Chapters Transcript Video Wrist and Hand Injuries in Primary Care: Evaluation and Management Lauren Shapiro, MD discusses hand and wrist injuries. Awesome. Thanks, Virginia. Thank you, Christina, for having me. Um, it's a pleasure to be here. Um, we can, we'll go ahead and get started for the sake of time. Um, this is my contact information. Feel free to reach out if you guys have questions or concerns, trying to get a patient in. Um, Liz can help you guys. If you're not sure about, you know, acuity of injury or where something needs to go or what the workup needs to be, feel free to shoot me an email. Um, for the sake of time, I'll skip over this too much, but Um, grew up in Arizona, did most of my training down at Stanford. Um, I was at, uh, Duke for fellowship, and then I've been on faculty at UCSF for, uh, almost about 5 years now. Um, Tuesdays, uh, I'm up in the Orthopedic Institute in Mission Bay. Um, Monday, Thursday, I need to change that typo. Um, I'm at Redwood Shores. Uh, so feel free to reach out and, uh, book something or, you know, have the patients reach out. We can get them in, uh, if needed. Um, today, we'll focus primarily on hand, wrist, elbow issues, um, primarily the subacute and chronic things that'll come into clinic. Um, we will talk less about, you know, acute fractures that'll usually present more to the ER urgent care facilities, but I'm happy to take questions and, and triage anything you guys have from that. Um, I don't do a lot of pediatric stuff either, um, so I won't hit on that too much. Um, We don't have the polling ability here. Uh, this is just kind of an idea to get it, how much, uh, and what you guys are doing. Um, so we'll go ahead and get started and feel free to put questions in the chat, um, or the Q&A, and we'll address those at the end. Um, starting off at the wrist, um, wrist pain can be hard to localize. It's often generalized to the entire wrist, um, but can be helpful to kind of identify where the pain is coming from, whether it's dorsal, volar, radial, or ulnar, um, can be a nice start. Um, trying to understand what motions or movements or activities reproduce the pain can be helpful. Um, the anatomy here is often quite complex. There's a lot of little bones, a lot of little ligaments that can all cause problems. Um, and oftentimes patients are looking for immediate answers and relief, which can make these a little bit more difficult. So, when you're trying to narrow these down, um, it's helpful to get a, an idea of which activities and or risk positions cause pain. Um, narrowing in on that location of pain, using that kind of four-box matrix we talked about, dorsal volar, radial, or ulnar. Um, and in, in which of those planes the pain is in will help you kind of narrow down what anatomy is in that region and what may or may not be causing pain. Um, and then X-rays are usually helpful, um, in the early treatment. Um, we put an asterisk there cause things like carpal tunnel, trigger fingers don't necessarily need, um, X-rays, but, you know, can be helpful at ruling other things out. Um, wrist, uh, X-rays can be a little bit tricky to read. Um, we're usually getting, um, AP or PA views, which is your frontal view, and oblique, um, and a lateral view. Um, these are both examples of PA or AP views. Um, this is an example of a scaphoid fracture, um, which oftentimes we like to see acutely, um, if these present, um, in a delayed fashion, that is OK, and we will, you know, we'd like to see them too if you guys find these fractures. Um, but if you do see this, um, not an emergency, but try to get these patients into us, um, within a couple of weeks usually. Um, this is a little bit more of a schematic of that dorsal volar, radial ulnar, uh, like anatomy that I was talking about. So trying to identify where, uh, the pain is coming from and what specifically is in that anatomic region. On the ulnar side, this is probably one of the more common things that you and we see. The two most common things, it's the 3 most common things that cause uh ulnar sided wrist pain are gonna be your ECU tendonitis, uh, which is your extensor carpi ulnari on the back of the wrist over here. Um, and the TFCC, uh, which causes pain at the foveal region, which is more on the ulnar side of the wrist. Those are two of your more common causes. Ulnar synovitis, uh, can also cause some pain. Harder to really differentiate, uh, that from your TFCC sprains, uh, or pain from the TFCC, but these are highest on the differential for ulnar-sided wrist pain. These oftentimes occur with tennis players, but you know, occur oftentimes wrist twisting, and ulnar deviation and extension, which puts more force and stress through the ulnar side of the wrist. The anatomy here is quite complicated, um, but this ulnar phobia, again, uh, is, uh, in this region, and your TFCC itself is really Uh, a complex structure made up of many different things that is, uh, pretty intimately involved with the ECU tendon and very close to the ulnar head. Um, so it can be difficult to differentiate some of these pains from, uh, one