pelvic-pain

Is Chronic Arm, Wrist, or Elbow Pain Controlling Your Life?

When discomfort in your arm, wrist, or elbow starts interfering with everyday movement, even simple tasks can feel impossible. The ache may travel beyond a single joint — radiating through the arm, reducing strength, and limiting your ability to move freely. If you have tried conservative treatments without lasting relief, specialized surgical care could be the answer.

The Center for Hand and Upper Extremity Surgery offers advanced treatment for complex nerve, joint, and tendon conditions. As a division of The Institute for Advanced Reconstruction, we help patients move beyond chronic pain through targeted surgical solutions for brachial plexus injuries, nerve compression, and other debilitating disorders.

You don’t have to live this way. Here’s who we help:

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Individuals with chronic wrist or hand pain after fracture, trauma, or surgery.
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Men and women experiencing nerve-related pain or weakness from carpal or cubital tunnel syndrome.
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Patients living with stiffness, weakness, or pain following tendon or ligament injury.
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Individuals with persistent elbow or shoulder pain from overuse or repetitive motion injuries.
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Those who’ve undergone multiple treatments for hand or arm pain without lasting relief.

Conditions We Treat

Our specialists diagnose and treat a wide range of complex upper extremity conditions that cause chronic pain.
Arthritis & Degenerative Disorders
Nerve Compression & Entrapment Syndromes
Post-Traumatic & Structural Conditions
Perineal & Scrotal Conditions
Pelvic Nerve & Pain Syndromes

Arthritis & Degenerative Disorders

Arthritis and related degenerative disorders involve the breakdown of joint cartilage and tissue, resulting in pain, inflammation, and loss of function. Learn more about:

  • Arthritis 
  • CMC Thumb Arthritis
  • DIP Arthritis
  • PIP Arthritis
  • Rheumatoid Arthritis in Hand
  • Wrist Arthritis
  • Shoulder & Elbow Arthritis

Nerve Compression & Entrapment Syndromes

When nerves in the arm or wrist are compressed, pain, tingling, and weakness often follow. Learn more about:

  • Cubital Tunnel Syndrome
  • Guyon’s Canal Syndrome
  • Pronator Teres Syndrome
  • Radial Tunnel Syndrome
  • Suprascapular Nerve Entrapment
  • Thoracic Outlet Syndrome
  • Nerve Compression Syndrome

Post-Traumatic & Structural Conditions

Persistent pain after trauma or surgery may be caused by structural or healing complications. Learn more about:

  • Post Trauma
  • Non-healing Fractures / Non-union Bones
  • Fractures (Distal Radius, Metacarpal, Phalanx, Scaphoid — when healing abnormally)

Tendon & Soft Tissue Disorders

Overuse, inflammation, or injury can cause chronic tendon pain and stiffness. Learn more about:

  • De Quervain’s Tenosynovitis
  • Tennis & Golfer’s Elbow
  • Trigger Finger

Nerve & Neuropathic Conditions

Nerve injuries can create lasting pain, weakness, and numbness if not repaired properly. Learn more about:

