Procedures & Conditions

The Hand Center can help.

Conditions

Amputation is the removal of an injured or diseased body part. A surgical amputation may also be recommended to revise a badly injured body part that is still attached but not functional or not healing adequately, or to prevent the spread of the disease in an infected finger or hand. (See also “Amputations” under “Procedures.”)

Arthritis is joint inflammation. The area where two bones join together is called a joint. The ends of bones are lined with smooth cartilage. In normal joints, the two bones form a matched set and the joint moves smoothly by the cartilage surfaces gliding over one another. Arthritis occurs when the smooth cartilage wears unevenly and the joint surfaces no longer fit well against each other. There are many conditions that can cause one or more arthritic joints. The most common causes are osteoarthritis and rheumatoid arthritis, but diseases such as gout and psoriasis can also cause arthritis. The main symptoms of arthritis are pain, stiffness and swelling. Sometimes the symptoms can be treated effectively with non-operative measures (such as rest, activity modification, splints/orthoses, anti-inflammatory medications and therapy). If non-operative measures fail, surgery may be recommended.


Osteoarthritis vs. Rheumatoid Arthritis

Osteoarthritis results from wear and tear on cartilage surfaces. This is your typical arthritis of older age, usually occurring in middle age and beyond. The normal process of daily wear on joints can lead to osteoarthritis, but the problem can be accelerated by traumatic injury to the joint cartilage surface (post-traumatic arthritis.) Rheumatoid arthritis, on the other hand, is an autoimmune disease. In this type of arthritis, your body attacks the cells in the tissue that lines the joint (synovium). The joints become red, swollen and painful. They may deform due to stretching of the surrounding soft tissues and destruction of the bone and cartilage. Osteoarthritis and rheumatoid arthritis typically have different presentations in the hand and wrist, as well as different treatments. Medical and conservative therapeutic management is initially recommended. Surgery may be suggested to treat specific problem areas causing significant pain and functional loss or to prevent further damage.


Small Joints Of The Hand

In rheumatoid arthritis, treatment with medications has been instrumental in decreasing the need for surgical intervention. Typically, the “big knuckles” (metacarpophalangeal joints) and the middle joints (proximal interphalangeal joints) may be involved. In osteoarthritis, it is the two joints closest to the ends of the fingers that are most commonly involved (the proximal and distal interphalangeal joints). Conservative management includes activity modification and splints/orthoses to improve function and minimize pain. Surgical options, if needed, include selective joint replacement and joint arthrodesis (fusion).


Thumb Carpometacarpal Joint Arthritis

Thumb carpometacarpal (CMC) arthritis is a painful, chronic condition that can affect your everyday life and prevent you from performing simple tasks. The CMC joint is the joint that connects the base of your thumb to your wrist. This joint plays an important role in many functions of the hand. Thumb CMC arthritis can cause pain, swelling, stiffness and tenderness.

Since arthritis is a chronic condition, treatment focuses on reducing pain and other symptoms to keep the disease from interfering with everyday life. A combination of treatments is often most effective and may include splints/orthoses, medication or injection. Surgery may be required for patients who do not respond to conservative treatment.


Wrist

The wrist is a complex joint made up of 8 wrist (carpal) bones that attach to the forearm bones (radius and ulna) and hand (metacarpal bones). Depending on the type and severity of the arthritis, damage to the wrist may be localized to one area, or may be more widespread, affecting multiple joints. If severe, it may eventually lead to a collapse of the wrist from its normal position, causing significant pain and loss of function. Conservative management may include splints/orthoses, activity modification and medication. Surgery may be required for patients who do not respond to conservative treatment. (See Wrist Surgery/Reconstruction.)

