Tests and Procedures for Hand & Upper Extremity Injuries

Hand and upper extremity injuries are the most frequently occurring workplace injuries. From a fractured finger to carpal tunnel syndrome or even an amputated limb, injuries and conditions affecting the hands and upper extremities can severely impact your quality of life. At the Center for Hand & Upper Extremity, our world-class surgeons provide comprehensive surgical and non-surgical treatment options to help our patients regain function in their fingers, hands, wrists, elbows, and shoulders.

A physical exam and imaging tests are the primary approaches to diagnosing a hand or upper extremity injury or condition. Tests may include:

X-rays: X-rays use electromagnetic rays to create a black-and-white image of your hand, arms, or shoulders. An X-ray can help your doctor diagnose fractures, foreign objects, and degenerative conditions such as arthritis. 

MRI: a magnetic resonance imaging (MRI) test uses radio waves, a magnetic field, and a computer to create an image of bones, tendons, blood vessels, and cartilage. MRIs can help diagnose joint disorders, fractures, and sports- and work-related injuries.

Ultrasound: an ultrasound test uses sound waves to produce an image of soft tissues, such as nerves,  joints, tendons, and cartilage. Ultrasound can help diagnose tendon and joint disorders, such as carpal tunnel and De Quervain tenosynovitis, as well as rotator cuff injuries.

Blood tests: blood tests can help diagnose rheumatoid arthritis and osteoarthritis. Blood tests measure the level of certain antibodies that are commonly present in a variety of arthritis and inflammation-related conditions.

Treatment options for hand and upper extremity issues aim to restore function and aesthetics to fingers, wrists, hands, elbows, and shoulders after a traumatic injury or progressive condition. Non-surgical treatment options may be the first line of defense you and your medical team explore. Surgical and micro-surgical procedures and medications may also be needed to fully restore function in your hands and upper limbs.

Non-Surgical Treatment Options

Many hand and upper extremity injuries may be addressed with non-surgical treatment options intended to eliminate swelling and inflammation. This may include:

• Steroid injections
• PRP (platelet-rich plasma) injections
• Splinting
• Physical therapy/ hand therapy
• Medications

If conservative, non-surgical treatment options do not offer complete relief from pain, your surgical team may proceed with a surgical treatment option for your hand or upper extremity injury.

Surgical Treatments for Tendon Injuries and Conditions

Tendons function as robust, cord-like connectors, bridging the muscles of the forearm and hand to the finger and thumb bones. They come in two categories: flexor tendons, responsible for finger flexion, and extensor tendons, which facilitate finger extension. Signs of a potential tendon injury include experiencing challenges or discomfort when manipulating your fingers or thumb to bend or straighten. Painful inflammation of the tendons in the hand, wrist, or forearm can be a sign of a tendon condition, such as tendonitis, tendinopathies, or tenosynovitis. Tendon injuries and conditions can include:

• Flexor tendon injuries
• Extensor tendon injuries
• Tendinopathy such as “trigger finger”
• 1st extensor tenosynovitis, or De Quervain’s syndrome
• Tennis elbow

Surgical treatments for tendon injuries aim to release compressed tendon tunnels. In cases of tennis elbow, a microsurgical denervation procedure may be needed to eliminate pain signals sent to your brain without disturbing the muscles or joints themselves. Tendon surgeries are typically done under local anesthesia. 

Surgical Treatments for Nerve Injuries and Nerve Compression Syndrome

Nerves function much like the body's “electrical system,” transmitting messages between the brain and the rest of the body, including the hands and the upper limbs. Some nerve clusters convey commands from the brain to mobilize muscles, while others send feedback to the brain, reporting sensory data such as discomfort, pain, heat, or cold. These critical nerve structures can sustain damage from traumatic injuries as well as compression or “pinching.” Nerves in the fingers are particularly susceptible to harm when a cut or deep wound occurs. Nerve injuries and compression syndromes include:

• Brachial plexus injuries
• Carpal tunnel syndrome
• Cubital tunnel syndrome
• Radial tunnel syndrome

Surgical treatment options for nerve injuries and nerve compression syndromes can include microscopic, minimally invasive techniques for releasing the pressure on affected nerves. There may be times when your surgical team recommends a more invasive, traditional “open” release of compressed nerves. Your surgeon will help you determine which technique will yield the best results.

Surgical Treatments for Hand, Wrist, and Finger Fractures

A fracture is a term for a broken bone. The bones in your hands, wrists, and fingers are made up of many small bones. Sometimes a fracture in the fingers, wrists, or hands can be treated with a cast, while other times, surgery is required to return the bones to their correct position. Fractures that may require surgical treatment include:

• Distal radius fracture
• Metacarpal fracture

Hand and wrist fractures can manifest in several ways, including:

• Simple: two fragments of bone
• Comminuted: bones that have shattered into many pieces
• Closed: fracture with no break in the skin
• Open: fracture with a break in the skin
• Intra-articular: a complex fracture involving the major joints of the hand or wrist 

Surgical treatments to return fractured bones to their correct positions include new forms of “rigid fixation,” which can offer an earlier range of motion, earlier access to physical therapy, and earlier return-to-work times post-surgery. Regardless of the fixation method used in a hand fracture surgery, your surgeon will likely recommend hand therapy or physical therapy to regain your motion and return to normal activities faster.

Hand Reconstruction

If your hand has suffered a traumatic injury, hand reconstruction surgery may be required to facilitate healing fully. Traumatic hand injuries often require specialized care to heal fractures, repair deep lacerations, reattach severed fingers, or repair injured tendons. Hand reconstruction surgery can treat a number of injuries, such as:

• Fractures
• Repairing or reattaching severed fingers
• Tendon injuries
• Complex reconstruction

Reattaching a severed body part is a remarkably complex procedure. This task requires significant proficiency in specialized areas such as bone restoration, tendon repair, and the highly refined technique of microsurgery to reconnect vessels as tiny as 1.0 mm or less in diameter. If reattachment is not an option, a toe-to-finger transplant may be utilized. In this micro-surgery, a toe may be transplanted to the hand to replace a missing finger.

Joint Denervation Surgery for Arthritis

Arthritis is a complex process that affects bones, joints, and surrounding soft tissues such as cartilage, ligaments, and nerves. It occurs when inflammation causes pain and stiffness in joints or, in the case of rheumatoid arthritis, when the immune system attacks the joints.

Moderate arthritis can be treated with Joint Denervation surgery, a procedure that halts the messages of pain sent from joints to the brain. This minimally invasive microsurgery removes nerve branches from the affected joints. More severe cases of arthritis may call for a classic joint replacement or joint fusion surgical procedure. 

Amputations and TMR

Following an amputation of a hand or arm, patients may experience phantom pain. Targeted Muscle Reinnervation (TMR) surgery can be beneficial to amputee patients who grapple with the phenomenon of phantom limb pain and neuromas.  When nerves are severed or injured, they will attempt to regenerate. When these nerve endings do not have a clear target, such as a muscle, to regenerate toward, the result can be a disorganized mass of nerve tissue that can cause pain and phantom pain.

During a TMR surgery, residual nerves from the amputated limb are redirected into new muscles, helping to prevent the development of painful neuromas. TMR surgery can be performed concurrently with an amputation or as a post-amputation procedure to reduce enduring phantom pain and help create a more comfortable experience with prosthetic limbs.