Hand & Wrist Surgery

Overview

Definitions and Anatomy

The human hand and wrist are very complex. Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. How well your hands and wrists interact with each other depends on the integrity and function of the ligaments, tendons, muscles, joints and bones. If a problem arises with any of these structures of the upper extremity function, it can cause major disruptions at home and work and negatively impact quality of life.

Conditions

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the result of increased pressure on one of the nerves in the wrist and hand. In patients with carpal tunnel syndrome, this nerve is compressed as it passes through the wrist. This compression causes the nerve to not function properly. Usually patients will experience numbness and tingling (paresthesias) in the hand, weakness in some of the muscles of the hand, and pain in the hand and wrist. Many of these symptoms become more pronounced at night, and patients with this condition often complain of inability to sleep.

Dupuytren’s Contracture

Dupuytren’s Contracture is a condition that affects the palmar fascia, the connective tissue that lies beneath the skin in the palm of the hand. Dupuytren’s Contracture causes a tightening of this tissue in the hand and the fingers can become permanently flexed, imparing function of the hand. Anatomically speaking, the palmar fascia is a thick tissue that lies above the tendons and below the skin of the hand. This fascia is attached both to the skin above and to the structures below. In Dupuytren’s Contracture, the fascia becomes diseased and thickened, which leads to the finger contractures. 

Finger Fractures

When a finger bone is fractured it can result in improper alignment of the entire hand. In addition, if left untreated, a fractured finger can remain painful and stiff for a long time. In the normal hand, the bones all line up precisely. This allows for manual dexterity and precise movement with the thumb and fingers. A fractured finger is usually considered a minor incident, however without the right treatment and early evaluation, it can cause serious problems.

Finger Sprains

A finger sprain is stretching or tearing of the ligaments that support the small joints of the finger. Ligaments are strong bands of tissue that connect bones to each other.

Ganglion Cyst

Ganglion Cyst is a swelling or tumor that appears on the top of a joint on the back or front of the wrist or the base of a finger. It looks like a sac of liquid and the inside of the cyst is composed of a thick, colorless, clear, jellylike substance. The cyst may feel firm or spongy to the touch and can vary in its size. One large cyst or several smaller ones may appear. Ganglion cysts are most common in women aged 20 – 40 years old. Ganglion Cysts can often also occur after an injury, but for the generally, it isn’t known exactly why they appear.

Arthritis

Can appear in only one or multiple joints of the wrist and hand. Cartilage works as a natural “shock absorber.” It provides a smooth, gliding surface for joints. Once your cartilage is gone, our bodies cannot replace it and bone on bone wear occurs. The body attempts to accommodate the lost cartilage by producing extra tissue in the joint lining (termed synovium). In addition, the joint lining creates more of the lubricating (synovial) fluid that is normally found in joints. This addition of extra tissue and fluid causes the joint to swell, thus restricting motion. The swelling also causes stretching of the joint covering, which in turn causes further pain. With time, the bones of the joint can lose their normal shape as bone spurs form. This creates even more pain while further limiting motion.

Hand Fractures

The most common symptoms of a broken hand bone include swelling, tenderness, deformity, shortened fingers, and inability to move your fingers. Fractures can occur anywhere in the hand and include the metacarpal(s). The hand bones can fracture near the midbone, knuckle, or near the wrist.

Mallet Finger

“Jammed Finger” extensor tendons are located just beneath the top surface of the skin, directly on the bone, and on the back of the fingers and hands. Due to their location, these tendons are often injured. Even the common trauma of jamming a finger could cause these thin tendons to rip away from their attachment to the bone. After an injury of this type, it may prove difficult to straighten one or more of the finger joints. Treatment is required to help return the tendon to normal functionality.

Trigger Finger

Is an inflammation of tissue inside your finger or thumb. It is can also called tenosynovitis. The tendons in your fingers become swollen as well as the synovium. The synovium is a slick membrane that allows the tendons to move easily. Once this occurs, it will be difficult to straighten the finger or thumb.

Wrist Fractures

Similar to other fractures, there are a number of different bones in the wrist that can break (fracture). The bone most commonly fractured in the wrist is the radius but can also include the ulna.

Wrist Sprains

When this type of injury occurs, the ligaments of the wrist are stretched beyond their normal limits. A ligament is made of tough, fibrous tissue that holds the bones together around a joint. The ligaments around the wrist joint help to stabilize the position of the hand and allow controlled motions. There are various grades of wrist sprains and are graded according to the severity of the injury. When more severe wrist injuries occur, small ligamentous tears may require a more aggressive approach with surgery. If not treated adequately, a torn ligament may lead to joint instability and arthritis.

Wrist Tendonitis

Wrist tendonitis is one of the most common causes of wrist pain. This condition is primarily characterized by inflammation and irritation of the tendons surrounding the wrist joint. Wrist tendonitis is also called tenosynovitis, and it usually affects one of the wrist tendons, but it may also involve two or more tendons. In most cases, wrist tendonitis develops at those points where the tendons cross each other or pass over a bony prominence. As wrist tendons pass by the wrist joint, they slide through sheaths that contain fluid. These tendon sheaths are designed to allow the tendons to glide effortlessly in a relatively low-friction manner.

Wrist tendonitis becomes a problem when the tendon sheath becomes thickened and begins to constrict the smooth gliding motion of the tendons. The accompanying inflammation also makes the movements painful.

Treatments

Carpal Tunnel Release
Closed Reduction (Finger)
Fasciotomy
Ganglion Cyst Surgery
Hand Fracture Surgery
Nerve Decompression
Non-Operative Finger Treatments
Non-Operative Wrist Treatments
Trigger Finger Release Surgery
Wrist Surgery