Your hands and upper extremities, such as your shoulders, elbows, and wrists, are essential for performing everyday activities. However, problems with muscles, ligaments, bones, and tendons can affect the function of your upper extremities. When you lose function in any of these areas, from your shoulders to your fingertips, it can disrupt your ability to work, move, play, and perform everyday activities.
A number of conditions can affect your hands and upper extremities, including:
- Nerve conditions (such as carpal tunnel syndrome)
- Accidents and injuries
- Congenital disorders
When left untreated, hand and upper extremity problems may lead to chronic pain, loss of function, and can significantly hinder a patient's quality of life. Our team of reconstructive surgeons deploys cutting-edge surgical techniques to help patients suffering from hand and upper extremity issues, including:
Tendon Injuries and Conditions
Tendons are fibrous, rope-like connective tissues that attach muscles to the forearm and hand bones. Tendon injuries typically start with some kind of trauma, such as a cut to the hand or "jamming" of a finger. When a tendon gets inflamed, you may experience a tendonitis condition such as:
- Trigger finger: when a thumb or finger locks or clicks as it bends towards the palm.
- De Quervain's syndrome: when tendons that control the thumb become inflamed when passing through a tunnel on the "thumb side" of the wrist.
- Tennis elbow: when muscles and tendons that extend the wrist become inflamed or degenerated as they insert onto the elbow.
Nerve Injuries and Conditions
Nerves send signals between the brain and the body. Some tell your muscles to move and alert you when something is hot, cold, or painful. Other nerves tell your organs to function so your heart can beat and your lungs can breathe. When nerves are damaged or inflamed, it can result in a loss of function or sensation. Muscles may become weak or non-operable, and you may experience numbness, a lack of sensation, or pain.
The brachial plexus is the "command center" for upper extremity nerves – all functional nerves of the upper extremity originate from the brachial plexus. In addition to brachial plexus injuries, you may also experience damage to nerves in your wrists, elbows, or shoulders. The most common nerve conditions include:
- Carpal tunnel syndrome: when the nerves in your hand become compressed passing through the carpal tunnel in your wrist.
- Cubital tunnel syndrome: affects the ulnar nerve (or "funny bone") in your elbow.
- Radial tunnel syndrome: a pinched nerve at the forearm level.
- Brachial plexus injuries: injury to the brachial plexus bundle of nerves that sends signals to the shoulders, chest, and arms.
Arthritis is an inflammatory condition affecting one or several joints, causing stiffness and pain that can worsen with age. Although classically thought of as a disease that affects only the bones and joints, arthritis is a more complex process involving the surrounding soft tissues such as cartilage, nerves, and ligaments.
Surgery may be needed to ensure that bones are returned to their correct position when an arm, wrist, hand, or finger fractures. In the wrist alone, there are eight small bones attached to the two forearm bones, while the hand is made up of 19 small bones. Confirming that fractures are properly positioned can help ensure healing after a break.
Nerve Surgery for Hand & Upper Extremity Injuries
Hand and upper extremity injuries and procedures often involve a skilled surgical team with extensive knowledge of muscles, bones, tendons, and ligaments. Many of the injuries and conditions affecting the upper extremities require nerve repair, reconstruction, or replacement procedures.
After an injury, a nerve will try to repair itself by growing or regenerating nerve units. These regenerating units will attempt to restore function to affected muscles in a process called reinnervation. When these nerves make a correct connection, the patient can recover muscle function and lost skin sensation. But if the regenerating nerve fibers do not connect correctly, it can lead to pain and a loss of function and sensation.
The surgical team at The Institute for Advanced Reconstruction specializes in numerous advanced nerve procedures, including:
- Neurolysis: when a nerve ending is damaged, scarring can build up around the edges. Neurolysis involves removing scar tissue to help nerve endings regenerate and grow.
- Nerve repair: when a nerve is cut, a nerve repair may be used to reattach the two endings.
- Nerve graft: if two cut nerve endings can't be reattached, then a small piece of donor nerve may be used to help "bridge" the gap. Nerve grafts may utilize donor nerves from other areas of the body or even a cadaver.
- Nerve transfer: sometimes, a nearby nerve is redirected into an affected muscle, allowing for more efficient recovery.
- Tendon/ muscle transfer: for some injuries, a nerve repair may be paired with a tendon or muscle transfer from an unaffected area of the body.
- Tunnel release: for inflammatory conditions caused by a nerve getting compressed inside a tunnel (such as carpal tunnel syndrome), an incision in the tunnel will widen the space and allow for the nerve to move freely. This is also known as nerve decompression surgery.
- Targeted muscle reinnervation (TMR): an advanced surgical procedure for amputated hands or arms that involves transferring nerves to reinnervate (restore function to) the remaining muscles.