Hand & Wrist

The hand and wrist consist of dozens of bones, joints, ligaments, tendons, and muscles that need to work together seamlessly in a variety of positions hundreds of times a day. As such, they often require highly specialized medical care when they become injured.

Newborn & Infant Pediatric Hand Clinic

Florida Orthopaedic Institute sees newborns and infant patients with congenital differences of the upper extremity, brachial plexus birth palsy, cerebral palsy, neuromuscular disorders, syndromes, and acute trauma and post-traumatic reconstruction

Led by Michael J. Garcia, M.D. and Alfred V. Hess, M.D., they have a combined experience of over 50 years.

To schedule an appointment, call (813) 978-9797, and specify “Pediatric Hand Clinic.”

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that causes numbness, tingling, weakness and other symptoms in the hand and arm because of pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand through a narrow passageway on the palm side of your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).

Pressure can come from swelling or anything that makes the carpal tunnel smaller such as health problems (hypothyroidism, rheumatoid arthritis, and diabetes), repetitive hand or wrist motions and pregnancy.

Tingling, weakness, numbness, or pain in the fingers or hand are some of the symptoms of carpal tunnel syndrome. They most often occur in the thumb, index finger, middle finger, and half of the ring finger. Some people experience pain in their arm between their elbow and their hand.

Proper treatment can relieve the tingling and numbness and restores wrist and hand function, starting with nonsurgical therapies.

Solutions for Peripheral Nerve Injuries

Peripheral nerve injuries happen to more than 1.4 million Americans every year, with nearly 900,000 needing surgical intervention. In the past, surgeons have used the patient’s nerves from another part of their body to repair the damage. Now surgeons at Florida Orthopaedic Institute are pioneering nerve repairs with new products from AxoGen. Learn more about how AxoGen’s products are helping with peripheral nerve reconstruction.

WRIST FRACTURES

The terms “wrist fracture” or “broken wrist” can be confusing or unclear because there are many bones in and around the wrist.

The most common type of wrist fracture is a distal radius fracture, which is a break near the wrist end of the long radius bone in the forearm. This fracture usually occurs as the result of a fall onto an outstretched hand.

There are several other possible types of wrist fractures that can occur. The second most common type of wrist fracture is a scaphoid fracture.

In the wrist, there are eight small round bones that sit in two rows, including the scaphoid bone. The scaphoid bone is near the base of the thumb, just above the long bone of the forearm, the radius.

Scaphoid fractures almost always are the result of a fall onto an outstretched hand but can also occur as the result of sports activities or car accidents.

Thumb Ulnar Collateral Ligament (UCL) Injuries

Common among athletes, this injury happens when an ulnar collateral ligament (UCL) gets stretched too far or tears. The ulnar collateral ligaments are tough and flexible tissues that connect bones in the thumb.

Because skiers are prone to this injury when they fall with their hand strapped to a ski pole, it is sometimes called “skier’s thumb.” A thumb UCL injury can make the thumb feel unstable and be very painful. It can also limit movements, such as squeezing and gripping.

According to recent research, 49% of thumb ulnar collateral ligament injuries were caused by a fall onto an outstretched hand. Only 2.4% were due to skiing injuries, with sports accounted for most of the rest.

FRACTURED FINGERS

A broken or fractured finger is not a minor injury, even though the bones in the hand are small. The bones in the hand line up precisely so you can perform many specialized functions, such as holding small objects. A fractured finger bone can cause your whole hand to be out of alignment. Your broken finger might stay stiff and painful without treatment.

Approximately 6 million Americans suffer from at least one broken bone every year, and finger fractures account for up to 10% of all broken bones.

There is no difference between finger fractures and breaks. While some people believe that a “fracture” refers to a crack while a “break” is a separated bone, “fracture” is the term medical professionals use to describe any crack or break in a bone.

Fractured finger symptoms include swelling, tenderness, and bruising at the fracture site, inability to move the injured finger completely, and deformity of the injured finger.