another. But, uh, when we're talking about ECU versus the fovea, people with ECU pain will more commonly present with pain here and say it hurts me on the back of the wrist over here. Versus when we're talking about foveal pain, where people point here on the ulnar side of the wrist and have pain with ulnar deviation. Um, so clinically, when we're looking at the ulnar side of the wrist, this is usually where people are pointing. Um, and again, on your exam, trying to differentiate between kind of pain, uh, on the back of the wrist in a more diffuse location versus, uh, on the ulnar side of the wrist, uh, at that foveal region right here. This is just what it looks like, uh, through an arthroscope. Um, treatment varies and is usually non-operative. Um, this wrist widget can be a good start. Um, it's a little bit less bulky and cumbersome than a removable wrist brace or a carpal tunnel brace like this here. Both of these work. People can, you know, play tennis and other sports and golf with the wrist ridget, um, so it's a little bit more low profile. Activity modification, meaning avoiding activities that hurt, um, anti-inflammatories can also be helpful. Um, we do steroid injections very frequently for ulnar sided wrist pain and or for ECU tendonitis. Um, if you guys don't feel comfortable doing that, we, we feel free to send patients over. We're happy to do it. Um, I try to shut people down in a brace or a wrist rigid for at least 6 weeks, um, oftentimes combined with an injection, anti-inflammatories, and activity modification to really, you know, calm things down and, uh, give that non-operative treatment the best uh option of working. Um, for your ulnar side corticosteroid injection, um, if you're doing it, uh, for the fovea, usually what I'll do is I'll feel that ulnar styloid and come just distal to it. Usually, we're injecting about 1 cc of Kenalog or another, uh, steroid and 1 cc of lidocaine. Um, for the ECU tendon, it's pretty superficial, and typically what I'll do is pop in just dorsal to the tendon. Um, if you're getting resistance, you're probably in the tendon, so you can pull back a little bit and inject along that tendon sheath. Um, usually, we'll follow up with these patients 6 weeks, 8 weeks. I tell patients that it'll take, you know, several weeks at least for that steroid to kick in. Um, oftentimes, we can perform another steroid injection if, if they've gotten better, but not, uh, to the point where they can fully return to the activities they want to do. Um, you know, if you've tried all these things, they're not getting better, um, feel free to send them over. We're happy to see them, re-inject them. Um, the role of an MRI, uh, the MRI does play a role here. Um, typically, I'll try to immobilize people, shut them down for a little bit, and try some steroid before we're getting the MRI, um, but it is an option, uh, helps us see some of the ligaments, um, in the wrist as well as other, uh, pathologies that we may be missing. So, quick summary, these are often tendonitis, uh, or like a TFCC sprain. Um, start with bracing, anti-inflammatories, activity modification, um, injection if needed, uh, and conservative treatment for usually 2 to 3 months before we're thinking about surgery. Um, moving on to dorsal wrist pains, this is what we call this dorsal central wrist pain. Um, this is often exacerbated with wrist extension and axial load, so push-ups, uh, a lot of yoga and Pilates positions can cause pain here. Um, patients will kind of point to the center of their wrist. Um, this is most commonly either dorsal capsular impingement, um, which is some of the wrist capsule and irritation getting caught as the bones move. This can also be ulnocarpal or radialcarpal abutment, uh, which is when the ulna is slightly longer than the radius, um, and that can cause some central pain. Um, dorsal central pain can also be from a scapholunate ligament injury, tear, uh, or a ganglion cyst or an occult ganglion cyst that you don't always see very easily. So those are the main causes. Um, the anatomy here as well is quite complex. There's a lot of ligamentous structures around here that can be sprained or strained or irritated. Um, when we're working on our exam here, this is again, what parts of the wrist are hurting, what is the anatomy, um, and what may be causing that pain based on the anatomy. Um, these patients obviously don't have a lot of loss of motion. If they do, uh, that would be an indication for X-rays and an earlier referral, um, similar with crepitus and or a locking motion, um, but these, again, oftentimes, uh, pain with, uh, extension and axial load of the wrist. Um, these are just some X-rays. This is an example of radiocarpal arthritis, uh, typically from a scapholunate ligament injury here. Um, and again, you guys probably recognize this, but this gap here is evidence of a scapholunate ligament injury, uh, and that can also cause that dorsal central wrist pain. So, if you're seeing these on Uh, your X-rays, feel free to send those patients over. Uh, this one is oftentimes surgical. Uh, this