Burns occur when skin contacts extreme heat, cold or certain chemicals. Burn severity ranges from first degree (redness, no blistering) to fourth degree (involvement of deep structures, such as tendons or bones). Minor burns in the hand are common and can often be treated with observation or topical creams and dressing changes. More severe burns may require surgery to remove damaged skin and replace it with skin grafts. Your doctor will evaluate your burn to determine the most appropriate course of treatment.
Carpal Tunnel Syndrome is a condition cause by increased pressure on the median nerve at the wrist. The nerve runs through a tunnel in the wrist along with 9 tendons that attach muscles in the forearm to the bones in your hand. These tendons help bend your fingers. Swelling that occurs in the tunnel around the nerve can compress the nerve, causing numbness, tingling and pain in the wrist, hand and fingers (typically your thumb, index, middle and part of your ring finger), and weakness in the muscles of the thumb that help you pinch. Fractures and arthritis can also narrow the tunnel and pinch the nerve, as can fluid retention from pregnancy, diabetes and thyroid conditions. Certain activities such as driving, reading and sleeping can bring on symptoms. Diagnosis can often be made by physical exam alone, although sometimes your physician may send you for additional testing to determine whether there are any measurable changes in the speed of nerve conduction or damage to the muscles of the thumb. Non-operative treatment options for carpal tunnel syndrome include splints/orthoses, exercise, activity modification and steroid injections. If non-operative measures fail, or symptoms are severe, surgery may be necessary. The carpal tunnel is opened by a surgical release, which can be done open or endoscopically. Each type offers different advantages, and should be considered after a thorough evaluation of the patient's individual condition.
CRPS or Reflex Sympathetic Dystrophy (RSD) occurs when there is an abnormal response to an injury, causing continued pain out of proportion to the injury, with unusual swelling, changes in blood flow and sweat patterns, and trophic changes (changes in the tissues due to lack of normal nutrition). These trophic changes include nail, skin and hair changes, loss of muscle bulk and bone loss. If not adequately treated in a timely fashion, permanent functional loss can occur. The “Stress Loading” program was developed at The Hand Center to treat this condition. The fundamental principle of this program is active exercise that requires progressive use of the affected extremity with minimal motion of painful joints. Load, not motion, is critical. Your hand therapist will measure your progress and modify the program accordingly. (See our Research page for additional information.)
Congenital differences of the hand are physical deformities present at birth that can significantly affect a child's hand function and appearance. These conditions may occur as a result of abnormal development or genetic factors, and can involve fingers that are fused together (syndactyly), an underdeveloped hand (club hand), extra fingers (polydactyly) and other abnormalities. Treatment for congenital deformities varies depending on the type and severity of the deformity, but may include tendon transfers, skin grafts, limb manipulation, external appliances or prosthetic devices to restore function and improve the appearance of the hand.
Cubital Tunnel Syndrome is caused by increased pressure on the ulnar nerve at the elbow. Significant nerve irritation and compression will cause symptoms, which may include pain at the inside of the elbow, numbness, and tingling of the small and ring fingers. Prolonged symptoms can cause hand weakness and functional loss. Treatment for cubital tunnel syndrome may include anti-inflammatory medication, splints/orthoses, activity modification and exercise to relieve symptoms or prevent them from occurring. For symptoms that do not respond to conservative methods, surgery may be needed to relieve pressure on the ulnar nerve. This can be done through ulnar nerve release or transposition (moving the nerve out of its groove into the front part of the elbow to decrease the strain on the nerve).
DeQuervain's disease is an inflammation of the tendons at the base of the thumb that help move the thumb away from the hand. The lining or sheath around the tendons can swell, causing pain with certain thumb and wrist movements. Pain is localized at the thumb side of the wrist, especially with grasping or twisting. This condition may be caused by overuse, trauma or disease, and is more common in women than in men, especially new mothers (positioning and holding infants). DeQuervain's disease can be diagnosed through physical exam. Treatment for this condition focuses on relieving pain and minimizing swelling. Treatment may include anti-inflammatory medication, corticosteroids, splints/orthoses and rest. Surgery to make more room for irritated tendons may be recommended for severe cases that fail conservative management.
Dupuytren's disease is a hereditary condition causing abnormal thickening of the tissue layer just under the skin of the palm, known as fascia. Nodules (lumps) may occur. Over a period of time, a contracture may develop, which means the fingers are pulled into a bent position and may be unable to straighten. Dupuytren's contracture is not usually painful. Although the exact cause of this condition is not known, it tends to run in families of Northern European decent and most commonly affects men older than 40. Mild cases of Dupuytren's contracture that do not affect hand function may not require any treatment beyond simple observation. More severe cases may benefit from treatment, including surgery to remove the abnormal tissue or a newer injectable medication (Xiaflex) that can break down the abnormal tissue and allow the finger to be manipulated into a straighter position. (See Dupuytren’s Treatment.)
The extensor tendons are found on the back of the hand and wrist, and work to straighten (or extend) the fingers, thumb and wrist. Common extensor tendon injuries include a Boutonniere injury (middle joint of the finger cannot straighten) and Mallet finger (drooping of the tip of the finger). Other injuries may involve the tendons on the back of the hand, wrist or forearm. Depending on the type of injury, treatment may include splints/orthoses alone or in conjunction with a surgical procedure to repair the tendon. (See Tendon Repair.)
Fingertip injuries are very common and can include damage to skin, bone, nail, nail bed and tendon. We use our hands for a variety of tasks, and our fingertips are exposed during many activities. Fingertips can get crushed (in a door or with a hammer) or cut (knife, saw or snow blower injuries). Fingertip injuries can often be treated with dressing changes and splints/orthoses for comfort. Sometimes the nail has to be removed to examine and repair the nail bed tissue underneath the nail. Larger wounds with bone exposure may need skin grafts or flaps to cover the wound. Your doctor will carefully examine your fingertip injury to determine the most appropriate treatment.
