Hand, Wrist, Arm & Shoulder

Injury & Accident

Hand, wrist, elbow, arm and shoulder injuries occur every day. Causes of these injuries include repetitive job duties (carpel tunnel syndrome), slip/trip and fall accidents, boat and automobile collisions, falling objects and work-related accidents. These injuries can result in fractures, ligament damage, carpal tunnel syndrome, dislocated joints, nerve damage and muscle problems. The attorneys at the law firm of Brais, Brais & Rusak with offices in Miami, Florida, Boston, Massachusetts and Houston, Texas realize a lawyer’s job is to help clients on their road to recovery.

Fractures:

Fractures can be caused by direct blows, twisting injuries or falls. Fractures are often easy to diagnose because there can be an obvious deformity. At times, however, fractures cannot be easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed. The type of force applied on a bone very often determines the type of resulting injury. Descriptions of fractures can be confusing, but are based upon:

  • Where the break occurs,
  • How the bone fragments are aligned, and
  • Whether any complications exist.

The first step in describing a fracture is whether it is open or closed. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn or abraded (scraped), but if the skin's integrity is damaged, the potential for an infection to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively.

Carpal Tunnel Syndrome (CTS):

CTS is a type of compression neuropathy (nerve damage) caused by compression and irritation of the median nerve in the wrist. The nerve is compressed within the carpal tunnel, a bony canal in the palm side of the wrist that provides passage for the median nerve to the hand. The irritation of the median nerve is specifically due to pressure from the transverse carpal ligament. This can be due to trauma from repetitive work such as that of waiters, luggage handlers, bellmen, receptionists, typists, word processors and, as well, others.

The symptoms of CTS include numbness and tingling of the hand, wrist pain, a "pins and needles" feeling at night, weakness in the grip and a feeling of lack of coordination.

The diagnosis is suspected based on symptoms, supported by signs on physical examination, and confirmed by nerve conduction testing.

Treatment for CTS depends on the severity of symptoms and the underlying cause. Early CTS is usually treated by modification of activities, a removable wrist brace and anti-inflammatory medicines. Caught early, CTS is reversible. If numbness and pain continue in the wrist and hand, a cortisone injection into the carpal tunnel can help. Surgery is only indicated if other treatments have failed. In advanced CTS, particularly with profound weakness and muscle atrophy (wasting), surgery is done to avoid permanent nerve damage. The surgical procedure is called a carpal tunnel release. It relieves the pressure exerted on the median nerve within the carpal tunnel. This surgical procedure is performed via a small incision using conventional surgery or a fiberoptic scope (endoscopic carpal tunnel repair).

Dislocated Shoulders:

The shoulder joint is the most mobile joint in the body and allows the arm to move in many directions. This ability to move makes the joint inherently unstable and also makes the shoulder the most often dislocated joint in the body.

The head of the humerus (upper arm bone) sits in the glenoid fossa, an extension of the scapula, or shoulder blade. Because the glenoid fossa (fossa = shallow depression) is so shallow, other structures within and surrounding the shoulder joint are needed to maintain its stability. Within the joint, the labrum (a fibrous ring of cartilage) extends from the glenoid fossa and provides a deeper receptacle for the humeral head. The capsule tissue that surrounds the joint also helps maintain stability. The rotator cuff muscles that move the shoulder also provide a significant amount of protection for the shoulder joint.

Dislocations of the shoulder occur when the head of the humerus is dislocated from its socket. These are described by the location of the humeral head after it has been dislocated. Ninety percent or more of shoulder dislocations are anterior dislocations, meaning that the humeral head has been moved to a position in front of the joint. Posterior dislocations are those in which the humeral head has moved backward toward the shoulder blade. Other rare types of dislocations include luxatio erecta, an inferior dislocation below the joint, and intrathoracic, in which the humeral head gets stuck between the ribs.

Dislocations in younger people tend to arise from trauma and are often associated with strenuous work, sports and falls. Older patients are prone to dislocations because of gradually weakening of the ligaments and cartilage that supports the shoulder.

Anterior dislocations often occur when the shoulder is in a vulnerable position. A common example is when the arm is held over the head with the elbow bent, and a force is applied that pushes the elbow backward and levers the humeral head out of the glenoid fossa. This scenario can occur with throwing a ball or hitting a volleyball. Anterior dislocations also occur during falls on an outstretched hand. An anterior dislocation involves external rotation of the shoulder; that is, the shoulder rotates away from the body.

Posterior dislocations are uncommon and are often associated with specific injuries like lightning strikes, electrical injuries and seizures. On occasion, this type of dislocation can occur with minimal injury in the elderly, and often the diagnosis is missed in this case.

Nerve Damage:

Nerve damage causes neuropathic pain which is a chronic complex pain state that usually is accompanied by tissue injury. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. These damaged nerve fibers send incorrect signals to other pain centers. The impact of nerve fiber injury includes a change in nerve function both at the site of injury and areas around the injury.

Symptoms of neuropathic pain include shooting and burning sensations as well as tingling and numbness of the body’s extremities. One example of neuropathic pain is called phantom limb syndrome. This occurs when an arm or a leg has been removed because of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb. These nerves now misfire and cause pain.

Neuropathic pain often seems to have no obvious cause; but, some common causes of neuropathic pain include:

  • Fractures
  • Joint Dislocation
  • Amputation
  • Spinal Surgery

Muscle Damage:

Muscle damage generally causes the muscle to spasm or cramp. Muscle spasms or cramps are an involuntary contraction of a muscle. These occur suddenly, usually resolve quickly, and are often painful.

Spasms can occur when a muscle is overused and tired, particularly if it is overstretched or if it has been held in the same position for a prolonged period of time. In effect, the muscle cell runs out of energy and fluid and becomes hyper excitable and develops a forceful contraction. This spasm may involve part of a muscle, the whole muscle, or even adjacent muscles. Overuse as a cause of skeletal muscle spasm is often seen in workers who are doing strenuous activities in a hot environment. Usually, these spasms will occur in the large muscles that are being asked to do the work.

It is also commonly thought that dehydration and depletion of electrolytes will lead to muscle spasm and cramping. Muscle requires enough water, glucose, sodium, potassium, calcium, and magnesium to allow the proteins within muscle cells to interact and develop an organized contraction. Abnormal levels of these elements can cause the muscle to become irritable and spasm.

Atherosclerosis, or narrowing of the arteries, may also lead to muscle spasm and cramps because adequate blood supply and nutrients are not able to be delivered to the appropriate muscle. Leg spasms are often seen related to exercise but cramps may also be seen at night involving calf and toe muscles.

If you suffered an injury to your hand, wrist, arm or shoulder and would like to discuss your legal rights, do not hesitate to contact us. The attorneys at the law firm of Brais, Brais & Rusak have the experience to protect your rights, the compassion to serve your needs, and the skill to obtain the compensation you deserve. To reach our lawyers you may click email the firm, call 1-800-499-0551 from within the U.S., Skype BraisLaw worldwide or click Contact Us to select and complete a form for a free evaluation of your case.


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