one is, you know, we can try injections immobilization, but, um, this one can be surgical as well for arthritis. Um, if there's no obvious fractures or ligamentous instability or any red flag signs like loss of motion or, you know, increasing pain, um, these again are typically braced with a removable wrist brace like this. The thumb spica component is not usually needed here. And similar to the ulnar side, anti-inflammatories, activity modification, um, steroid injections can be helpful for these. Uh, it really depends on the diagnosis. Um, if you're injecting someone, I would just make sure they don't have a scap ligament injury. Uh, but for things like an occult ganglion cyst or dorsal carpal synovitis, um, uh, a steroid injection can be helpful. Um, and again, typically, uh, trialing non-operative treatment for at least, you know, 2 to 3 months before we're, uh, thinking about either an MRI or surgery. Um, this is a little bit about wrist arthroscopy. I think we can skip over that. Um, but again, uh, MRI, a reasonable option for patients who are failing conservative management for dorsal central wrist pain. These are again just some photos of what we'll see. This looks like some dorsal capsular synovitis that we're seeing back there. Um, radial-sided pain, so on the thumb side, the two most common reasons for that sort of pain are deervain's tenosynovitis, which is gonna be dorsal, radial, and a little bit more proximal over here. Your thumb CMC arthritis is gonna be, uh, dorsal radial, uh, and a little bit distal, uh, to where your decur veins is gonna be. Um, this is oftentimes aggravated with weightlifting, um, ulnar deviation, or, uh, like jars and keys will exacerbate CMC arthritis. Um, so, when we're talking about thumb arthritis here, patients will oftentimes do the C sign where they grasp the base of the thumb with deer veins. Oftentimes they're talking about right here with radial with ulnar deviation. Um, so with Diker veins, uh, I'm sure you guys are all aware of that Finkelstein's test. Uh, ulnar deviation will usually, uh, cause these people a fair amount of pain here. Um, we're looking at CMC arthritis. Uh, that CMC grind where you take that metacarpal and grind it in the trapezium will cause them pain. Um, and again, oftentimes they're, you know, grabbing their thumb or the base of the thumb in a C shape. Um, treatment for deer veins, uh, almost always non-operative. Um, for this one, the thumb spica can be helpful to really minimize, uh, thumb extension, uh, and abduction and ulnar deviation. Um, when we're injecting steroid here, we try to use, I use dexamethasone as opposed to Kenalog. The solubility properties are a little bit different, uh, and will cause less fat atrophy in an area where we're relatively superficial or close to the skin. Um, the success rate of steroids is quite high, uh, so very few of these patients end up needing to go to the operating room. Um, and again, for this, I'll oftentimes have patients say, you know, put a finger on where it hurts, uh, and I'll inject around that region. I'll put my fingers around that first dorsal compartment and get, make sure my needle's kind of right in the middle of that. Um, and again, just be aware of that fat atrophy. We don't wanna inject these folks too much, um, just given that risk as well. Um, send the patients over, you know, if they're failing injections, uh, or still having pain, uh, after injections or bracing. Um, a lot of different treatments for thumb arthritis. Uh, we typically start with X-rays. Um, these are the two main braces. This is not, this is the brace that I like a lot. This is called the CMC Push Metarip. Um, there are softer braces like this. There's also the Comfort Cool. It's a little neoprene brace. Um, these are very effective, uh, for non-operative treatment of thumb arthritis. Uh, anti-inflammatories, Voltaren Voltaren gel activity modification can be very helpful. People can garden and surf and, you know, do all sorts of things in this, uh, meta grip, so people really like those. Um, thumb injections can be very helpful as well. Um, what you're doing here is you wanna kinda palpate the base of that metacarpal, which is gonna be kinda right there. You'll oftentimes fall into it when you walk along the metacarpal. Um, there's oftentimes not a lot of joint space in there. Uh, so we try to get into the joint. If you're getting steroid around the joint, that's usually OK. The joint itself is small, even when there is not arthritis, so these, uh, injections can be quite painful, um, and fracture to the thumb can help open up that joint, uh, if you need or having trouble getting that, uh, in there. Um, there's a lot of options for treatment. Um, trapeziectomy here, where we take this bone out and put a suture, uh, to hold this space open is kind of the tried and true way of taking care of this. Um, a thumb denervation, uh, is a newer option, uh, earlier return to work. Um, we have about 5-year outcome data on that, um, and the literature and, uh, uh, clinical experience is telling us that Usually, about 