Treating hand and upper limb conditions
one patient at a time
With cutting edge clinical equipment, expert clinical staff and advanced training at Dr O’Farrell’s disposal, patients are able to return to work and home with improved mobility and comfort of the hand, elbow and shoulder joints.
Treatment of the hand and upper limb allows patients from all walks of life, from professional athletes to stay-at-home mothers who no are no longer able to perform daily tasks, receive personalised treatment that best suits their lifestyle.
orthopaedic treatment for
Hand & Upper Limb Conditions
Dr O’Farrell and his team of dedicated anaesthetists and clinical support staff focus on treating patients who experience injuries in the hand, wrist, elbow and shoulder.
The shoulder has a wide range of motion, making it the most mobile joint in the body but because of this flexibility, it is not very stable and is easily injured. Some of the most common injuries patients experience in both daily and sporting activities include:
Acromioclavicular (AC) joint injury
Commonly called a separated shoulder, an AC joint injury occurs when ligaments attached to the collarbone tear away from the shoulder blade.
Throwing-related shoulder injuries. These injuries can include shoulder tendonitis, a torn rotator cuff, a labral or “SLAP” tear or even a broken humerus (upper arm). Common ways to injure your shoulder include throwing a ball too hard and falling.
Collar bone fractures
The clavicle, or collarbone, is an important part of your shoulder structure, providing stability to the shoulder joint.
A clavicle fracture, or broken collarbone, is a very common type of fracture. It can occur due to a direct blow, such as from a sports injury or a car accident, or from an indirect injury, such as falling off of a bicycle.
Rotator cuff tendonitis
When the rotator cuff tissue gets irritated due to injury or overuse with time, it becomes inflamed. This is called rotator cuff tendinitis.
Tendinitis can be difficult to distinguish from a torn rotator cuff.
Rotator cuff tears
The rotator cuff helps stabilize your shoulder joint and allows you to raise and rotate your arm.
There are four rotator cuff tendons in each shoulder that attach the rotator cuff muscles to the top of the arm bone (humerus) and help the shoulder move. These tendons are prone to full and partial tears due to wear and tear, such as from tendonitis or injury, including sports injuries.
Shoulder arthritis is the damage of the cartilage that covers the surface of the bones in the shoulder joint.
As the cartilage thins out, shoulder bones start to rub together, which may cause pain and limit your range of motion.
Shoulder instability / Dislocation
When your shoulder joint becomes loose and pops out of its socket. The more frequently your shoulder fully or partially dislocates, the more unstable it becomes.
Shoulder instability can also be caused by prior shoulder injuries, overuse or genetic conditions.
Shoulder labrum tears
The labrum is a piece of fibrocartilage (rubbery tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place.
When this cartilage is torn, it is called a labral tear. This may result from injury, or as part of the ageing process. Symptoms and treatment vary depending on the type and severity of the tear.
A more severe condition than the stiff shoulder, frozen shoulder is also called adhesive capsulitis.
Frozen shoulder results from the loss of movement in the shoulder over time. This lack of motion allows adhesions — sticky bits of tissue — to grow between the bones that make up the shoulder joint, restricting motion and causing pain when moving the joint.
The key to recovery is to find the best form of treatment that allows both the patient and his/her family return to normal daily activities. Some of the popular options to treat orthopaedic injuries include:
Platelet-Rich Plasma Therapy
Platelet-Rich Plasma (PRP) Therapy is a cutting-edge procedure that is revolutionizing the field of orthopaedic medicine. PRP therapy is a new treatment that relieves pain and promotes long-lasting healing of musculoskeletal conditions.
PRP Therapy uses components of the body’s own blood cells to formulate a customized “cocktail” that stimulates the natural healing process in certain orthopaedic conditions.
PRP Injections are a much simpler procedure than surgery. PRP Injections are short office procedures. To complete PRP therapy, a sample of your blood is drawn (similar to a lab test sample) and the blood is then spun at high speeds, separating the platelets from the other components. The concentrated PRP is then injected into and around the point of injury. No stitches are necessary since just a needle is used.