The flexor tendons are found on the palm side of the hand and wrist, and work to bend (or flex) the fingers, thumb and wrist. Flexor tendons may be injured from a deep cut or secondary to other trauma or disease. If completely severed, you will be unable to bend the affected part. A cut flexor tendon usually requires surgery. There may also be other structures injured at the same time, including nerves and blood vessels, which need to be repaired. (See Tendon Repair.)
A fracture (or broken bone) of the hand can occur as a result of a direct blow or a fall onto an outstretched hand. Finger, hand and wrist fractures are very common. In the wrist region, the radius is frequently injured due to a fall (also commonly known as a Colles fracture). Patients with a hand or wrist fracture may experience pain, swelling, tenderness or physical deformity, depending on which bone is broken. Treatment for a fracture often involves open or closed reduction, which restores the bone back into its normal position. Fractures may be held in place with pins, screws, rods or plates, and may be removed or left in place once healing is complete. (See Fracture Care.)
A ganglion is a benign fluid-filled mass that typically forms in the soft tissues of the wrist or hand near joints or tendons. It feels like a firm lump and can be painful, especially when pressure is applied. Common locations include the back of the wrist (dorsal wrist ganglion), palm side of the wrist (volar wrist ganglion), base of the finger on the palm side (ganglion/retinacular cyst) or at the top of the end knuckle of the finger (mucoid cyst). Treatment can often be non-surgical, including observation. If cysts are symptomatic, aspiration can be attempted in the office. If non-operative treatment fails, surgical options exist. Ganglion surgery involves complete removal of the cyst and any attached tissue.
Hand infections can occur from minor trauma. They can range in severity from a small superficial cellulitis (skin infection) or abscess to a deep space infection in the hand that is a surgical emergency. Symptoms of infection include redness, swelling, pain, warmth and possibly fever, chills or drainage of pus from a wound. Many minor infections can be managed in the office and with antibiotics. More severe infections, however, may require urgent surgical attention.
Animal bites, snow blowers, lawn mowers, power saws… you name it, the doctors and therapists at the Hand Center have seen it and treated it. Treatment focuses on the repair of the injuries and restoration of function to meet the unique needs of each situation and each patient.
Any abnormal lump or bump (or mass) can be called a tumor, but this does not mean it is cancer. The vast majority of lumps and bumps in the hand are benign (non-cancerous). Tumors can occur in the skin, soft tissues under the skin or in the bone. The most common cause of tumors in the hand are ganglion cysts (See Ganglion Cyst). Treatment of hand masses can range from observation to surgical excision.
Lateral epicondylitis is a painful condition affecting the area where the extensor tendons attach to the bone on the outside of the elbow. Degeneration or tearing of the tendon origin occurs, causing localized pain that increases with activities, including lifting and gripping. This condition may be caused by overuse or trauma. Conservative treatment is often beneficial, including activity modification, splints/orthotics, exercise and injection. Surgery may be appropriate in cases that do not respond to conservative measures.
Medial epicondylitis is a painful condition affecting the area where the flexor tendons attach to the bone on the inside of the elbow. Degeneration or tearing of the tendon origin occurs, causing localized pain that increases with activities, including pinching and gripping. This condition may be caused by overuse or trauma. Conservative treatment is often beneficial, including activity modification, splints/orthoses, exercise and injection. Surgery may be appropriate in select cases that do not respond to conservative measures.
Nerves carry messages to and from the brain to allow you to move and feel. Nerve injuries range from compression of the nerve (such as carpal tunnel syndrome) to a complete laceration or cut of the nerve and its surrounding sheath. Damage to a nerve can affect your ability to use your muscles and your ability to feel (sensation). Nerves that are compressed or stretched may respond to conservative treatment. If a nerve is completely cut, surgery will be necessary to restore function. (See Nerve Repair.)
The Hand Center treats all sports-related injuries affecting the hand, wrist and elbow. Treated injuries include everything from minor injuries (such as lateral epicondylitis, muscle strain or joint sprain) to more major traumatic injuries (such as fractures or dislocations). Our services include diagnosis, conservative and surgical management, and assessment of your ability to return to your sport activity in an appropriate period of time.
A sprain is an injury to a ligament. Ligaments connect bone to bone, and help stabilize a joint. Injuries commonly occur due to a fall on an outstretched hand, or during sports activities, such as skiing. Symptoms typically include pain, swelling and stiffness. A thorough medical evaluation is necessary to assess the severity of the injury and joint instability. Treatment is often conservative if there is a partial injury using a cast or splint/orthosis. If there is a complete tear, surgery may be necessary.
Trigger finger is caused by inflammation and restriction of the tendons that bend the finger as they pass under the A1 pulley in the palm. This condition may be caused by overuse, trauma or disease. Symptoms include pain, swelling, tenderness at the base of the finger, and “catching” or “locking” when trying to move the finger. While some cases of trigger finger can be treated with steroid injections that relieve swelling and inflammation or splints/orthoses that provide relative rest, others may require surgery. Trigger finger release is a common surgical procedure that releases the tightened portion of the flexor tendon sheath.
The Hand Center is a “full-service” provider of services for patients with work-related injuries. We treat everything from traumatic injuries (such as fractures, tendon, nerve and crush injuries), to those injuries that may occur over a period of time (such as carpal tunnel syndrome or trigger finger). Our highly respected team of qualified professionals includes physicians, physician assistants and certified hand therapists. Our services include diagnosis, conservative and surgical management, and assessment of your ability to return to work in an appropriate period of time.