50% of the patients end up undergoing a different surgery at about 5 years after a denervation. Um, we also now have an implant arthroplasty. Um, that was just approved by the FDA in July. Um, we've done our first couple of cases here at UCSF. Um, there is great 10-year data out of Europe, um, and we're, you know, learning, uh, at UCSF in the states, um, but thus far our experience has been positive. So feel free to send patients over if you feel like they are candidates and have failed non-operative treatment or if they have questions about operative and or non-operative treatment. Um, volar wrist pain, often non-specific, uh, but oftentimes patients kind of pointing in this region. Um, it can be FCU tendonitis. The pisiform bone sits over here in that FCU and can cause some pain. Um, if they're pointing to more pain on the radial volar side, that may be the FCR tendon. Um, patients can also have some STT arthritis, which you can find on X-ray. Um, The FCU, uh, again, volar ulnar patients will oftentimes have pain on the volar ulnar side of the wrist. Patients with FCU and or FCR tendonitis will oftentimes have pain with resisted wrist flexion in that specific anatomic region. Um, so this is similar to the FCU. This is the FCR anatomy here. Um, for both of these, wrist bracing is very reasonable with the carpal tunnel brace or removable wrist brace. Again, anti-inflammatories, activity modification. Um, these can get injected as well. Um, a little bit trickier when you're injecting around the FCR just given the radial artery. Um, but if you're, you know, you palpate the artery and you're away from it, draw back before you inject, you're usually good to go. Um, happy to do this for you guys if you want as well. Um, some mimickers and things to not miss. You know, carpal tunnel syndrome usually presents more with numbness and tingling than isolated pain. Um, these patients often complain of numbness and tingling here, waking up in the middle of the night, having to shake their wrist out. Um, These patients, uh, a wrist brace at night can be very helpful for these folks. Um, an injection can be helpful. Literature tells us that it's temporary and not disease modifying, but can be very helpful for these symptoms. Um, usually inject just ulnar to the, uh, palmaris if they have it. Uh, and I aim my needle about 45 degrees, uh, distal and about 45 degrees radial. Oftentimes, you'll feel yourself pop through that transverse carpal ligament. Um, again, if you're feeling resistance, you may be in a tendon, so you can pull back. The median nerve is very radial, um, in the carpal tunnel. So usually we start ulnar and aim a little bit radial and get into the carpal tunnel itself. Um, trigger fingers, very, very common. Uh, probably the most common cause of a traumatic finger pain. These are oftentimes worse in the morning. Uh, patients can present with, usually pain at the A1 pulley. Oftentimes, these patients have pain at the PIP joints as well on the backside of that affected finger, um, and oftentimes they'll present with locking, clicking, or catching of the finger. Um, hand therapy and tendon glides can be helpful. Um, there's a trigger finger splint, uh, that patients can get on Amazon for, I think, less than $10. It is very helpful. Um, to where at night it blocks the MCP, allows for motion of the PIP, and can be very effective, uh, at trading trigger finger. Um, muscle sprains or strains, often overuse activities in younger patients, often those at a keyboard a lot or who are doing, you know, weekend warrior type activities. Um, these can cause some cramping in the fingers and the forearms, you know, making sure you're not missing something, um, and that pain is not. Uh, too, uh, intense and or, you know, it's more intermittent and improves with rest. Um, wrist braces can be helpful for these patients and shutting down the wrist a little bit to avoid that overuse. Um, scaphoid fractures, uh, if patients have snuff box pain, um, that, or pain that is not going away at the wrist, X-rays are usually very helpful. Um, send these over to us as soon as you find them. Um, we'll put them in a short arm, uh, cast if you're able to. We don't need the thumb spica component, um, but, you know, cast them, send them over as soon as you're able to. Send us an email if you need to. We try to get to these sooner rather than later. Um, dorsal wrist ganglion also quite common. Um, oftentimes you'll see these on exam. They're, you know, more prominent with the wrist flexed. Um, you can aspirate these if you want. Um, they're typically filled with a like mucin or, uh, like gelatinous fluid, so it can be difficult to extract, uh, jelly out of, you know, a thin needle. Um, typically, what I'll do for these is inject a little bit of lidocaine. Just distal to the mass, and I'll use an 18 gauge needle actually to get into the mass. Um, if they're multiloculated, um, it can be hard to get in. If you use a small needle, it can also be hard to, um, suck that fluid out. So, uh, the rate of recurrence with aspiration is almost 50%. So, if