Orthopedics - Hand & Wrist

Conditions / Procedures

• Baseball (mallet) finger

  Overview:

  Baseball finger, also known as mallet finger, occurs when the tip of finger is injured due to impact and the tendons attached to your bones are affected. Typically, the tendons provide stability and motion and once torn or detached from the finger, the tip of the finger begins to droop, and active motion is lost.

  Symptoms may include:

  • pain
  • bruising
  • inflammation
  • tenderness
  • restriction in the fingertip, inability to straighten
  • a detached fingernail
  • redness under the fingernail bed

  Treatment/procedure options:

  Generally, baseball finger can be treated with a splint worn for about 8 weeks straight to hold the fingertip straight until it heals. After the initial 8 weeks, the splint is usually worn for about three or four weeks on an occasional basis. When a splint is not an option, such as when the nail is no longer intact or the skin has been broken due to the joints moving out of alignment, known as a fracture, surgery may be necessary. Our orthopedic surgeons can perform an outpatient procedure with the use of pins to keep the joints aligned and optimize the chances of recovery.

• Carpal tunnel syndrome

  Overview:

  Carpal tunnel syndrome is a common condition caused by a compressed median nerve, one of the major nerves in the hand. The carpal tunnel is a passageway located in your wrist where the median nerve is located and can become irritated due to tissue swelling. Generally caused by repetitive motions with the hand, increased pressure on this nerve will decrease sensation to the fingers, except the pinky finger.

  Symptoms may include:

  • numbness or tingling sensation
  • weakness of the hand or decreased ability to hold a strong grip
  • pain or burning to the hand or fingers

  Treatment/procedure options:

  Non-surgical treatment options include rest, applying ice to the affected area, anti-inflammatory medications, injections, or use of a splint. Surgery may be appropriate if symptoms persist and do not respond to other treatments. Generally, two techniques are performed in the operating room: endoscopic surgery and open surgery. Both intend to increase the size of the tunnel to relieve pressure on the nerve.

• Dupuytren’s contracture

  Overview:

  Dupuytren’s contracture is thickening of the connective tissue in the palm of your hand at the base of your fingers. The tissue can develop into a thick lump or band, causing one or more of the fingers to curl downward toward the palm. Generally affecting the small or ring finger, Dupuytren’s contracture is believed to run in families, but the cause is unknown.

  Symptoms may include:

  • thickening of the tissue at the base of the fingers
  • development of a firm lump of tissue
  • sensitivity to touch
  • fingers being pulled in toward your palm

  Treatment/procedure options:

  Treatment options include removing or breaking apart the cords that are pulling your fingers toward your hand.

• Finger dislocations

  Overview:

  Out of the 27 bones in the hand, more than half are in the fingers. Dislocation of a finger occurs when the bones are out of alignment with the joint and are caused by a fall, sports injury, or trauma. The most common joint to become dislocated is the middle finger.

  Symptoms may include:

  • pain
  • swelling
  • bruising
  • injured finger is pale in color
  • crooked appearance
  • inability to bend or straighten the finger
  • a break in the skin where the finger is dislocated

  Treatment/procedure options:

  Non-surgical treatment, such as a reduction, is generally performed. The procedure includes a local anesthetic injection in the finger to help decrease or stop the pain, followed by manipulating the bones to realign. A protective splint worn around the finger to protect and immobilize the joint will be used along with placing buddy tape around the affected finger and an adjacent finger for stability. If the finger dislocation is severe, surgery may be necessary to repair any fractures or torn ligaments.

• Ganglion Cyst

  Overview:

  Ganglion cysts most commonly develop along the tendons or joints of wrists or hands but can also grow on the ankles and feet. Due to injury, trauma, or overuse, ganglion cysts occur when fluid accumulates in the joint or tendon. The cysts are round or oval and vary in size, often getting larger when the joint affected engages in repetitive motion and can cause pain if the cyst begins to press on a nerve.

  Symptoms may include:

  • loss of mobility
  • numbness
  • pain
  • a tingling sensation

  Treatment/procedure options:

  Immobilizing the joint with the use of a splint can be used temporarily and if effective, the cyst may shrink, which could ease the pain. Another form of treatment may be aspiration, which is a process in which our orthopedic surgeons will use a needle and syringe to draw out the fluid in the cyst. In the case that this method does not work, surgery may be considered to completely remove the cyst and the stalk that attaches it to the tendon or joint.