  • Nerve Injuries
  • Nerve Lacerations
  • Chemotherapy-Induced Peripheral Neuropathy
  • Spinal Cord Injury 
  • Complex Regional Pain Syndrome
"Dr Shah is extremely good at explaining the diagnosis in full detail in a language anyone can understand! Dr Ajul Shah -is one of the best hand surgeons and upper extremity peripheral nerve reconstruction surgeon! I was having severe pain in my forearm I tried to let it rest but when i went to see dr shah he was able to pinpoint my pain and advised me i had radial tunnel syndrome, and with a simple nerve decompression surgery i was pain free. My strength is continuing to improve with time. The recovery after surgery was minimal and simple. I highly recommend a consult with Dr Ajul Shah"
— Patient of The Center for Hand and Upper Extremity Surgery
"I was struggling with left arm pain with numbness and tingling traveling down my arm to my fingers. I was also dealing with weakness and tiredness in my arm. Even after a year with dealing with these symptoms my shoulder started to droop and hang down feeling like it was constantly out of place. I went to multiple different doctors trying to figure out what was causing my symptoms. I was told I had a pinched nerve or that it was thoracic outlet syndrome. But after visiting Dr.Shah he told me that it was Human Disharmony Loop and that this surgery could fix all of my symptoms. This surgery was the best thing that I did all my symptoms went away instantly. I highly recommended going to see Dr.Shah he’s very professional and understanding as well as everyone else at the office. I’ve had a great experience!!"
— Patient of The Center for Hand and Upper Extremity Surgery
"After three long years of being in chronic pain 24/7 and searching for answers, seeing many doctors, and almost giving up on ever getting relief, I came across, in my extensive research, Dr. Shah. From the beginning, he listened and cared in a way so many others did not. Where others dismissed my symptoms, his expertise & compassion gave me answers and finally some hope. Dr. Shah went above and beyond at every step. I traveled out of state to his office for surgery, and throughout the entire journey he personally emailed me, checked in on me, and even texted me after surgery and during my travel back home to make sure I was okay. That level of care is rare and deeply meaningful, especially when you’ve been struggling for so long. Dr. Shah saved my life. I will always and forever be in his debt. I am most grateful for his compassion, expertise, knowledge, his kindness, and his unwavering support"
— Patient of The Center for Hand and Upper Extremity Surgery
"Had Dr. Tsai help me with long-term pain and weird issues I’ve had since a bad fall years ago, and just gotta say I really appreciate his openness and willingness to help. As someone in pain, and wanting to get function and my life back that’s all I could really ask for in someone. Extremely easy to talk to, and kind which sadly is more of a rarity these days in the medical field. "
— Patient of The Center for Hand and Upper Extremity Surgery
"Dr Nicole Ferro is the best Dr at pain management, I highly recommend her for pain management over any other doctor"
— Patient of The Center for Hand and Upper Extremity Surgery
"After almost 5 years of pain, doctors, imaging, procedures, and unnecessary surgery- Dr Shah was the one who finally figured out what was causing my intense and debilitating nerve pain in my shoulder. He was kind, incredible bedside manner and talented as a surgeon. After hearing my story he immediately suspected suprascapular nerve compression and promptly ordered a test that would help determine diagnostically if surgery was the right move. He prepared me for my surgery with risks vs benefits and what to expect afterward. Everyone in the office was kind and compassionate. I had such a wonderful experience and I cannot believe I’m finally out of pain! If you are searching for an answer for your pain- this is the guy to go to! Thank you Dr. Shah for fixing me!"
— Patient of The Center for Hand and Upper Extremity Surgery
"I'd give him 10*s if possible. Started seeing Dr. Tsai...I immediately loved he wasn't trying to give me new meds as none had helped. He did Xray & MRI, pain mgmt as last resort did surgery. Once he determined problem both carpel tunnel and needed decompression of shoulder nerve...TODAY I HAVE FULL MOBILITY BACK. It's been 3 months I have NO shoulder, neck, thumb, blades. Absolutely no pain and full use of my right arm back. Many thanks cannot praise him enough."
— Patient at The Center for Hand and Upper Extremity Surgery
"Very patient, knowledgeable, and unpretentious at diagnosing my elbow pain. I would recommend Dr.Shah to anyone with hand to shoulder problems."
— Patient of The Center for Hand and Upper Extremity Surgery
"Dr. Iyer is amazing! He did surgery on my broken wrist and a bone in my hand, and it was very successful. He is very clear about what he will do and welcomes questions, which I find rare in a doctor! His staff is professional, knowledgeable and really helpful, especially with handling insurance. It’s been a real pleasure in a difficult/painful situation. I’m very grateful for the expert care. Highly, highly recommend Dr. Iyer and his staff!!"
— Patient of The Center for Hand and Upper Extremity Surgery
ground-breaking