Flexor Tendonitis

The flexor tendon connects the muscles to the bone in your hand. When there is a strain on the tendons flexor tendonitis can occur, making it difficult and painful to bend your thumb or fingers. Sometimes flexor tendonitis can stop hand movement altogether.

WALANT (Wide Awake Local Anesthesia No Tourniquet)

WALANT (Wide Awake Local Anesthesia No Tourniquet) is an operating technique that uses two medications (lidocaine and epinephrine) for some types of hand and wrist surgeries in a safe and painless manner. This technique eliminates the use of tourniquets and general anesthesia. WALANT has many advantages including no preoperative testing, no costs associated with anesthesia, no need for an IV, and a lower overall cost.

SUDDEN (ACUTE) FINGER, HAND, AND WRIST INJURIES

Even though most of our movements don’t cause problems, minor injuries to the finger, hand, or wrist that cause pain or swelling are common. can develop from everyday wear and tear, injuries, or overuse.

Some of the more common finger, hand, and wrist injuries include bruises, sprains, specific injuries to ligaments (skier’s thumb), injuries to tendons (mallet finger), strains (pulled muscles), broken bones (fractures), crushing injury (leading to Compartment Syndrome and dislocations.

Ulnar Neuritis

Ulnar neuritis, also known as cubital tunnel syndrome, is an inflammation of the ulnar nerve in the arm that causes numbness or weakness in the hand. The ulnar nerve gives feeling to the little finger and half of the ring finger and is more commonly known as the “funny bone.” The ulnar nerve controls most of the small muscles in the hand that help with delicate movements and some of the bigger muscles in the forearm that help create a strong grip.

Activities that place constant pressure against the ulnar nerve at the elbow or wrist can cause ulnar neuritis. It can also be caused by repetitive motion at the elbow or wrist.

Targeted Muscle Reinnervation (TMR)

Targeted Muscle Reinnervation (TMR) is a surgical procedure that gives amputees easier, more intuitive prosthesis control. The nerves to spare muscles of an amputated patient are cut and/or de-activated (denervated), then reinnervated with residual nerves of the amputated limb. EMG (Electromyography) signals of the targeted muscle can be used to drive motorized prosthetic devices. The reinnervated muscles serve as biological amplifiers of the amputated nerve motor signals, allowing for better control of sophisticated prosthetic arms.

Wrist Tendonitis

When a tendon — the thick fibrous cords that attach muscle to bone – is inflamed or irritated, the condition is called tendonitis. It causes pain and tenderness just outside a joint, like the wrist. Tendonitis can occur in any of your tendons.

Wrist tendonitis is a common condition characterized by irritation and inflammation of the wrist joint where many tendons surround the joint. Wrist tendonitis usually affects one of the tendons, but it can also involve two or more. Wrist tendonitis often occurs at points where the tendons cross each other or pass over a bony prominence.

WRIST SPRAINS

Wrist sprains can also result from accidents or falls around the home or work. They are also common and painful sports injuries.

Our natural instinct is to put our hands out to break a fall. In doing so, the wrist can get bent back, stretching, twisting, or tearing the ligaments connecting the bones in your wrist and hand. Wrists can also be sprained when there is a direct blow to the wrist.

To learn more about the symptoms, diagnosis and treatment of wrist sprains, click below.

GANGLION CYSTS

Ganglion cysts, also called bible cysts, are noncancerous lump, often on the tendons or joints of wrists and hands. Ganglion cysts are common with more than 200,000 cases in the United States per year.

Ganglion cysts are round, small, and usually painless. They do not spread to other areas. Although rare, they can be painful if they press a nerve. In some cases, the cyst can interfere with joint movement.

The cause of ganglion cysts is unknown. A ganglion cyst often clears on its own. If troublesome, it can be drained or removed.

