint deformities, preserving uninvolved skin, and maintaining proper flexion and grip strength. The procedure does not cure the disease; it is only able to modify disease progression and improve hand function by removing obviously diseased tissue.
Rehabilitation
The surgical procedure and degree of damage dictates the type, duration, and intensity of rehabilitation following Dupuytren's release.

    • Would care
    • Splinting
    • Edema control
    • Thermal modalities (hydrotherapy, fluidotherapy)
    • Gentle strengthening
    • Functional exercises
    • Return to work

Reference:


Eckhaus, D. "Dupuytren's Disease." Hand Rehabilitation: A Practical Guide. Eds. Gaylord L. Clark, et al. 2nd ed. New York: Churchill Livingstone, Inc., 1998.
Carpal Tunnel Release

Carpal tunnel release is a common surgical procedure. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Many patients require surgery on both hands.


Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties after recovery from surgery. The majority of patients recover completely.  Treatment includes splinting to immobilize the wrist to decrease pressure in the carpal tunnel, tendon gliding exercises, wound care, scar management, and range of motion exercises, and strengthening.
Trigger Finger Release

Trigger finger and thumb are painful conditions that cause the fingers or thumb to catch or lock in a bent position. The problems often stem from inflammation of tendons that are located within a protective covering called the tendon sheath.
The affected tendons are tough, fibrous bands of tissue that connect the muscles of the forearm to your finger and thumb bones. Together, the tendons and muscles allow you to bend and extend your fingers and thumb, for example, as in making a fist.
A tendon usually glides quite easily through the tissue that covers it (also called a sheath) because of a lubricating membrane surrounding the joint called the synovium. Occasionally a tendon may become inflamed and swollen. When this happens, bending the finger or thumb may pull the inflamed portion through a narrowed tendon sheath, making it snap or pop.
Trigger finger may be caused by highly repetitive or forceful use of the finger and thumb. Medical conditions that cause changes in tissues -- such as rheumatoid arthritis, gout, or diabetes -- also may result in trigger finger. Prolonged, strenuous grasping, such as with power tools, also may aggravate the condition.
What Are the Symptoms of Trigger Finger?
One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected finger. This catching sensation tends to worsen after periods of inactivity and loosen up with movement.


In some cases, the finger or thumb that is affected locks in a flexed position or in an extended position as the condition becomes more severe, and must be gently straightened with the other hand. Joint contraction or stiffening may eventually occur.
     Hand & Upper Limb Clinic    Thunder Bay, ON     Tel: 807-345-4462 | Fax: 807-344-9030