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Shoulders Elbows Wrists Hands and Fingers

Replaced knees and hips may garner more press, but recent advances in medical technology bring good news for patients who need upper extremity joint repair. Shoulders, elbows, wrists, and hands-our upper limbs-are a veritable gallery of different joint designs, but they all endure life's general wear and tear. Orthopedic physicians are finding new ways - both surgical and non-surgical - to keep these joints gliding smoothly.

Joints exist anywhere in our bodies where two or more bones come together. Some have limited movement, like our vertebrae, or are even fixed, like those in our skull. Most, like the ones in our upper extremities, are built of intricate parts that work in concert to move our bodies. Tendons link muscles to the joint bones and pull on the bone for movement. Ligaments stabilize the joint by linking bones to other bones. Fluid lubricates the joint structure, and the bones that slide against each other are coated with a slick cartilage that minimizes friction.

The complex joints in our upper extremities are susceptible to a variety of problems. Muscle groups like the rotator cuff-a group of four muscles surrounding the shoulder-can tear. Tendons can swell, leading to painful tendonitis like tennis elbow. Arthritis can ravage the glassy cartilage surfaces in the shoulder, and cause overall swelling, sparking pain and limiting movement.

When Shoulders Don't Work

The shoulder is one of the body's ball and socket joints: a bony ball fits into a bony socket and allows a full range of almost 360-degree motion. Frequent shoulder problems include arthritis, tendonitis, tendon tears, labral cartilage tears and impingement syndrome, in which the muscles become painfully pinched between shoulder bones during movement. Doylestown Hospital orthopedic surgeon Douglas Boylan, MD, who specializes in repairing shoulders, says that joint work in this are has become less invasive.

"With newer, smaller tools available, we can operate arthroscopically to repair rotator cuffs and remove bone spurs that cause impingement and limit motion," he comments. "People often go home the same day, heal faster and return to normal activities sooner." Physical therapy is starting earlier and more intensively as well, Dr. Boylan adds, which aids recovery.

Shoulder replacements are becoming more common, with an estimated 60,000 taking place last year. Because of its complexity and lenghtly rehabilitatoin, this procedure is usually reserved for people with severe arthritis that causes debilitating pain.

Elbows and Wrists

Elbows are candidates for joint replacement, too, though this technique also is usually reserved for serious impairments that don't respond to less invasive remedies. As hinge joints, elbows are comprised of a convex surface of one bone that fits snuggly into the concave surface of another. This joint moves only in one plane.

Wrists are gliding joints, with flat surfaces that slide across one another and allow a wide range of motion. Wrists are prone to fracture as they take the brunt of falls. It's a particular issue among the elderly, and complex wrist physiology makes it a tough site for repair. Nonetheless, advances continue. "We're moving away from using external fixators-exposed metal bars that attach directly to the bones to stabilize a broken wrist," Dr. Boylan explains. "Internal plates are getting patients moving and healing more quickly."

Restoring Finger Joints

Hands contain a startling number of joints; there are fifteen in each finger alone. Arthritis is a common complaint in these joints-hinge finger joints, which move in one plane only, and in the thumbs' saddle joints, which allow for side to side and back and forth motions. There are a number of advanced medications that can selectively target the immune and inflammatory responses that trigger arthritis. These drugs may slow finger joint damage and deformity, a noteworthy advance from non-steroidal anti-inflammatory drugs that are used primarily to alleviate pain.

Healthy fingers move nimbly without much thought. But when knuckles are painfully swollen and arthritic, it's difficult to concentrate on the task at hand. "Daily movements-even the slightest touch to my frozen, swollen joint-caused excruciating pain," recalls New Hope resident, Dennis Cianci, who had severe arthritis in his index finger. "I limited what I did to avoid the pain as much as possible. It was always on my mind." Until Doylestown Hospital hand surgeon Gregory Gallant, MD, helped Cianci trade in his tired natural joint for a flexible new model made of high-tech carbon.

When non-surgical methods fail, technology supplies an alternative. "New, smaller joints have come out fairly recently that allow us to replace the second finger knuckles and some are made of very light, strong materials like carbon," Dr. Gallant points out. "We also can replace more than one joint at a time, if necessary." For Cianci, a new carbon joint furnished immediate relief and the freedom it offers continues to please him. "The surgery was extremely easy," Cianci says. "When they took the cast off after six weeks...oh my gosh, what a tremendous difference. I was pain-free again."

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