DUPUYTREN’S DISEASE

Also called Dupuytren’s contracture, it is a gradual thickening and tightening of tissue under the skin in the hand. It is fairly common, with over 200,000 cases in the United States every year.

Over time, Dupuytren’s contracture (also known as palmar fibromatosis) can cause one or more fingers to stay bent toward the palm. This can complicate everyday activities, such as placing hands in pockets or shaking hands.

It can last for years or be lifelong and most often affects the ring and pinky fingers.

Trigger Finger

Trigger finger, also called trigger thumb, is a condition in which a finger gets stuck in a bent position and then snaps straight. In the United States, there are more than 200,000 cases per year.

When the tendon in the affected finger becomes inflamed, trigger finger occurs. It most commonly effects women, people with diabetes or arthritis, and people whose regular activities strain their hands.

Symptoms can include stiffness, a popping or clicking sensation, and tenderness in the affected finger.

FINGER DISLOCATIONS

Finger dislocations are joint injuries that happen when finger bones move apart or sideways and out of normal alignment. They can happen when the bones of a finger are moved (dislocated) beyond their normal range of motion.

Finger dislocation is a common injury usually caused by a “jamming” force applied to the end of the finger, or the finger forcefully overextended. Either of these situations, and sometimes a combination of both, can result in a dislocation.

RHEUMATOID ARTHRITIS OF THE HAND

Rheumatoid arthritis, also called RA, is a chronic inflammatory disorder affecting many joints, including those in the hand. In rheumatoid arthritis, the body’s immune system attacks its own tissue, affecting joint linings and causing painful swelling. Over time, the inflammation can cause bone erosion and joint deformity.

Rheumatoid arthritis is common, with over 200,000 cases in the United States every year. The condition can’t be cured but treatment can help. Physiotherapy and medication can help slow the disease’s progression. Many cases are managed with a class of medications called anti-rheumatic drugs (DMARDS).

Wrist Arthroscopy

Wrist arthroscopy is a minimally invasive technique which can be used for diagnostic purposes as well as for therapeutic interventions. First introduced in 1979, wrist arthroscopy became accepted as diagnostic tool around the mid-1980s.

Wrist arthroscopy utilizes a small fiber optic instrument called an arthroscope that lets the surgeon to see inside the joint, without making large incisions into the muscle and tissue.

Basal Joint Surgery

Arthritis of the thumb happens when the thumb joint cartilage (carpometacarpal joint) wears away from the bone. This condition is also known as basal joint arthritis. Normally the cartilage acts as a cushion between the bones of the joint. When it is worn away, the direct contact and friction between the bones causes pain, swelling, decreased strength and limited range of motion.

Basal joint arthritis makes it difficult to grip and hold or twist objects between the thumb and fingers. It can be difficult to performing simple tasks such as turning a doorknob, opening a jar and pinching or gripping an item. Although it may be successfully treated with non-surgical options such as medications, severe cases of basal joint arthritis usually need surgery. Basal joint surgery removes and rebuilds the basal joint.

COLLES’ FRACTURES (BROKEN WRISTS)

A Colles’ fracture is a type of fracture in which the broken end of the radius is bent backwards. Colles’ fractures typically occur from a fall on an outstretched hand, but risk factors also include osteoporosis. These types of fractures are also called broken wrists.

Colles’ fractures are common – about 15% of people have a Colles’ fracture at some point in time. Colles’ fractures occur more commonly in young adults and older people than in children and middle-aged adults, and in more women than men.

The fracture is named after Abraham Colles who first described it in 1814.

DE QUERVAIN’S TENOSYNOVITIS

De Quervain’s tenosynovitis, also called radial styloid tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. The condition can worsen with repetitive hand or wrist movements.

There are more than 200,000 cases of de Quervain’s tenosynovitis per year in the U.S.

Primary symptoms are pain and tenderness in the wrist, often below the base of the thumb.

The condition is treatable by a medical professional and requires a medical diagnosis, with lab tests or imaging usually not required.

