Shoulder, Arm & Hand

Acromioclavicular Joint Injuries

The acromioclavicular joint, or AC joint, is one of four joints in the shoulder. It connects the clavicle (collar bone) to another smaller bone in the shoulder called the scapula. The bones can become dislocated from the joint where they are not fitting together properly. This kind of injury can be extremely painful and creates a visible deformity. Fortunately, Mount Sinai’s orthopedists can often treat AC injuries without surgery or by immobilizing the bones using stitches and a graft.

Adhesive Capsulitis (frozen shoulder)

Patients with frozen shoulder have difficulty moving their shoulder. The condition can be caused by a shoulder injury, by an infection, or by inflammation. Mount Sinai’s orthopedic team can often help patients suffering from frozen shoulder with steroid injections and physical therapy. For patients with persistent stiffness, surgical manipulation or arthroscopic surgery may be required.

Bicep Tendon Injuries

Just like all muscles, your bicep connects to bones with tendons. And these tendons can tear from an injury, like lifting a heavy object, or they can become inflamed or swollen from overuse. The bicep tendons at the shoulder are called proximal, and the tendons that connect the bicep to the elbow are called distal. Proximal biceps injuries cause pain at the front of the shoulder, while distal biceps injuries can cause a sudden pop and pain. Proximal biceps injuries can improve with rest and steroid injections. For distal biceps injuries, time-sensitive surgery may be necessary by a Mount Sinai orthopedic surgeon who will repair the tendons with a “button” and a screw. Then patients will need to go through a period of rehabilitation.

Brachial Plexus Injuries

The brachial plexus is made up of the nerves around the neck and shoulder, and injuries to the brachial plexus can be caused by sudden pulling or stretching, known as a traction injury, or from penetrating injuries that puncture the skin. Your Mount Sinai orthopedist may recommend physical therapy for mild injuries, or more complex treatments, including surgery, for severe cases.

Cartilage Injuries

Cartilage is a flexible but firm tissue found in your joints and other parts of your body, like your nose and ears. Injuries to the cartilage, such as osteochondritis dissecans (OCD lesions), are more common among young athletes and usually cause pain when you’re active. Many times, your Mount Sinai orthopedist can treat a cartilage injury with a brace or cast, but when the injury is unstable, surgery may be required.

De Quervain’s Tenosynovitis

When the tendons that connect muscle to the wrist bones become inflamed, this condition can develop. It’s especially common among new mothers. We often recommend using a brace, and in some instances, we inject steroids into the affected areas. Persistent symptoms can be fully resolved with surgery.

Elbow Ligament Injuries (collateral ligament injuries)

Elbow ligaments connect the top of your arm to your forearm, and injuries to these ligaments can be caused by falling, getting hit (while playing sports), or any other trauma. At Mount Sinai, our orthopedists often treat these injuries with surgery.

Extensor Tendon Injuries

The tendons that connect the extensor muscles on the back of the hand, wrist, and fingers, can be injured in a fall or other traumatic way. Depending on the severity of the injury, your Mount Sinai orthopedist who specializes in hand surgery will determine if the injury can be treated with a splint or brace, or if it requires surgery.

Fingertip Injuries

Fingers often get slammed in doors. These are crush injuries, and the delicate bones and nerves in the hand require careful treatment. At Mount Sinai, patients with fingertip injuries receive treatment from an orthopedic surgeon who specializes in hand surgery to make sure the finger heals without infection and to prevent issues with future nail growth.

Flexor Tendon Injuries

The tendons that connect the flexor muscles in the palm of your hand, fingers, and wrist can be injured. These injuries almost always require surgery in a timely fashion, followed by rehabilitation exercises to prevent finger stiffness and scarring.

Fractures

At Mount Sinai, we treat broken bones in the upper extremities differently depending upon which bone breaks. Some fractures only require physical therapy, while others require surgery to reconnect the bone and make sure it doesn’t move in order to heal. This may require using metal plates and screws. Other fractures require a cast or other device to immobilize the bone. Fractures of the upper extremity include the following:

• Clavicle fracture
• Shoulder and arm fractures (humerus, clavicle, glenoid, and scapular bones)
• Elbow fractures
• Fractures of the fingers/hand/wrist/forearm

Lunate/Perilunate Dislocations

The lunate and perilunate are located in the wrist, and in rare instances, can be dislocated, usually from a high impact injury like a car accident, sports injury, or hard fall. To make sure patients maintain functionality of their wrist, a Mount Sinai hand specialist needs to operate immediately.

Mallet Finger

A jammed fingertip, where the bones of the finger get pushed together, can usually be treated with a splint to hold the finger still for a number of days. However, in some cases, your Mount Sinai hand specialist may need to perform surgery to make sure you maintain function of the finger and avoid a permanent deformity.

Peripheral Nerve Injuries and Compression

We use the term “peripheral nerve” to talk about nerves in the extremities, hands, and legs. These kinds of injuries include conditions like carpal tunnel syndrome and cubital tunnel syndrome. While they can be caused by a fall or other trauma, they are more often caused by chronic compression or pressing on the nerves. These conditions can cause numbness or tingling during the night. At Mount Sinai, we use specialized nerve tests to diagnose these conditions, and then, depending upon the diagnosis, we use braces at night. More severe symptoms may require injection or even a minimally invasive surgery to free up the nerve and prevent permanent nerve damage.

Rotator Cuff Tears

Tendons connect muscle to bones, and in the case of a rotator cuff, some or all of the tendons that stabilize and move the shoulder can tear. Small tears can be treated with physical therapy, but for larger tears, or when all the tendons are torn, patients may require arthroscopic surgery.

Shoulder Instability

An unstable shoulder can lead to a dislocation, subluxation (a partial dislocation), or feeling as if your shoulder is “slipping out of place.” At Mount Sinai, we typically treat shoulder instability with physical therapy; however, severe instability often requires surgery – either arthroscopic or open surgery – to repair the shoulder.

Tennis Elbow and Golfer’s Elbow

These conditions affect either side of the elbow. Tennis elbow, or lateral epicondylitis, causes pain on the bony outside of the elbow. Golfer’s elbow, or medial epicondylitis, causes pain on the inside, folding part of the elbow. Both conditions are caused by damage to the tendons that connect the muscle to the bone and can result from overuse, small tears in the tendon, or an injury. Both conditions can cause mild to extreme pain and can make lifting and gripping difficult. Most patients tend to get better over a period of months; however, in some instances, your Mount Sinai orthopedist will recommend physical therapy.

Triangular Fibrocartilage Complex injury (TFCC)

TFCC stands for triangular fibrocartilage complex, and it’s part of the wrist. TFCC injuries are usually caused by sports or from overuse. Some injuries will get better by using a brace, having physical therapy, and receiving steroid injections. Injuries that cause instability or loss of motion may need arthroscopic wrist surgery.