Procedures

An amputation may be recommended to revise a badly injured body part that is still attached, but not functional or not healing well. It may also be a planned operation to prevent the spread of the disease in an infected finger or hand. In many cases, it is possible to close the amputation site, but sometimes skin must be rearranged (flap) or transferred from another body part (graft) in order to close your wound.
Arthrodesis (joint fusion) is a procedure for the treatment of a painful joint condition of the hand, wrist or elbow caused by arthritis or injury. This procedure may be needed to decrease pain and improve function when conservative measures have failed, and when there are no other reconstructive surgical options available. Your doctor will determine which procedure is best for you based on a thorough evaluation of your condition.
Arthroplasty (joint modification or joint replacement) is a procedure for the treatment of painful joint conditions of the hand, wrist or elbow caused by arthritis or injury. This procedure may be needed to decrease pain and improve function when non-operative measures have failed. Your doctor will determine which procedure is best for you based on a thorough evaluation of your condition.
Arthroscopy is a minimally invasive procedure that allows doctors to diagnose and treat joint injuries and disease through small incisions in the skin. During an arthroscopic procedure, a small camera is inserted into the problem area, allowing your doctor to examine the joint in great detail. It is then possible to treat the problem using this approach or with a combination of arthroscopic and “open” surgery. Potentially treatable injuries include torn cartilage or ligaments, inflamed joint lining (synovitis), carpal tunnel syndrome, rotator cuff tears, and loose bone or cartilage.
Joint aspiration, also known as arthrocentesis, is a minor procedure that involves draining fluid from a joint with a sterile needle and syringe. This may be performed for either diagnostic or treatment purposes in patients with swelling, inflammation and pain within the hand and wrist. Aspiration of joints can usually be performed under local anesthesia and involves inserting a needle with a syringe attached to it into the affected area. Fluid within the joint is withdrawn (aspirated) into the syringe and then sent to a laboratory for complete testing.
Dupuytren’s disease affects the fascia in the palm, causing finger contractures. It can be treated surgically with removal of the diseased tissue. A joint release may also be necessary (See Joint Release.) The use of Xiaflex for treatment of Dupuytren’s contracture is a relatively new procedure, and can be extremely effective when properly administered, without the trauma associated with surgery when used in appropriately selected patients.