Barbotage for Calcific Tendinitis
Barbotage therapy is an established technique for the treatment of calcific tendinitis of the rotator cuff.
Ultrasound-guided barbotage therapy is an outpatient treatment. A diagnostic ultrasound scan is performed firstly. The skin is then marked and sterilised and a local anaesthetic is given.
Using the ultrasound image, the needle is guided into the calcification under direct vision. The calcification will then be attempted to be aspirated/withdrawn. To encourage healing the calcification is punctured several times under local anaesthetic. Finally, the tendon is bathed in some more local anaesthetic.
Hydrodilatation is one of the latest techniques for treatment of frozen shoulder or adhesive capsulitis.
Adhesive capsulitis or frozen shoulder is a condition characterised by the contraction and inflammation of the joint capsule surrounding the shoulder joint. This is associated with pain, stiffness and loss of range of motion in the shoulder joint. Hydrodilatation is performed to decrease the pain and improve the mobility of the shoulder joint.
The hand is susceptible to multiple forms of injuries due to the amount of stress placed on the hand during day-to-day activities. Some of the most common injuries that occur include arthritis, carpal tunnel syndrome, De Quervain’s tenosynovitis, Trigger finger/thumb and Dupuytren’s contracture.
The term arthritis is used to describe an inflamed joint but does not indicate the cause.
There are many different types of ‘arthritis’ including osteoarthritis, rheumatoid arthritis and gout which can affect the hand. The commonest by far is osteoarthritis which may be familial or post-traumatic. In the hand, the joints most affected are the base of the thumb and the terminal joint of the finger.
Carpal tunnel syndrome
Carpal tunnel syndrome (CTS) is a condition where the median nerve is compressed where it passes through a short tunnel at the wrist. The tunnel contains the tendons that bend the fingers and thumb as well as the nerve.
The main symptom is altered feeling in the hand, affecting the thumb index, middle and ring fingers; it is unusual for the little finger to be involved. Many people describe the altered feeling as tingling. Tingling is often worse at night or first thing in the morning. It may be provoked by activities that involve gripping an object, for example, a mobile telephone or newspaper, especially if the hand is elevated.
De Quervain's tenosynovitis
De Quervain’s syndrome is a painful condition that affects tendons where they run through a tunnel on the thumb side of the wrist.
It appears without an obvious cause in many cases. Mothers of small babies seem particularly prone to it, but whether this is due to hormonal changes after pregnancy or due to lifting the baby repeatedly is not known. There is little evidence that it is caused by work activities, but the pain can certainly be aggravated by hand use at work, at home, in the garden or while participating in sport.
Trigger finger or thumb is a painful condition in which a finger or thumb clicks or locks as it is bent towards the palm.
Dupuytren’s disease affects the hands and can produce contractures of the fingers which interfere with function.
It is a benign disease which has no cure as yet. It can affect the hands in many different ways. Surgery can usually make bent fingers straighter, though not always fully straight; it cannot eradicate the disease.
Elbow injuries can be minor or serious and may include symptoms such as pain, swelling, numbness, tingling, weakness, or decreased range of motion.
Golfer’s elbow is a condition that causes pain where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain might spread into your forearm and wrist.
Golfer’s elbow is similar to tennis elbow, which occurs on the outside of the elbow. It’s not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer’s elbow.
Golfer’s elbow is characterised by:
- Pain and tenderness: Usually felt on the inner side of your elbow, the pain sometimes extends along the inner side of your forearm. Pain typically worsens with certain movements.
- Stiffness: Your elbow may feel stiff, and making a fist might hurt.
Weakness. You may have weakness in your hands and wrists.
- Numbness or tingling: These sensations might radiate into one or more fingers — usually the ring and little fingers.
Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.
The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.
The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:
- Shake hands or grip an object
- Turn a doorknob
- Hold a coffee cup
Collateral ligament tear
An ulnar collateral ligament (UCL) tear is an injury to one of the ligaments on the inner side of your elbow. This ligament connects the inside of your upper arm (humerus) to the inside of your forearm (ulna) and helps support and stabilize your arm.
