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Patients seem to suffer from amnesia after shoulder surgery in one specific area: driving. I tell my patients before they undergo shoulder surgery that, if I perform a repair, they will be in a sling for a minimum of four weeks — and this means no driving. I realize how difficult this is, but there is no way around it.
Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons. The most common locations are the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger (see Figure 2). The ganglion cyst often resembles a water balloon on a stalk (see Figure 3), and is filled with clear fluid or gel.
The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages.
These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.
The diagnosis is usually based on the location of the lump and its appearance. Ganglion cysts are usually oval or round and may be soft or firm. Cysts at the base of the finger on the palm side are typically very firm, pea-sized nodules that are tender to applied pressure, such as when gripping. Light will often pass through these lumps (trans- illumination), and this can assist in the diagnosis. Your physician may request x-rays in order to look for evidence of problems in ad-jacent joints. Cysts at the far joint of the finger frequently have an arthritic bone spur—which is a small bony bump or projection—associated with them, the overlying skin may become thin, and there may be a lengthwise groove in the fingernail just beyond the cyst.
Ultrasound or other advanced imaging such as magnetic resonance imaging (MRI) may be helpful in confirming the diagnosis. There are different types of growths that can occur around the and wrist, and additional imaging is sometimes required.
Treatment can often be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless, as they frequently disappear spontaneously. If the cyst becomes painful, limits activity, or is otherwise unacceptable, several treatment options are available.
The use of splints and anti-inflammatory medication can be prescribed in order to decrease pain associated with activities.
An aspiration can be performed to remove the fluid from the cyst and decompress it. This requires placing a needle into the cyst, which can be performed in most office settings. Aspiration is a very simple procedure, but recurrence of the cyst is common. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available.
Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath (see Figure 3). In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques usually yield good results. Surgical treatment is generally successful although cysts may recur. Your surgeon will discuss the best treatment options for you.
Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.
Common problems treated include:
Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).
If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.
The biceps muscle is in the front of your arm (see Figure 1). It bends your elbow and twists your forearm to turn your palm upward. The biceps tendon connects the biceps muscle to your radius bone, which is one of the forearm bones. Such maneuverability may lead to distal biceps tendon problems.
Over time, the biceps tendon can weaken. This is called tendonosis. Tendonosis of the biceps tendon can be painless or it can cause dull or sharp pain in the area of the tendon just past the elbow in the forearm. Tendonosis can lead to tendon tears or tendon rupture. Not all pain in the area of the elbow is caused by biceps tendon problems. There can be other causes for pain in this area.
Biceps tendon tear or rupture can also cause weakness. This can happen without any warning. It often occurs when lifting heavy objects such as furniture. Weightlifters are more likely to experience this injury when doing “negatives,” which is done while holding a weight and extending the arm at the elbow.
A biceps tendon rupture usually occurs when the tendon tears away from the forearm bones (See Figure 2). This may be felt as a “pop” in the front of the elbow and can be painful. Often, but not always, people feel continued pain, swelling, bruising and warmth in the elbow. Sometimes, people feel a relief from pain that was present before. Muscle spasms in the biceps muscle are common when this happens. Symptoms usually get better over a few weeks. Also, sometimes the muscle can pull up in the arm toward the shoulder. This results in a muscle with a larger-than-normal appearance.
The elbow will usually continue to work after a biceps tendon rupture. This is because there are other muscles that can do part of the job of the biceps muscle. You may experience weakness when flexing the elbow. Most of the weakness after a biceps tendon rupture occurs when twisting your forearm to turn the palm upward, or in supination. You may experience fatigue with repetitive motions if your tendon is not repaired.
There are many medical problems that can make people more likely to have tendon ruptures. Chronic steroid use, whether for medical purposes or when used to gain muscle, is one of the most common reasons for this to happen.
Tendon rupture is most common in men over age 30, but can happen in women too.
If the biceps tendon tears completely, it will not grow back to the bone. You must seek care immediately if this occurs since surgery is an option and surgery is best done soon after the injury. If too much time passes, the tendon may not be repairable.
Your surgeon may choose to use imaging, such as an MRI or ultrasound. This can help to diagnose your tear or to plan for surgery. X-rays are often used at the initial visit. X-rays do not show the tendon well, but can be helpful in looking for other causes of elbow pain.
Surgery is not absolutely required for a biceps tendon rupture, but your doctor may suggest it. If your arm is working well after the rupture, you may choose not to have surgery. If you choose to avoid surgery then you should expect permanent weakness and an arm that becomes more easily fatigued.
Surgery is done to reattach the tendon to the bone or to a nearby muscle. There are many different ways surgeons can reattach tendons to bone. Figure 3 shows a repair of the biceps tendon. After surgery, you will require rehabilitation and time to heal. Often, people are able to resume even heavy activities after surgery and rehabilitation.
Figure 2A – Illustration of an acute rupture of the biceps tendon
Figure 2B – Image of an acute rupture of the biceps tendon
Figure 3A – Repair of the biceps tendon
Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.
Common problems treated include:
Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).
If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.