From the youngest to the oldest of patients, upper extremity fractures are a common part of our everyday practice at the Hand Center. A fracture is a broken bone. Fractures can be very simple or very complex in appearance as well as treatment. Each fracture is individually evaluated and treated by the doctor, taking into consideration the specific needs of each patient.


Splints/Orthoses and Casts

Many fractures in the fingers, hands, wrists and elbows can be treated without surgery. Most require some amount of immobilization to allow the fracture to heal. Depending on specific patient and fracture characteristics, this can be achieved with custom orthoses (splints) made on site by our therapy staff or by casts that are applied by our physicians/physician assistants.


Closed Surgery

When a fracture results in bone ends that are not appropriately aligned, you may need more than a cast or splint. You may require a procedure, either in the office under local anesthesia (numbing medicine) or in the operating room under general anesthesia, to reset your broken bones. Often, this type of procedure has been done in an Emergency Room prior to your arrival at The Hand Center. When done in the operating room, metal pins may be added to hold unstable fractures in place.


Open Surgery

If a fracture has substantially shifted out of position or is unstable in a cast or splint, it may not be possible to treat it appropriately without an open surgery. This type of surgery is called an open reduction internal fixation (ORIF). It allows your surgeon to piece together your broken bone through one or more skin incisions, and fix the pieces together with metal implants such as pins, wires, plates or screws. Your doctor will discuss the specifics of surgery with you at your pre-operative visit.