• Hand & Wrist Arthritis

  Overview:

  Common forms of arthritis which affect the joints in the wrist, hands and fingers include osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. Osteoarthritis is a degenerative condition which causes the cartilage to break down over time whereas rheumatoid arthritis and psoriatic arthritis are systemic, inflammatory diseases.

  Symptoms may include:

  • inflammation
  • pain
  • stiffness
  • tenderness
  • redness at the sight of the affected area
  • reduced range of mobility
  • grinding or popping in the affected joint

  Treatment/procedure options:

  Treatment options depend on the type of arthritis, the number of joints affected, age, activity level, and other existing medical conditions. Once all variables have been considered, treatment options include anti-inflammatory medications, the use of immobilization devices such as a splint or brace, injections, and non-surgical approaches such as exercises, hot and cold therapy, rest, occupational therapy, and weight loss. Once non-surgical treatments no longer provide relief, surgery may be an option.

• Strains and Sprains

  Overview:

  Strains and sprains are interchangeably used because of the common symptoms of the two conditions. For instance, a joint sprain is the overstretching or tearing of ligaments, which are the bands of tissue that connect bones in a joint, whereas a joint strain is the overstretching or tearing of tendons or muscles. Commonly affected areas of the body include the back, ankle, wrist, knee, and thumb.

  Symptoms may include:

  • pain around the joint affected
  • swelling
  • limited mobility and range of motion
  • stiffness
  • instability
  • feeling or hearing a pop in the joint when injury occurred
  • warmth, or redness of the affected joint
  • Symptoms that differentiate the two conditions include bruising in a sprain and muscle spasm in a strain.

  Treatment/procedure options:

  Treatment options for mild strains and sprains may include anti-inflammatory medications, rest, applying ice on and off for 20 minutes during the first 24-48 hours, compression to reduce swelling, and elevating the affected area above the heart. More severe cases may require immobilization such as splint or cast. Severe cases may require surgery to repair torn ligaments and/or reattach muscles and tendons.

• Tendinitis

  Overview:

  Tendinitis occurs when the tendon, connecting muscle to bone, becomes inflamed or irritated commonly caused by overuse or sudden injury. Most likely to develop in the shoulder, knee, elbow, heel, or wrist, tendinitis can be caused by repetitive motion required to perform a certain task at a job or in sports such as tennis, golf, or basketball. In severe cases, tendinitis may lead to surgery due to ruptured tendon.

  Symptoms may include:

  • dull, aching pain that occurs during upon movement
  • tenderness
  • warmth, or redness of the affected area
  • mild swelling
  • a lump may develop along the tendon affected

  Treatment/procedure options:

  Treatment options include applying ice to the affected area, rest, anti-inflammatory medications, physical therapy exercises, injections, and assistive devices such as a brace to immobilize the muscles surrounding the injured tendon. If symptoms do not improve despite non-surgical treatment, our surgeons are experienced with minimally invasive tendon treatments that can be performed in the office without general anesthesia. Our surgeons also perform the entire spectrum of arthroscopic and open surgery for these conditions.

• Trigger finger

  Overview:

  Trigger finger occurs when your fingers or thumb becomes stuck in a bent position. Trigger finger can occur in one or more fingers and is more commonly experienced in people who engage their fingers and/or thumb in more strenuous or repetitive motions due to a job, hobby, or task. Inflammation of the tendon impedes mobility through the sheath tunnel causing it to become locked in position.

  Symptoms may include:

  • pain
  • swelling
  • finger stiffness, especially in the morning
  • tenderness
  • locking in bent position

  Treatment/procedure options:

  Conservative treatment includes rest, gentle stretching exercises, or use of a splint. Additional options include injections and surgical procedures such as a percutaneous release which can be performed in the clinic and entails breaking apart the constriction with a needle avoiding damage to the tendon or nerves. Surgery in an operating room can also be performed by making a small incision near the base of the finger to cut open the tendon sheath giving way to the tendon so that it can move through the tunnel more easily.