Download file | Play in new window | |
The functionality of our upper extremities is essential for almost every aspect of daily life. From lifting a morning coffee cup to typing on a keyboard or enjoying a round of golf, our arms, hands, and shoulders are constantly in motion.
Yet many of us only truly appreciate this intricate system when pain or discomfort begins to interfere with our activities. That’s when expertise in upper extremity care becomes crucial for maintaining our quality of life.
Expert Insights From Dr. Samuel Crosby
I recently sat down with Dr. Samuel Crosby, a distinguished board-certified orthopedic surgeon specializing in hand and upper extremity surgery. His extensive training includes education at Vanderbilt University and a fellowship at Harvard University.
Dr. Crosby’s experience spans prestigious institutions, including Brigham and Women’s Hospital, Massachusetts General, and Boston Children’s Hospital. Now practicing in the Nashville area with Elite Sports Medicine and Orthopedics, he brings this wealth of expertise to our community.
The Importance of Staying Active While Managing Pain
“From my standpoint, being active — exercise — is so important for physical health and also mental health,” Dr. Crosby says. “And a lot of the things I treat limit people’s ability to stay healthy and keep exercising.”
The number one suggestion Dr. Crosby shares with patients is to take advantage of activity modifications. Listen to your body, letting it tell you what it can and can’t do. “There are a lot of ways to modify workouts, modify the sports you play, and modify your equipment to keep you active,” he says. “And also keep you out of the orthopedic surgeon’s office.”
That said, Dr. Crosby reminds us to take a mindful approach. Be honest with yourself about what’s hurting, and don’t just try to “push through the pain.” If needed, take a week or two off to allow the issue to calm down. And practice moderation.
“Exercising every day is fine,” he shares. “But if you play four hours of tennis a day, something in your arm is going to break down, whether it’s tendinitis or arthritis of the wrist.”
Recognizing When to Seek Help
For those experiencing upper extremity pain, it can be difficult to know when to treat it at home and when to seek professional help. Dr. Crosby shares tips on how to determine what needs a doctor’s attention.
“The normal aches and pains typically respond well to rest and anti-inflammatories,” he says. However, three key signs suggest you need more than just over-the-counter solutions:
- Pain that keeps you awake at night
- Pain that makes you miserable
- Pain that significantly interferes with your daily activities
If you’re experiencing any of these indications, make an appointment to speak with a physician.
Diagnostic Approaches
Connect NowModern medicine provides excellent tools to help diagnose and treat upper extremity pain and injuries, and these tools each function best in different situation. X-rays, for instance, show the bones and joints, but they don’t show tendons or ligaments. MRIs, on the other hand, deliver clear images of the soft tissues.
“X-rays are a good screening tool,” Dr. Crosby explains. Because they’re quick and available in-office, he uses them as an initial stop to screen for bone injury, joint health, and arthritis. “Then, if it doesn’t respond to those modalities we treat it with, we’ll get an MRI,” he shares.
The exception is with acute injuries. If a patient has likely ruptured a tendon or torn a ligament, he addresses that injury directly.
Common Upper Extremity Conditions
The three conditions Dr. Crosby treats most frequently include carpal tunnel syndrome, tennis elbow, and arthritis. Each presents unique challenges and requires specific approaches to treatment.
Knowing the Most Common Arthritis
“The most common arthritis that brings people into my office is basal thumb joint arthritis, where the thumb meets the wrist,” Dr. Crosby explains. This condition can significantly impact daily activities since we use our thumbs in almost everything we do.
When gripping or squeezing something tightly, the force at the tip of the thumb is multiplied six times at its base. This mechanical reality helps explain why this form of arthritis can be particularly troublesome.
Understanding Tennis Elbow
Despite its name, tennis elbow dosn’t afflict only tennis players. “It’s basically a tendinopathy, which is a wearing out of the tendon(s) or degeneration of the tendons,” Dr. Crosby clarifies.
This condition affects the tendons on the outside of the elbow responsible for extending your wrist. Even simple activities like lifting a coffee cup become challenging when these tendons are compromised.
“Sometimes it’s from overuse, and sometimes it’s just unavoidable — part of the natural aging process,” Dr. Crosby notes. The good news is that most cases respond well to non-surgical management.