Peripheral Nerve Surgery (Hand) Revision

Several different reasons can cause hand-related nerve damage. Traumatic injuries are a common cause, such as a significant fall or a car accident. An underlying illness like Diabetes, Immune system deficiencies, bacterial or viral infections, tumors, or kidney and liver problems are also common factors.

Hand-related nerve damage can also come from repeated exposure to toxic chemicals, alcoholism, chronic use of certain medications, and certain vitamin deficiencies.

If you are experiencing symptoms that might suggest hand nerve damage, contact one of the hand specialists at Florida Orthopaedic Institute.

HAND & FINGER REPLANTATION

For more than 50 years ago, thousands of severed body parts have been reattached, helping preserve the quality of life for thousands of patients through improved function and appearance.

Hand and finger replantation is the reattachment of a finger or hand that has been completely cut from someone’s body. The goal of this type of surgery is to give the patient back as much use of the injured area as possible.

Your surgeon may offer to clean, smooth, and cover the cut end (called a completion or revision amputation replantation) if the detached part is too damaged.

HAND NERVE DECOMPRESSION

Nerve decompression surgery alleviates pressure on a nerve. It is done to either open any narrow spaces to give the nerve more room or remove whatever is pressing on the nerve, or both. Due to the surrounding skeletal structure, some nerves are more prone to compression than others

Peripheral nerve decompression is for conditions that begin somewhere other than the spine, while spinal nerve decompression surgery is in response to conditions caused by pressure on nerve roots in the spine.

REVASCULARIZATION OF THE HAND

Revascularization is the restoration of blood flow (perfusion) to a body part or organ that has suffered a restriction in blood supply to tissues (ischemia), causing a shortage of oxygen needed by your cells.

In hand revascularization, an experienced and skilled hand surgeon repairs injured or damaged blood vessels to fix damaged tissue and restore blood flow to as normal a level possible.

Blood vessel damage can be caused by a traumatic event (injury), disease, high blood pressure, or an obstruction (blockage).

HAND SKIN GRAFTS

Hand skin grafts are used to treat skin damaged by burns, infection, or other injuries. Sheets of healthy skin are removed from one part of the body (the donor site) and placed on the damaged hand. If possible, healthy skin is taken from areas not easily seen or that are usually covered by clothes.

There are two primary types of hand skin grafts: Split-Thickness Skin Graft (STSG) and Full-Thickness Skin Grafts. A split-thickness graft removes the epidermis (the top layer of the skin), as well as a portion of the dermis (the deeper layer of the skin). Full-thickness grafts use all the epidermis and dermis from the donor site. They are generally used for small wounds on highly visible parts of the body, as they blend in with the skin around them for a better cosmetic outcome.

TENDON TRANSFERS OF THE HAND

Tendon transfers restore lost hand function after the loss of muscle or tendon function from a nerve injury (cut, stretched, or torn nerve) or muscle injury (trauma, rheumatoid arthritis). Tendon transfers are also used for neuromuscular disorders (cerebral palsy, stroke, traumatic brain injuries, and spinal muscle atrophy) or congenital disabilities (infants born without certain muscle functions).

Tendon transfer surgery is also used when a muscle has ruptured or been lacerated and cannot be repaired.

FUNCTIONAL NERVE TRANSFERS OF THE HAND

When a nerve injury results in loss of muscle function or sensation, a functional nerve transfer is a surgical technique that is used to restore lost function and sensation.

Nerves with less important roles or branches of a nerve that perform redundant functions are surgically transferred to the nerve area that has been damaged.

The goal of a functional nerve transfer is to restore as much of the nerve’s function as possible. It can allow you to regain feeling and the ability to move and conduct basic activities.

Florida Orthopaedic Institute’s Hand & Wrist center features the Bay Area’s greatest number of years of combined experience in hand and microvascular surgery. Our fellowship-trained microvascular surgeons provide the capability for complex reconstruction, as well as free tissue transfer and limb replantation.