The Center for Hand and Upper Extremity Surgery

Hand Surgery

Hand surgery is a sub-specialty of reconstructive surgery which addresses several injuries and conditions that might impact the function, flexibility and strength of the upper extremities (the hand to the shoulder).

Wrist and Hand Fractures

  • The medical term for a broken wrist is known as a wrist fracture. The wrist is made up of eight small bones that connect with the forearm bones called the radius and ulna. A wrist fracture can involve any of these bones. Some fractures can be treated with a cast while others require surgery to return the bones to their correct position. The most common fracture of the wrist is a fracture of the radius, often termed a “distal radius fracture.” To learn more about distal radius fractures, please click here.
  • A hand fracture is the medical term for a broken hand. The hand is made up of 19 small bones between the tips of the fingers and the end of the wrist; a fracture can involve any of these small bones. Some fractures can be treated with a cast, while others will need surgery to return the bones to their correct position.

Tendon Injuries

  • Tendons are strong, rope-like structures that connect muscles in the forearm and hand to the bones of the fingers and thumb. There are two different types of tendons, known as the flexor tendons (which bend the fingers) or the extensor tendons (which straighten the fingers). Usually a tendon injury starts with some type of trauma – either a cut to the surface of the hand or an aggressive pulling or jamming injury to the finger. If you have difficulty bending or flexing your fingers or thumb, trouble straightening your fingers or thumb, or if you have pain when trying to straighten or bend your finger, you may have a tendon injury. To learn more about extensor tendon injuries, click here. To learn more about flexor tendon injuries, click here.

Nerve Injuries

  • Nerves, known as the “electrical wiring” of the body, are responsible for sending signals from the brain to various parts of the body, including the hand and upper extremities. Some nerves carry signals from the brain to make muscles move, while other nerves carry signals back to the brain and relay information such as pain and temperature. Nerves can be damaged from a variety of traumatic injuries including a cut or a stretch. Nerve injuries might present themselves with a difficulty in moving a muscle in the arm or hand or with an altered or absent sensation in a specific part of the hand or fingers. Nerves in the fingers may be easily injured when you suffer a laceration or cut to the finger. There are a multitude of factors that determine how to best treat a nerve injury. To learn more about nerve surgery, click here.
  • The brachial plexus is the “command center” for upper extremity nerves – all functional nerves of the upper extremity originate from the brachial plexus. The brachial plexus can be injured in a multitude of traumatic situations, and the management of these injuries is very complex. To learn more about brachial plexus injuries, click here.

Finger Reattachment (“Replantation”) and Hand Reconstruction

  • Replantation is the reattachment of a finger, hand or arm that has been severed or detached from the body. Since it is a physically and emotionally traumatic injury, it requires surgical expertise to treat. Ultimately, the purpose of replantation is to regain functional usage of the reattached body part. In some cases, the detached part is unsalvageable, making it impossible to reattach. If the lost part cannot or should not be reattached, our surgeons could offer to clean, smooth and cover the cut end. In some cases, this option will give you a better and faster recovery than reattaching the body part.
  • A toe-to-hand transplant is a unique surgical intervention that restores function to the finger by removing the toe and transplanting it to the hand, taking with it the blood vessels, bones, tendons and nerves. To learn more about replantation and hand reconstruction, click here.

Nerve Compression Syndromes of the Upper Extremities

Nerves of the upper extremities can be subject to excessive pressure, known as “compression” or “pinching” of the nerve. This may cause numbness and pain in certain areas of the hand, wrist and fingers. The compression of different nerves may lead to a nerve compression syndrome, such as: carpal tunnel syndrome, posterior interosseous syndrome, cubital tunnel syndrome and radial tunnel syndrome. To learn more about nerve compression syndromes, click here.

Tendonitis or tendon conditions

  • Tendonitis, tendinopathies, or tenosynovitis are all terms that describe painful inflammation of tendons occurring in multiple different areas of the hand, wrist, and forearm. Tendons can become inflamed, causing significant amounts of pain upon movement of various parts of the upper extremity. Common areas for tendonitis include: the thumb tendons at the wrist level, the tendons as they insert near the elbow, the tendons as they glide through a sheath at the base of the fingers, etc.
  • There are many types of tendonitis or tendinopathies, including trigger finger (the most common tendinopathy), 1st extensor tenosynovitis, De Quervain’s syndrome, “tennis elbow” or lateral epicondylitis. To learn more about De Quervain’s Tenosynovitis, click here.

Arthritis

  • Arthritis is the medical term for “wear and tear” on the joints within your body and leads to a loss of the cartilage that normally lines the bones of the joints. Arthritis pain is a result of the bones rubbing on each other. Arthritis can affect any of the bones of your hand and wrist, and the pain it causes may prevent you from doing the activities that you enjoy. The most commons locations for arthritis are at the base of the thumb and in the joints of the fingers. There are many types of arthritis including osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, 1st CMC arthritis, arthritis of the fingers and rheumatoid arthritis.

Dupuytren’s Disease

  • Dupuytren’s disease (or contracture) is an abnormal thickening of the tough layer beneath the skin known as the “palmar fascia.” The thickening generally starts or occurs in the palm and can extend into the digits. Firm bumps, firm pits and cords may also develop. The firm bumps, referred to as nodules, can sometimes be uncomfortable. The main reason the disease may bother you is that the nodules can extend to form cords that pull the finger towards the palm and prevent it from fully straightening. The common condition generally arises in mid- to late-life, generally seen in men more than women. Without proper treatment, one or more fingers may become stuck in a bent position. Contracture of fingers is usually slow, generally taking months and years rather than weeks. Treatment may include an injection or potentially surgical intervention.

Lumps and Bumps

  • The hand and upper extremity are vulnerable for potential lumps and bumps, which may arise in different areas of the hand and wrist. There is a wide range of conditions associated with these growths, such as cysts, masses, tumors, and possibly cancers. There are many possibilities for treatment depending on your specific condition. If you have a growth or mass on your hand or upper extremity, our surgeons can evaluate and determine the best treatment to restore your function.

 

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