Advanced Procedures That Relieve Chronic Pain

Every patient’s story is unique, which is why each treatment plan is tailored to the source of pain. As leaders in microsurgery and surgical pain management, our specialists provide advanced procedures that restore motion, function, and comfort for patients with chronic arm, wrist, and elbow pain.
Joint Denervation
Removes or interrupts the small pain fibers within arthritic or damaged joints to reduce chronic wrist, elbow, or shoulder pain while maintaining motion and stability. Read More
Targeted Muscle Reinnervation (TMR)
Redirects residual nerves into healthy muscles after injury or amputation, relieving nerve pain and improving muscle control and prosthetic function. Read More
Amputation (with or without TMR)
Performed only when severe injury or irreversible pain prevents recovery. Combining amputation with TMR helps reduce residual limb and phantom pain while improving long-term comfort. Read More
Hand Reconstruction
Repairs hand structure and movement following trauma, failed surgery, or degenerative disease, using advanced microsurgical and tendon repair techniques. Read More
Hand, Finger, Arm Replantation & Reattachment
Reattaches or reconstructs partially or completely severed limbs or digits, restoring circulation, sensation, and motion while preventing long-term pain and stiffness. Read More
Toe-to-Finger Transplant
Uses a patient’s toe to replace a lost or nonfunctional finger, restoring dexterity, grip strength, and appearance for improved daily function and comfort. Read More
Decompression Surgery
Releases pressure on compressed nerves and tendons in the wrist, elbow, or forearm to relieve pain, numbness, and weakness caused by entrapment syndromes. Read More
Nerve Grafts
Uses a segment of healthy nerve tissue to bridge a gap in a damaged nerve, allowing regeneration and recovery of sensation and muscle control. Read More
Regenerative Peripheral Nerve Interface
Uses a small muscle graft to cap and stabilize injured nerves, reducing neuroma formation and chronic nerve pain while promoting healthy nerve signaling. Read More
Tendon Transfer Surgery
Moves working tendons to restore movement and function when other tendons or nerves are irreparably damaged, helping patients regain strength and coordination. Read More
Nerve Reconstruction Surgery
Repairs and reconnects damaged nerves to restore sensation and function in the arm, wrist, or hand. Read More
35
Nerve Surgeries
Performed
20
Peer-Reviewed
Studies Published
250
Global Patients
Served
12
Years Pioneering
Microsurgical Techniques

Want to know how our breakthroughs translate into better outcomes?

Why Patients Choose The Institute When Others Can’t Help

Global Leaders in Surgical Pain Management

Chronic pain care requires more than surgical expertise. It requires deep diagnostic insight, multidisciplinary coordination, and a relentless commitment to outcomes. Through the Center for Hand and Upper Extremity Surgery, patients gain access to the same innovative techniques and outcomes The Institute is known for – delivered with specialized focus on arm, wrist, and elbow procedures. 

Here, pain management physicians and reconstructive surgeons work side-by-side to develop highly specialized treatment plans for patients who’ve exhausted other options. The result is care that is not only advanced but also personal, coordinated, and centered on restoring long-term quality of life. For those living with pain that hasn’t responded to conventional care, we represent a path forward.

Patients trust The Institute because we provide:

 

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Nationally recognized specialists in pain and reconstruction
proven-outcome
Groundbreaking surgical techniques backed by published research
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Expertise in rare and complex nerve conditions
proven-outcome
Collaborative care from multidisciplinary teams
proven-outcome
Personalized treatment plans
proven-outcome
Proven outcomes for patients who’ve exhausted other options
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We’re Changing Lives

See how
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Your Questions, Answered

Can surgery really help with chronic arm or wrist pain after injury or failed treatment?

