Hand/Wrist/Elbow

We offer an assortment of treatments for various injuries to the hand, wrist, and elbow. These include:

• Carpal tunnel release
• Trigger finger release
• Wrist arthroscopy
• Elbow arthroscopy
• Treatment for elbow fractures
• Dupuytren's release
• Tennis elbow injections and surgery
• Injections for DeQuervain's tenosynovitis
• Ganglion cyst excision
• Ulnar nerve transposition

Carpal Tunnel Release

Carpal tunnel syndrome is compression of the median nerve at the wrist. It is a common problem seen in repetitive type use syndrome. Mild situations can be treated with anti inflammatories or wrist splinting, while advanced stages will most commonly require surgical release. Surgery will take pressure off the nerve. It takes several weeks to heal and will usually require physical therapy to improve range of motion and strength after the operation.

Trigger Finger Release

Trigger finger is the catching or locking of a nodule on the flexor tendon in the palm of the hand. This can commonly be seen with repetitive use and sometimes as a result of a hand injury. Initial treatment includes rest, ice, and anti inflammatories. Additional treatments include stretching and Cortisone injections. If all of these methods fail, surgical release of the A1 Poly in the palm of the hand will enable the nodule to pass freely without catching or locking.

Wrist Arthroscopy

Wrist arthroscopy is a common procedure that can be used in conjunction with fixation of wrist fractures to treat cartilage injuries as well as treatment of the triangular fibrocartilage complex. If conservative measures fail after wrist pain or injury, additional methods of physical therapy and injection can be used. If all these do not result in minimized pain, the wrist can be visited arthroscopically and synovectomy, chondroplasty, and cartilage debridement can be performed.

Elbow Arthroscopy

Elbow arthroscopy can be used for many factors, including bone spurs, damaged cartilage, as well as releasing the tendon with tennis elbow. The procedure is minimally invasive and is usually treated through two to four arthroscopic portals. One is used for the camera to enable direct visualization. Additional portals are used for placement of shavers as well as high-frequency ultrasound devices to remove inflammation, release the capsule, remove loose bodies, and remove spurs in the elbow.

Treatment for Elbow Fractures

Elbow fractures are a result of direct trauma from a blow or a fall from height, landing on an extended or flexed elbow. There are a variety of injuries that can occur, including injuries to the radial head, the distal humerus, the proximal ulna, or both bones in the forearm. Typical treatment for displacement includes open reduction with internal fixation. Additionally, radial head replacement can be used for a bone that is broken into many pieces. Treatments for minimally to non-displaced fractures include splinting and casting or fracture braces. Additional treatments can include flexible rodding and tension bands.

Dupuytren's Release

Dupuytren’s contracture is seen in the palm of the hand and it can extend up into the fingers. Typically patients see initial nodules that form which are very firm and they can extend into the finger through chords(?). After time they begin to contract and cause contractures of the fingers, making them difficult to extend. Initial treatments include stretching and injections. Ultimately if these fail, contracture release with excision of the chords(?) as well as palmar fascia are performed to allow for restoration of range of motion in the hand.

Tennis Elbow Injections and Surgery

Tennis elbow is a condition that includes irritation or partial tearing of the origin of the extensor muscles from the lateral aspect of the elbow. This can result as either a traumatic injury or a repetitive use. Initial treatments include rest with ice and anti inflammatories. If this does not resolve the issue, often times Cortical(?) steroids can be injected into the area that is most tender. If several months of conservative treatment fail, surgical repair as well as debridement may be required.

Injections for DeQuervain's Tenosynovitis

Dequervain’s tenosynovitis is pain along the thumb side of the wrist, typically seen with extension of the wrist or when the thumb is placed in the palm of the hand with the wrist turned down. This is most often caused by repetitive use, but it can also be the result of a fall with injury. The pain and inflammation in this area is treated with ice, rest, and anti inflammatories. If these measures do not alleviate the problem, an injection is oftentimes all that is required to resolve the pain. However, in cases where conservative measures fail, surgical release will be required.

Ganglion Cyst Excision

Ganglion cysts usually form on top of a joint as a result of some type of defect or injury to the joint capsule. Fluid leaks out from the capsule and is encapsulated in a cyst by the body to try to keep it from spreading. Often times, up to 50 percent of the time Ganglion cysts will disappear on their own. They can be drained but oftentimes return to the same size or become even larger. If time does not resolve the issue, typically a cyst excision is performed. The joint capsule is repaired through a small incision. Oftentimes the extremity is splinted for a short period of time to allow for good capsular healing before physical therapy and strengthening are instituted.

Ulnar Nerve Transposition

Ulnar nerve impingement at the elbow is commonly seen due to trauma or repetitive use and pressure. Over time, numbness occurs on the small finger side of the hand, usually including the ring and small fingers. Treatment can include rest, therapy, anti inflammatories, and icing. If nerve impingement symptoms are moderate to severe, typically nerve decompression at a minimum is required. Oftentimes the nerve is transposed, meaning that it is moved to the anterior portion of the elbow to take pressure off the nerve, especially with elbow flexion.