The UCL is rarely stressed in daily activities. It is injured in throwing types of sports or after elbow dislocation or surgery. It may occur as a sudden tear or may gradually stretch out over time with repetitive injury.
- Swelling and bruising (after 24 hours) at the site of injury at the inner elbow and upper forearm, if there is an acute tear
- Inability to throw at full speed or loss of ball control
- Elbow stiffness or inability to straighten the elbow
- Numbness or tingling in the ring and little fingers and hand
- Clumsiness and weakness of hand grip
Osteoarthritis of the Elbow
Osteoarthritis of the elbow occurs when the cartilage surface of the elbow is worn out or is damaged. This can happen because of a previous injury such as elbow dislocation or fracture. Most commonly, however, it is the result of a normal wearing away of the joint cartilage from age and activity.
The following symptoms are the most common:
- Difficulty moving the joint
- Bone spurs
- Bone grating or scraping
- Joint locking
- Joint instability
- Joint swelling
Limb Reconstruction refers to the subspecialty of orthopaedic surgery that specifically deals with problems in which a limb is a wrong shape or length and function is affected as a result.
The Ilizarov treatment is a highly successful orthopaedic surgical technique designed to lengthen or straighten bone and soft tissue.
Limb correction and Ilizarov treatment may be prescribed for a variety of conditions, such as:
- Congenital limb length discrepancies
- Pediatric hip disorders
Limb lengthening is achieved using the body’s own capacity to regenerate new bone as well as the soft tissues, ligaments, blood vessels, and nerves that surround and support it.
The process begins with an operation called an osteotomy, in which the orthopaedic surgeon cuts the bone to be lengthened.
Whilst participating in sporting activities, like jogging, running, rugby and the like, the human form takes extra stress that may cause injuries to the knee and ankle’s ligaments.
knee ligament injuries
Knowing what knee injuries you are at risk for in your sport of choice are an important part of protecting yourself.
Sudden knee pain is common in contact sports, particularly those that involve twisting. It’s usually caused by a sprain, strain or tendonitis.
Other knee injuries include:
- Runner’s knee: Caused by overuse of the knee; symptoms include soreness and discomfort beneath or to one side of your kneecap; it can also cause a grating sensation in your knee
- Cartilage damage: Where a piece of cartilage breaks off, affecting the movement of your joint; your joint may feel like it’s locking or catching and it may also sometimes give way
- Torn anterior cruciate ligament (ACL): Is a tear or sprain of the anterior cruciate, one of the major ligaments in your knee.
ankle ligament injuries
Ankle injuries are very common and it’s important not to delay the diagnosis and treatment when injuring the ankle during sporting activities.
Common ankle injuries that occur to athletes include:
- Ankle Sprain: When a sprain occurs, one or more ligaments have been stretched or torn. High ankle sprains, among the most common foot and ankle injuries, impact the syndesmotic ligament, which runs from the knee down into the ankle.
- Stress Fractures of the Foot: The impact of excessive and repetitive force can cause microscopic damage to the bones in the foot. When the bones and their supporting muscles do not have time to heal between exercise sessions, tiny cracks in the bones can occur.
- Fractures of the Ankle: An ankle fracture is a much different injury than an ankle sprain (although it is not uncommon for them to occur simultaneously), but sometimes patients confuse these two and wrongly self-diagnose.
- Plantar Fasciitis: Those suffering from Achilles tendonitis are also more prone to an Achilles tear or full rupture after repetitive inflammation and damage have been built up over time.
- Achilles Tendonitis or Tear: The largest tendon in the body, the Achilles connects the two primary calf muscles to the bone in the heel. The tendon runs lengthwise down the back of the ankle and it is particularly susceptible to inflammation because of overuse. Those suffering from Achilles tendonitis are also more prone to an Achilles tear or full rupture after repetitive inflammation and damage have been built up over time.