We provide advanced treatment and rehabilitation of the hand and upper extremities. We focus on applying advanced techniques in both operative and non-operative conditions of the hand, wrist, elbow and shoulder to minimize pain, while restoring function, specializing in the following:
Hand Procedures & Treatments
Generally, electrodiagnositc (either electromyography (EMG) or nerve conduction studies (NCS)) testing can accurately determine injuries to the nerves or nerve roots as well as diseases of the nerves and muscles. Accuracy of the tests depends on the skill of the person conducting the test and precision of equipment used. They cannot however determine the existence or extent of pain.
Restore Hand Function (following Spinal Cord injuries)
Arthroscopic surgery can be used to diagnose and treat a number of conditions of the wrist including fractures, ganglion cysts, carpal tunnel and chronic wrist pain. A small fiber optic instrument called an arthroscope enables the surgeon to see inside the joint without making large incisions into the muscle and tissue.
Wrist Joint Replacement (Wrist Arthroplasty)
During wrist joint replacement surgery, damaged parts of the wrist bones are removed and replaced with artificial components (prosthesis). The primary reasons for this surgery are to relieve pain due to arthritis and to maintain function in the wrist and hand. Wrist replacement does require gradual exercises to increase power and endurance.
For some hand conditions, a steroid injection is recommended when anti-inflammatory medication is not appropriate or before surgical procedures. They typically contain a long-lasting anesthetic and a steroid that can provide pain relief for weeks to months. These injections can only be repeated a limited number of times due to possible side effects such as weakening of the tendons and ligaments, or infection.
Tendon Transfer Surgery
Hand Surgery Anesthesia
Flexor Tendon Injuries
Distal Radius/Scaphoid Fractures (Broken Wrist)
Mallet Finger (Baseball Finger)
Trigger Finger (Jammed Finger)
Trigger finger is a condition that affects the tendons in your fingers or thumb where you cannot straighten your finger without it locking or catching. While there is no known cause, there are nonsurgical treatments such as medications and steroid injections as well as an outpatient surgical procedure. Surgery widens the opening of the sheath tunnel so that the tendon can slide through it more easily.
Golf Injuries to Hand, Wrist or Elbow
Most golf injuries are the result of overuse and repeating the same golf swing motion over and over again. Stress is placed on the same muscles, tendons and joints, which can cause golfer’s elbow and wrist injuries, such as tendinitis or carpal tunnel syndrome. Golfer’s elbow is the most common and is an inflammation of the tendons that attach your forearm muscles to the inside of the bone at your elbow. Exercises that strengthen your forearm muscles can help to avoid injury and stretching before playing.
Arthritis of Hand/Thumb/Wrist
Ulnar Sided Wrist Pain
Carpal tunnel Syndrome
Carpal tunnel syndrome occurs with the synovium tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. Heredity, age, hand use and existing medical conditions can contribute to the development of carpal tunnel. Nonsurgical treatments options include bracing or splinting, medications, activity changes and steroid injections. The traditional surgical procedure involves dividing the roof of the carpal tunnels and the endoscopic procedure cuts the ligament from the inside of the carpal tunnel to speed up recovery time. Many symptoms improve after surgery, but recovery may be gradual and involve a hand therapist.
Compartment syndrome develops when swelling or bleeding occurs within a compartment, (group of muscles, nerves and blood vessels), disrupting blood flow and potentially damaging them. Acute compartment syndrome caused by a severe injury is a medical emergency and requires immediate surgery. Chronic compartment syndrome usually caused by athletic exertion involves numbness, visible muscle bulging or other pain or cramping during exercise. Treatment includes physical therapy, medication or surgical procedure. An elective procedure known as a fasciotomy is performed to open the fascia and provide room for the muscles to swell.
Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
De Quervain’s Tendinosis
De Quervain’s Tendinosis occurs when the tendons around the base of the thumb are irritated or restricted causing pain. Usually caused by overuse, swelling of the tendons or thickening of the tendon sheath results in increased friction and pain with thumb or wrist movements. Treatment options include: splints, anti-inflammatory medications, corticosteroids or surgery to open the thumb compartment to make room for the irritated tendons. Your Orthopaedic surgeon will advise you on the best treatment option for your situation.
Dupuytren’s Contracture is the thickening of the fibrous tissue layer underneath the skin of the palm and fingers, which can cause the fingers to curl (flex). Although there is no known cause, the symptoms usually occur gradually and it can be difficult to straighten your fingers affecting your grasp. Splints or steroid injections are used to slow the disease. A surgical procedure can be recommended if the disease is progressing, where the thickened bands are removed to restore finger motion. After surgery, physical therapy may be advised.
Ganglion Cyst of Hand/Wrist
These non-cancerous cysts are the most common mass or lump in the hand and usually develop on the back of the wrist. With no known cause of the formation, if these fluid-filled cysts are painful, interfere with function, or have an unacceptable appearance, there are treatment options. Observation, immobilization and aspiration (draining) are all nonsurgical options. An outpatient surgical procedure requires an excision to remove the cyst as well as the “root” of the ganglion so it does not return.
Ulnar Tunnel Syndrome of the Wrist