3-Point Products' Blog

Medial epicondylitis or golfer's elbow as it is commonly termed, is characterized by pain at or around the boney prominence at the medial aspect of the elbow where the wrist flexors and one of the forearm pronators (pronator teres) originate. This diagnosis is associated with degenerative changes of the musculotendinous origins at the medial elbow and most often involves the pronator teres, flexor carpi radialis or palmaris longus.

Wrist instability is a common injury treated by many hand therapists. The anatomy of the wrist includes eight carpal bones that, with the combined efforts of the intercarpal ligaments, allow for circumduction of the wrist joint while imparting stability anywhere within the range of motion. An injury to one or several of the ligaments can lead to wrist instability.

Causes of Deformity in the Rheumatoid Thumb

Rheumatoid arthritis (RA) is a destructive inflammatory disease that impacts soft tissue. This disease commonly involves the thumb and causes deformities to the thumb through tendon rupture or tendon subluxation and the abnormal stretching of ligaments and other joint structures.

TFCC Wrist Injuries

The Triangular Fibrocartilage Complex (TFCC) is a group of ligaments and cartilage on the ulnar side of the hand. The TFCC ligaments attach the cartilage to the small wrist bones which also suspend the ends of the two forearm bones, the ulna and the radius.

The primary cause of Ulnar Deviation of the Metacarpal Phalangeal joints (MP) of the fingers, a chronic, irreversible condition, is Rheumatoid Arthritis (RA). The MP joints are a primary site of rheumatoid deformities due to several anatomical and bio mechanical factors. Chief among the factors are:

• The shape of the metacarpal head allows for a certain degree of motion in an ulnar direction which contributes to the hands ability to create a strong grip

Instability in the ulnar carpal wrist may present with pain, swelling, and tenderness in the ulnar aspect of the wrist. Instability due to weakened or rupture ligaments, can occur between the ulna and the carpus, the lunate-triquetral joint, and/or the triquetrohamate joint.

The following describes a few important assessments to assist clinical evaluation of ulnar sided wrist pain when the symptoms are suspected to be related to ulnar carpal instability.

Scaphoid fractures most often occur in males between the ages of 15 to 30 years old and usually are sustained with wrist hyperextension and radial deviation as a consequence of a fall onto an outstretched hand. Individuals with a scaphoid fracture often present with pain, swelling, decreased range of motion, and tenderness in the anatomic snuffbox.

The term Gamekeeper’s Thumb is used when referring to an ulnar collateral injury caused by repetitive stress on the thumb during such activities as using a wrench, twisting electrical cords or wringing out heavy cloths. The term Skier’s Thumb is commonly used when there is an acute, forceful abduction of the thumb as when a skier falls without letting go of the ski pole. The injury may also be the result of falling on an outstretched thumb or catching a ball with an outstretched thumb.

Along with a more common thumb deformity caused by osteoarthritis and rheumatoid arthritis, thumb deformities can also be a result of thenar wasting, caused by median nerve injury or compression.

What causes the deformity?

The median nerve innervates the opponens pollicis (OP) and abductor pollicis brevis (APB). These two muscles make up most of the bulk of the thenar eminence and allow the thumb to perform palmar abduction (thumb opening away from the palm) and rotation for pad to pad prehension.

Types of Carpal Tunnel Release Surgery

Carpal tunnel syndrome is the most common nerve compression and at any one point in time it impacts 3% of the population.  Surgery for a carpal tunnel release is considered a gold standard in treatment and is performed when symptoms are severe enough to warrant surgical intervention. There are two main categories for types of carpal tunnel releases at this point in time.