Yes. Many patients experience lasting pain from nerve compression, scar tissue, or incomplete healing after an injury or previous surgery. Our specialists use advanced diagnostic testing to identify the exact source of pain and offer procedures such as nerve decompression, reconstruction, or joint denervation to relieve it.

Who is a candidate for surgical pain management?

Patients with chronic upper extremity pain that has not improved with conservative treatments may benefit from a surgical evaluation.

→ Learn more about becoming a patient

Does insurance cover these procedures?

Many of these surgeries are considered medically necessary and are covered by insurance. Our team helps confirm benefits and explore available options.

→ Visit our Insurance and Billing page to learn more.

Do I need a referral to be seen at The Institute?

No referral is required. Patients can contact us directly, though we often collaborate closely with referring providers such as neurologists, primary care physicians, physical therapists, etc.

→ For provider-specific referral information, visit our Referrals page.

How long is recovery after surgical treatment for chronic arm, wrist, or elbow pain?

Recovery time depends on the procedure and the extent of the condition. Some patients experience immediate improvement in symptoms, while others may need several weeks of physical therapy to regain full motion and strength. Our team provides detailed recovery guidance and works closely with each patient throughout rehabilitation.

What makes The Institute different from other centers?

We are one of the few centers in the world dedicated to advanced surgical solutions for chronic arm, wrist, and elbow pain. Our surgeons have pioneered microsurgical and nerve reconstruction techniques that restore motion and bring lasting relief to patients who have not found success with traditional treatments. People travel from across the country and around the world to receive the specialized care available only at The Institute for Advanced Reconstruction through The Center for Hand and Upper Extremity Surgery.

→ Learn more about why patients choose us.

What makes The Institute’s approach different for upper extremity pain?
Unlike general orthopedic or pain management practices, The Institute focuses exclusively on surgical solutions for complex nerve, joint, and tendon conditions. Through The Center for Hand and Upper Extremity Surgery, patients receive specialized care from surgeons who are among the few in the world performing these advanced microsurgical techniques for lasting pain relief.

Meet Our Surgeons

Behind every surgery is a surgeon who understands what’s at stake: your comfort, independence, and quality of life. Our world-renowned specialists bring unmatched skill and the compassion and commitment to guide you through every step of your journey.