people want these drained, you know, we're happy to do it with the caveat that it's likely to come back. Um, all right. So, quick summary, uh, ulnar side or wrist pain, oftentimes either ECU or TFCC, uh, start with wrist widget or wrist immobilization, anti-inflammatories, activity modification, uh, low threshold for a steroid injection here, um, and would really start these off with, you know, 2 or 3 months of non-operative management before we're thinking MRI or any sort of surgery. Dorsal wrist pain, uh, pain with, uh, axial load and extension, oftentimes dorsal capsular impingement, ulnarcarpal radiocarpal abutment, uh, SL injuries, and or, uh, a ganglion cyst. Um, again, immobilization, bracing, um, OK for an aspiration for a cyst and or an injection if things aren't getting better, uh, with non-operative or noninvasive measures. Um, radial-sided pain, Dervain's tendonitis, CMC arthritis, similar brace, anti-inflammatories, activity modification, low threshold for injections, both for Dervains and CMC arthritis. Um, make sure you're using dexamethasone or something a little bit, uh, with more favorable solubility properties. If you're doing the Decerveins. Um, FCR, FCU, um, similar, shut them down for a little bit of time. Activity avoidance. Um, if, if you're, uh, hesitant to inject in there, feel free to send them over. Some of the PM and our colleagues will put an ultrasound on the tendon, um, just to make sure they're in the tendon sheath and or, you know, not in an artery or vessel. Um, we can go through a little bit of elbow pain. I wanna try to wrap up, uh, and save some time for questions. So, I'll go for about 10 more minutes and maybe leave time for about 10 minutes of questions at like 1:05. Um, elbow anatomy, you know, another complex area with a lot of different things going on here, we'll hit the highlights. Um, most commonly, you'll see lateral-sided elbow pain. Oftentimes worse with repetitive activities, tennis, pickleball, uh, golf, weightlifting, um, even, you know, typing at a computer. We have a lot of engineers who, um, get this kind of overuse of the lateral elbow. Um, patients are usually pointing to the, you know, lateral aspect over here, sometimes into the forearm. Um, all of the, most of the tendons that extend the fingers attach kind of at the same spot over here. That puts a lot of stress and strain on that one area. Um, and it makes it difficult for that to heal. Um, so patients will usually, uh, point to this area over here. Um, sometimes they'll point further out into the muscle belly. Uh, this can be a little bit of radial tunnel, uh, compression as you get a little bit more distal, but lateral epicondylitis, just distal to the lateral epicondyle is gonna be, uh, the most common cause of this type of pain. Patients will oftentimes have pain with resisted wrist extension and or resisted digital extension, primarily of the middle finger. Um, you know, this takes a long time to go away, um, but almost always goes away on its own. So, this is probably one of the least favorite things I enjoy talking about in clinic just because there's not a lot that we do surgically or from an intervention perspective for them, and it just takes a lot of time and a lot of therapy. Um, so, managing patient expectations, anti-inflammatories, rest, um, getting these into therapy. The AAOS, um, I'll pop that in there, AAOS lateral epicondylitis has some great exercises for this. I print that out for patients almost every day in clinic. Um, this counterforce brace can be very helpful. It really distributes the force, uh, from those tendons, uh, across an area, so it's not at one area. Um, make sure patients are putting this kind of distal to the elbow itself and kind of not on the lateral epicondylar region, but a little bit distal. Um, a wrist brace can be helpful as well, cause it really prevents, um, wrist extension, which exacerbates some of those tendons. Um, This is an article from one of our frequently read journals, uh, kind of talking about why and how this is a little bit annoying, but, you know, this is one of the more common things that we see. Uh, it oftentimes lasts, I tell patients sometimes 8 months, um, and oftentimes goes away on its own. I think the exercise can be quite helpful, um, but we rarely get to surgery for that. Um, we talked a little bit about radial tunnel, which is compression of the nerve as it kind of goes through that radial tunnel. Um, hand therapy, very helpful for these patients as well. Uh, would not use a counterforce brace for these. Um, so, uh, if you can try to differentiate between that lateral epicondylitis, which is a little bit more proximal, much more common, um, than your radial tunnel, which is gonna be a little bit more volar and a little bit more distal. Um, send those patients over. Sometimes, a, a steroid injection can be helpful. It's not something we quickly jump to. Um, Other types of injections, non-steroid, are some of the things that our PMNR colleagues are doing. Things like Toradol. There's a couple of different needling type