Demystifying Carpal Tunnel Syndrome
Many people associate carpal tunnel syndrome with excessive keyboard use, but Dr. Crosby challenges this common assumption. “That’s kind of been disproven to be a big part of the carpal tunnel causation,” he says.
Instead, carpal tunnel syndrome often begins with nighttime symptoms. Patients often wake up with a numb hand and need to shake it out. As the condition progresses, symptoms occur during daytime activities like driving or reading.
The progression of carpal tunnel syndrome is particularly important to monitor. “Unlike arthritis and tendonitis, where surgery is a last resort, carpal tunnel is a progressive problem,” Dr. Crosby warns. “Once you progress beyond a certain threshold, the changes can be irreversible.”
Conservative and Advanced Treatment Options
When it comes to treating these conditions, Dr. Crosby notes that different treatment solutions serve different needs. He also emphasizes the importance of starting with conservative approaches. “About 85% of people with thumb arthritis can get through without any type of surgical management,” he says.
Topical and Oral Medications
Bone and joint pain tend to respond well to treatment with non-steroidal anti-inflammatory drugs (NSAIDs), which are now available in both topical and oral formulations.
Topical NSAIDs like Voltaren gel can be particularly effective for conditions affecting joints close to the skin surface, and they typically have fewer systemic side effects than oral medications. As such, Dr. Crosby often recommends topical treatments for hand arthritis or tennis elbow, though deeper joints — like the shoulder — usually still require oral medications.
Physical Therapy
“The role of physical therapy is huge in helping alleviate pain,” Dr. Crosby shares. But he reminds us that therapy isn’t the right treatment for all ailments.
A new pain you wake up with or from lifting items overhead often benefits greatly from therapy. However, Dr. Crosby cautions that “if there’s actually an acute injury — you feel a pop, you feel a tear, you’re in significant pain — it’s something that should be evaluated before you do therapy.”
Targeted Injections
For many conditions, Dr. Crosby finds success with targeted injections, such as steroid injections. “The idea behind injections is it gives you a powerful dose of anti-inflammatories right in the area where you hurt,” he explains.
Beyond traditional steroid injections, newer options like platelet-rich plasma (PRP) are showing promise. “PRP is almost the opposite of steroids,” Dr. Crosby shares. “Whereas steroids are anti-inflammatory, PRP is pro-inflammatory, generating inflammation to help your body heal itself.”
Minimally Invasive Surgical Advances
When surgery becomes necessary, technological advances have made procedures less invasive and recovery times shorter. For example, Dr. Crosby now performs most carpal tunnel releases endoscopically, using a small two-centimeter incision.
Recent developments in nerve blocks have also transformed post-surgical care. “We now have nerve blocks that make pain not begin until about two or three days after surgery,” Dr. Crosby explains. This advancement has significantly reduced the need for narcotic pain medications.
Looking to the Future
Dr. Crosby remains optimistic about continuing advances in his field. “It’s an exciting time to be in medicine because things are changing rapidly,” he says. New technologies and techniques continue to improve patient outcomes and recovery times.
While we can’t yet regenerate cartilage within joints or completely reverse some conditions, medical science continues to advance. As Dr. Crosby notes, “We may have that technology in 20 years. We may have it in 50 years. That’ll be a game-changer.”
Taking Action for Your Upper Extremity Health
The key takeaway from my conversation with Dr. Crosby is the importance of early intervention and proper diagnosis. Don’t wait until pain severely impacts your daily life or sleep before seeking help.
Remember that maintaining upper extremity health is crucial for your overall well-being and quality of life. If you’re experiencing persistent pain or discomfort, I encourage you to seek a professional evaluation.
If you’re a member at Brentwood MD, don’t hesitate to bring up any persistent pain you’ve been experiencing, even if it seems small. We work closely with specialists like Dr. Crosby to ensure our members receive comprehensive care that addresses both immediate concerns and long-term health goals.
Dr. Wright joined Brentwood MD in 2022 as the model allows him to spend more time connecting with patients and build a foundation of exceptional care. He is a Nashville native and completed his family medicine residency at the University of Tennessee Health Science Center, where he also served as Chief Resident. He believes that your health deserves a prominent position on your priority list, and would be honored to serve you and your family.
