Treatment of traumatic and pathologic fractures/dislocations of the wrist and hand

  • Fractures of the Distal Radius and Ulna—injuries to the two long bones of the forearm at the level of the wrist may cause significant lack of mobility, function, pain and arthritis of the wrist if not treated appropriately.
  • Carpal Bones—injuries to these small bones of the wrist are common; the most common being a scaphoid fracture which may be treated with cast immobilization, arthroscopically assisted surgical treatment
  • Metacarpal Bones—fractures and dislocations of these “long” bones are common and may require splint immobilization, placement of pins or plates for healing
  • Phalanges—fractures and dislocations of the bones of the finger may be associated with significant decrease of mobility and stability of the fingers; treatment consists of splint immobilization, placement of pins or plates for healing

Treatment of the stiff hand

Causes of the stiff hand include post-traumatic stiffness, post infection, or arthritis-related stiffness. Treatment ranges from aggressive hand therapy to surgical release of scar to joint placement.

Wrist arthroscopy

Treatment of disorders of the wrist structures including arthroscopic treatment of injuries to the cartilage of the wrist (called the Triangular Fibrocartilage Complex), arthroscopic diagnosis and treatment of wrist disorders due to trauma.

Nerve compression syndromes

  • Carpal Tunnel Syndrome- a condition brought on by increased pressure or a pinched nerve at the wrist which may cause pain, numbness, and tingling in the hands.
  • Cubital Tunnel Syndrome- a condition brought on by increased pressure or a pinched nerve at the elbow which may cause pain, numbness, and tingling in the hands.

Treatment of nerve injuries

Treatment of injuries from traumatic wounds such as a severed nerve or a stretch injury causing loss of function and sensation of the hand.

Tendon disorders

  • DeQuervain’s Tenosynovitis- a condition causing wrist or thumb pain due to inflammation of the lining of a tendon to the thumb.
  • Trigger Finger (Stenosing Tenosynovitis)- involves the pulleys and tendons in the hand that bend the fingers. It may cause pain in the palm of the hand and occasional locking of the finger with the inability to move the finger temporarily.
  • Extensor Tendon Injuries- injuries of the tendons which may lead to an inability to straighten the fingers; a common cause of these types of injuries are sharp cuts on the back of the hand.
  • Flexor Tendon Injuries- and injury to the tendon that attaches the flexor muscles to bone which in turn bends or flexes the fingers.
  • Tennis Elbow- pain on the outer part of the elbow, especially with gripping.
  • Golfer’s Elbow- pain on the inner part of the elbow, especially with gripping.

Arthritis of the wrist and hand

  • Arthritis of the Base of the Thumb- arthritis of the basilar joint, formed by a small wrist bone and the first bone of the three bones in the thumb; treatment may consist of splint, cortisone injection, or surgery to remove the arthritic bone and replacement of the joint.
  • Osteoarthritis of the Joints of the Hand-various treatment modalities may be required such as medical treatment, joint replacement, arthrodesis or fusion of the bones of the joint which may eliminate pain but leaves the joint immobilized.
  • Rheumatoid Disease of the Hand- an illness that often attacks the tissues, called synovium, that line the joint and tendons. The tissue becomes swollen and covers the joints, destroying bone and cartilage and may cause tendon rupture; usually treated medically.

Soft tissue disorders

  • Dupuytren’s Disease- an abnormal thickening of the fascia (the tissue between the skin and the tendons in the palm) that may limit movement of one or more fingers.
  • Ganglion Cysts- a very common condition when a mass (lump) grows in the hand or wrist due to “leaking” of joint of tendon sheath fluid under the skin; may be treated with aspiration or surgical treatment; surgical treatment of the wrist may be performed arthroscopically.
  • Burn or Electrocution Injuries of the Hand and Upper Extremity- a comprehensive approach to burn reconstruction via skin grafting, skin graft substitutes, microvascular reconstruction and treatment of nerve disorders after such injuries.

Microvascular reconstruction of the upper extremity

  • Microvascular Reconstruction of the Upper Extremity- trauma or cancer of the upper extremity and hand cause missing or severely injured parts which would require “transplanting” tissue (also called free flap reconstruction) from one part of the body to the injured hand or upper extremity to restore form and function.
  • Replantation- the reattachment of the amputated finger or part of the hand after traumatic injuries.

Congenital disorders

Treatment of children born with hand disorders:

  • Syndactyly- a condition where at least two if not more fingers are “attached” to one another by skin and there is no separation between the fingers.
  • Polydactyly- a condition in which a child is born with more than five fingers on one or both hands; these may be small pendulous attachments or a fully developed extra finger.
  • Triphalangeal Thumb- a condition in which a child is born with three small bones (phalanges) instead of two bones of the thumb, which would lead to a longer and possibly less functional thumb.
  • Congenital Trigger Thumb-
  • Amniotic Disruption Sequence- a condition in which a child is born with tight rings of skin/scarring around a finger or amputated fingers.
  • Congenital Absence of the Thumb- a condition in which a child is born without a thumb on one or both hands.
  • Thumb Duplication- a condition in which a child is born with two thumbs on one or both hands.

Tumors of the hand or wrist

Treatment of skin cancers (melanoma, squamous cell cancer, basal cell cancer), nerve tumors, tendon sheath tumors and bone tumors of the hand and wrist, and reconstruction of the hand and/or wrist.

Infections of the hand

  • Paronychia- infection of the nail fold or cuticle
  • Felon- infection of the fingertip
  • Fungal infections of the nail
  • Joint infections of the hand and wrist
  • Pyogenic Flexor Tenosynovitis- infection of the tendon sheath usually caused by puncture injuries to the palm; may cause severe pain, swelling, and tenderness with movement of the finger.