procedures that they can do that can be helpful as well. We do have a surgery for lateral epicondylitis. Um, it's not the most enjoyable thing and we don't end up doing it a lot cause the majority of these patients will get better on their own. And with some therapy. Um, medial epicondylitis, uh, is kind of the brother or sister of your lateral epicondylitis, but is more on the medial side. Um, again, golf sports, racket sports, um, overuse activities. This, uh, opposite to lateral epicondylitis can be made worse with wrist flexion and pronation. Um, so, pain with resisted wrist, uh, flexion. Um, we don't use a counterforce brace on these. Um, again, managing patient expectations, anti-inflammatories, uh, getting these folks into hand therapy can be helpful. Similar to your lateral epicondylitis, a wrist brace can be helpful in preventing that overuse. Um, just be aware, you know, asking about numbness and tingling, um, along the medial part of the elbow. Um, patients will oftentimes have a Tinel sign if they have some cubital tunnel or irritation of that ulnar nerve as it runs around that epicondyle. Um, you can start with some occupational therapy and nerve glides. Um, nighttime cubital tunnel braces can be helpful. You know, we all fall asleep with straight elbows and wrists and then wake up with them bent, and that can put a lot of, uh, irritation on the nerve. Um, having patients, uh, partners tape a pillow around their elbow at night can be helpful. Um, having them go to Dick's or Big Five Sporting Goods and take an elbow brace and wrap it around, so it's, uh, prevents that flexion, uh, can be helpful as well. Um, you know, anterior posterior elbow pain, um, much less common. Um, you can get some triceps tendonitis on the back of the, uh, elbow. Uh, biceps, tendonitis on the front of the elbow. Um, patients with complete ruptures are not common, um, but can happen. Oftentimes they have difficulty extending the elbow or extending the elbow against resistance. We try to get these patients in sooner rather than later. Um, bursitis, another common thing that we see on the back of the elbow. Um, I would urge you to not aspirate these. Um, if they're, if it's a septic bursitis, meaning that they look red, inflamed, uh, we'd send those to an urgent care. Give some antibiotics and a compression wrap that will almost always work. If they're non-septic, meaning not infected, not appearing infected, Um, we'll just do a compression wrap. Um, we're happy to see those. Uh, these are almost always non-operative for us, uh, and almost always go away on their own. Um, again, don't aspirate these compressive wrap, activity modification, trying to avoid pressure on the area, uh, and, uh, aggravated range of motion. Um, we can take out the bursa. Um, it's a not wonderful area to operate. The blood supply to that part of the elbow is not great, which is why the aspirations oftentimes continue to drain and don't heal and lead to bigger issues, um, as does surgery in this area, um, sometimes. Um, anterior elbow, oftentimes the biceps here, um, you can get some distal biceps tendonitis as it, as it comes in and attaches. Um, and again, that's very typically pain at the biceps insertion, um, pain with resisted flexion and supination. Um, again, managing patient expectations, anti-inflammatories, activity modification, um, uh, hand therapy, occupational therapy can be very helpful in helping get these folks back to their activities. Um, MRI's can be helpful, um, if you're not sure what's going on and or if somebody has pain that has been going on for a long time or feels a pop in that area, um, go ahead and send those our way if you're concerned. Um, you can get complete ruptures of these. We're oftentimes seeing those on an MRI. Um, those can be fixed surgically. Um, arthritis pain mimicker, or sorry, elbow pain mimickers. Um, arthritis is a common one. typically presents with long-standing elbow pain. Um, X-rays that look something like this. Um, this can certainly limit motion of the elbow and cause a fair amount of pain. Um, anti-inflammatories, rest, activity modification. Um, an injection, um, into the elbow can be very helpful. Um, we'll go kind of in this middle of this triangle here. So it's the triangle between the lateral epicondyle, the olecranon, and the radial head. Um, usually, there's a little soft spot there. You can inject some steroid in there. Feel free to send those patients over. Um, happy to inject them and help take care of them. Um, a lot of different types of surgeries, um, for elbow arthritis, um, that can be quite helpful, but typically managed non-operatively. Um, Don't miss your, you know, neck pain, radicular pain, cervical, uh, stenosis and symptoms that are coming from the neck. Uh, I'm sure you guys are all probably more aware of this than I am. Um, just a quick overview, uh, of the elbow stuff we talked about. These are some references, um, and I can go ahead and take some questions. Published August 24, 2026 Created by Related Presenters Lauren Shapiro, MD, MS Orthopedic surgeon View Full Profile
