Orthopaedic Hand Condition

Skier’s Thumb

A “skier’s thumb” is an injury to the ulnar collateral ligament of the thumb. This ligament is an important attachment between the thumb proximal phalanx and metacarpal bones. Sometimes this ligament sprains or tears following a fall onto the thumb. If the thumb is bent backwards or forced to the side (such as when falling with a ski pole in one’s hand), the ulnar collateral ligament may abruptly tear. However, sometimes the ligament slowly stretches out and fails over time, this injury is then referred to as a “gamekeeper’s thumb”.

Thumb anatomy.png

A thumb with a torn ulnar collateral ligament will be painful, oftentimes swollen, feels week, and is difficult to bend normally. The pain tends to be worse when pinching or grasping items, such as a holding a coffee cup, a doorknob or a pencil.

The severity of a thumb sprain can usually be determined by an orthopaedic or hand physician, who will test the stability of the injured thumb compared to your uninjured or normal side. X-rays can be helpful to assess for fractures, and in some cases an MRI may be obtained to visualize the ligament.

Low-grade thumb sprains will usually heal in a brace. Normal ligament healing typically takes around ~6-8 weeks. A thumb spica splint or brace is usually worn full time for 4 weeks, then part time (such as for activities, lifting, or when sleeping) for another 4 weeks.

High-grade tears, or more complete ligament injuries, especially those resulting in the thumb being unstable, may be treated surgically. The torn ligament is sutured back in place. Approximately 90% of the time the ligament is torn from the proximal phalanx, and 10% of the time from the metacarpal bone. A suture anchor is typically used to hold the suture and ligament back to the bone. This is an outpatient procedure, done through a ~1 inch incision, which takes ~30 minutes. Afterwards, a splint is worn full time for ~4 weeks and part-time for another ~4 weeks. Typically normal motion is restored, and pain is eliminated.

A suture anchor is placed into the proximal phalanx. The attached sutures allow for the torn ligament to be stitched back down to the the bone. Image from AO Foundation.

If a skier’s thumb, or ligament tear is not diagnosed or treated, the pain and weakness continues to be present, and can oftentimes result in arthritis.

Read more about thumb sprains here.

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is an injury to the tendons along the outer elbow. The inflammation from this injury can cause pain, weakness, aching and tightness. The muscles that open the fingers and extend the wrist all combine to form a common tendon along the outside of the elbow. In tennis elbow, inflammation or tearing of this tendon causes pain with use of the hand and arm.

"Can using a computer cause carpal tunnel syndrome?"

Many patients will ask the question: “Did I develop carpal tunnel syndrome from too much time spent using a computer or keyboard?” The answer to this question is typically: “Maybe”. For most individuals, the cause of carpal tunnel syndrome is unknown. However, there are several risk factors that have been identified, one of which is computer work.

“My tingling hands wake me up at night!”

One of the most common reasons for which a patient will come see me in my office is due to a tingling sensation in their hands. This oftentimes happens at night when sleeping, and can severely disrupt the quality of their sleep. These patients oftentimes say that a burning sensation, or pain in their hands wakes them up throughout the night, and they either need to 1) shake the hand, 2) hang it off the side of the bed, or 3) raise the hand up in the air to alleviate the symptoms.

Dr. Schreiber selected winner of the "Outstanding Paper" award at the 2017 American Association of Hand Surgery Annual Meeting in Hawaii

The American Association for Hand Surgery (AAHS) had their 2017 annual meeting last week in Waikoloa, Hawaii.  A research study that I have been working on with colleagues at Stanford University was presented, and was fortunate enough to have been selected as the winner of the meeting’s “Outstanding Paper” award. The goal of the study was to try and find an easy way for hand surgeons to diagnose osteoporosis in their office.  

Dupuytren Disease – from Vikings to Napoleon to a New Injection

Dupuytren disease, known by the medical term “palmar fibromatosis,” bears the name of Guillaume Dupuytren – a French surgeon, and private physician of Napoleon Bonaparte – who famously described its surgical treatment in 1831. It is a genetic disorder most commonly seen in people of northern European descent, hence the colloquial term of “Viking disease”.

Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.