A joint release is a surgical procedure involving removal of soft tissue that prevents full motion. This may be needed after an injury that damages a joint, or a crush or other traumatic injury that causes significant swelling (edema) in the hand. Surgery is indicated only if conservative treatment methods have been unsuccessful in regaining functional mobility.
There are many conditions that can cause lumps or bumps (masses) to develop in the upper extremities. Most of these conditions are benign (non-cancerous), but the mass may be causing pain or dysfunction in the arm. To treat the mass, your doctor may recommend having it removed (excised). Excision of a mass can not only treat your symptoms, but also make a definitive diagnosis by sending the removed tissue to the laboratory and allowing specialized Pathology doctors to analyze it microscopically. (See Hand Tumors.)
When a nerve becomes entrapped within tight spaces or scarred tissue, it can cause symptoms of pain, numbness, tingling and weakness (see Carpal Tunnel Syndrome and Cubital Tunnel Syndrome). Your surgeon may recommend surgical release of the nerve if non-operative measures fail. This type of surgery involves releasing any tight structures that are putting pressure on the nerve, to allow the nerve to have more room and better blood supply. The nerve may also have to be moved out of a bed of scar tissue into a more protected location (transposition). The goals of a nerve release are to improve the health of the nerve, decrease your symptoms and increase your ability to function.
Nerves carry messages to and from the brain to give you sensation (feeling) and the ability to move. If a nerve is completely cut, surgery will be necessary to restore sensation and motor function. Depending on the nature of the injury, your surgeon may recommend a direct repair or graft. A nerve conduit or tube may also be used to help guide the recovering nerve. It is important after surgery to protect the repair and to follow your doctor and therapist’s instructions.
In cases of finger or hand amputation, your surgeon may be able to reattach (replant) your injured part. In many circumstances, this is not possible for a variety of patient and injury related reasons. If performed, replantation surgery is a highly specialized skill that requires microscopic instrumentation and a dedicated team approach, both within the hospital and upon your discharge (usually several days after injury). The Hand Center staff is dedicated to the care of these complex injuries and we put forth a team effort to help your hand to function as well as possible after injury. When replantation is not possible, there are a variety of prosthetic options that may improve the appearance and/or function of your hand.
Surgery may be performed on the hand to enhance its appearance in patients after the treatment of skin cancer or a hand injury that has left the hand in a less-than-ideal aesthetic and/or functional condition. A personalized surgical plan will be determined for each patient to most effectively treat the individual condition. Our doctors utilize the most advanced surgical techniques to restore function and appearance to the affected hand, which may involve the use of tissue and skin grafts.
A steroid injection is a procedure that can be done in the office to treat the pain and swelling associated with many common upper extremity conditions, including arthritis and tendinitis. Your doctor will determine if you are an appropriate candidate for receiving a steroid injection. If so, the injection given is a combination of a short acting local anesthetic (numbing medicine) and a longer acting anti-inflammatory medication (corticosteroid). Cortisone injections may provide long term or temporary relief depending on the condition being treated.
In rheumatoid arthritis or other conditions causing inflammation, your body may attack the cells in the tissue that lines the joint (synovium). Surgical removal of inflamed tissue can help prevent further damage to the joints or surrounding tissues.
Certain common tendinitis conditions that occur in the hand and wrist are caused by entrapment of the tendon under tight structures. These structures, known as pulleys, normally function to hold the tendon in the correct place and allow it to glide smoothly. For a variety of reasons, these pulleys may tighten and cause the tendon to become restricted, resulting in the pain, swelling, and decreased motion seen with tendinitis (See DeQuervain’s and Trigger Finger). Often, tendinitis will respond to non-operative management such as rest, splints/orthoses, activity modification, anti-inflammatory medications, and specific exercises targeting the involved structures. When non-operative management fails to control your symptoms, your doctor may recommend surgery to release the tight pulley and allow the underlying tendon to glide more smoothly and without pain.
Tendons attach muscles to bones and enable us to be able to bend and move our joints. Many tendons in the hand and arm are located just beneath the skin and can be easily cut or injured with even minor trauma. Injuries to tendons affect your ability to fully move your joints properly. Some tendon injuries can be treated with immobilization, while most require surgical repair. During surgery to repair a cut tendon, your doctor will stitch the tendon ends back together. It is important after surgery to protect the repair and to closely follow your doctor and therapist’s instructions to gradually mobilize the repaired tendon.
Some conditions require working tendons to be transferred to non-working tendons (e.g. nerve injury, tendon rupture, stroke and cerebral palsy.) This type of procedure is called a tendon transfer. There are certain tendons in the arm that can be safely rearranged without sacrificing function, with the goal to restore or improve an absence of function. After tendon transfer surgery, you will need to protect the transferred tendon and will be seen in therapy to help maximize the function of the newly transferred tendon.
A tenolysis is the surgical release of a tendon from surrounding adhesions (scar) that prevent full active motion. This may be needed after an injury that damages a tendon, or a crush or other trauma that causes significant swelling (edema) in the hand. Surgery is indicated only if conservative treatment methods have been unsuccessful in regaining functional mobility.
The Hand Center is known worldwide for its pioneering work related to wrist reconstruction. Numerous publications and presentations over a period of more than thirty years have provided a major contribution to our understanding of common patterns of injury and degeneration of the wrist and innovative treatment approaches. Our goal is to preserve as much function and mobility as possible, with elimination of pain. Conditions that may require wrist surgery/reconstruction include rheumatoid arthritis, osteoarthritis and traumatic injury. There are a number of surgical options depending on the severity of the involvement and the functional needs of the patient. Options range from a simple synovectomy (removal of inflamed joint tissue) or localized excision of the involved portion of the joint, to a procedure that reconstructs the wrist, such as a limited wrist arthrodesis (partial fusion).