Michael Rose

Andrew Elkwood

MD, MBA, FACS
Michael Rose

Hamid Abdollahi

MD, FACS
Michael Rose

Edwin Acevedo

MD
Michael Rose

Peter Andrawes

MD
Michael Rose

Gary Arishita

MD
Michael Rose

Russell Ashinoff

MD, FACS
Michael Rose

Jonathan Bank

MD, FACS
Michael Rose

Sean Boutros

MD, FACS
Michael Rose

Anjeanette Brown

MD, FACS
Michael Rose

David Cabiling

MD
Michael Rose

Courtney Carpenter

MD
Michael Rose

Stephen Chagares

MD
Michael Rose

Eric I. Chang

MD, FACS
Michael Rose

Ann Chuang

MD, FACS
Michael Rose

Frank Ciminello

MD, FACS
Michael Rose

Kari L. Colen

MD, FACS
Michael Rose

Ryan Couvillion

MD
Michael Rose

Desiree D'Angelo

DO, FACS
Michael Rose

Joseph Dayan

MD, MBA
Michael Rose

Nicholas De Leo

MD
Michael Rose

Frank Dellacroce

MD
Michael Rose

Antonios Dimopoulos

MD
Michael Rose

George Dreszer

MD
Michael Rose

Stephen Dudick

MD
Michael Rose

Rodion Erenburg

MD
Michael Rose

Berry Fairchild

MD
Michael Rose

Randall Feingold

MD, FACS
Michael Rose

Adam Feintisch

MD
Michael Rose

Nicole Ferro

DO
Michael Rose

James Fletcher

MD
Michael Rose

Anton Fries

MD, PhD
Michael Rose

James Frost

MD, FACS
Michael Rose

Amon-Ra Gama

MD
Michael Rose

Andrew Gassman

MD
Michael Rose

Patrick Greaney

MD, FACS
Michael Rose

Ritwik Grover

MD, FACS
Michael Rose

Edward Hahn

MD
Michael Rose

Sanaz Harirchian

MD
Michael Rose

Cassie Hartline

MD
Michael Rose

Sean Herman

MD, FACS
Michael Rose

Zuhaib Ibrahim

MD, FACS
Michael Rose

Ron Israeli

MD, FACS
Michael Rose

Lisa Iucci

DO, FACS
Michael Rose

Hari Iyer

MD, FAAOS
Michael Rose

Priya Jadeja

MD, FACS
Michael Rose

Reza Jarrahy

MD, FACS, FAAP
Michael Rose

Santosh Kale

MD, MBA
Michael Rose

Karen Kaplan

MD
Michael Rose

Matthew Kaufman

MD, FACS
Michael Rose

Ergun Kocak

MD
Michael Rose

Peter Korn

MD, FACS
Michael Rose

Arjuna Kuperan

MD
Michael Rose

Chris Lakhiani

MD, FACS
Michael Rose

Peter Ledoux

MD
Michael Rose

David Light

MD, FACS
Michael Rose

Matthew Lynch

MD
Michael Rose

Tyler Merceron

MD
Michael Rose

Ahmed Nasser

MD
Michael Rose

Chet Nastala

MD
Michael Rose

Robert T. Nevitt III

MD
Michael Rose

Oscar Ochoa

MD
Michael Rose

William Ordoyne

MD
Michael Rose

Lauren Otaguro

MD
Michael Rose

Tushar Patel

MD, FACS
Michael Rose

Steven Pisano

MD
Michael Rose

Vaishali Purohit

MD
Michael Rose

Sidney Rabinowitz

MD, FACS
Michael Rose

Deepak Ramesh

MD
Michael Rose

David Rayfield

MD
Michael Rose

Rukmini Rednam

MD
Michael Rose

Michael Rose

MD, FACS
Michael Rose

Adam Saad

MD, FACS
Michael Rose

Nirvana Saraswat

MD
Michael Rose

Ali Seckin

MD, MBA
Michael Rose

Ajul Shah

MD, FACS
Michael Rose

Tzvi Small

MD, FACS
Michael Rose

Mohit Sood

DO
Michael Rose

Scott Sullivan

MD
Michael Rose

Darren Sultan

MD
Michael Rose

Yolanda Tammaro

MD
Michael Rose

Pankaj Tiwari

MD
Michael Rose

Stephen Toran

MD
Michael Rose

Christopher Trahan

MD
Michael Rose

David Tsai

MD, FACS
Michael Rose

Hakan Usal

MD
Michael Rose

Eric Weiss

MD
Michael Rose

Jonathan Weiswasser

MD, FACS
Michael Rose

Lauren Whipple

MD
Michael Rose

Eric Wimmers

MD, FACS
Michael Rose

Whitten Wise

MD
Michael Rose

Mary Jo Wright

MD
Michael Rose

Alex Xu

MD
Michael Rose

Mark Yazid

MD, FACS
Michael Rose

Sarosh Zafar

MD

What to Expect When You Reach Out

We know reaching this point has likely been a long journey. That’s why we make the next step clear and supportive.

1 Consultation

Share your history and symptoms with our specialized team, either virtually or in-person.

2 Evaluation

Our advanced diagnostic tools and extensive expertise help us understand your condition fully.

3 Personalized Care Plan

You’ll leave with a clear explanation of your options and what recovery could look like.

4 Surgery & Support

If surgery is right for you, our team guides you through every step: before, during, and after.
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Get Relief From Chronic Pain

You don’t have to live in constant pain or uncertainty. Our specialists provide advanced care that helps patients finally reclaim their lives.