Hand and wrist surgical treatments
Open reduction internal fixation
Some hand fractures (broken bones in the hand) need surgery to put the bones back together correctly and make them stable. These fractures usually break through the skin or result from a crushing accident. Our hand specialists can put the bones back in place and use tiny wires, screws or plates to hold them together.
Arthroscopic surgery can smooth bone surfaces and remove inflamed tissue. It is used to treat several wrist conditions, including:
- Chronic wrist pain: Your doctor can do arthroscopic exploratory surgery to find the cause of chronic wrist pain if other tests do not show the problem. A wrist injury can cause tissue inflammation or cartilage damage that does not show on an X-ray or other scan. In some cases, our hand specialists can find and treat your condition during the same arthroscopic surgery.
- Wrist fractures: Small fragments of bone can stay inside the joint after a bone breaks (fractures). Using wrist arthroscopy, your doctor can take out these fragments put the bone ends back together correctly and make the joint more stable.
- Ganglion cysts: Ganglion cysts usually grow from a stalk between two of the wrist bones. During arthroscopy, our hand experts can take out this stalk. This can make it less likely that these cysts will return.
- Ligament and triangular fibrocartilage complex tears (TFCC tears): Ligaments are bands of connective tissue that link bones together. They support the joints and make them more stable. The TFCC is a cushioning structure inside the wrist. If you fall on your outstretched hand, this can tear ligaments, the TFCC or both. You might have pain when you move your hand or feel a clicking sensation. During arthroscopic surgery, your hand surgeon can repair these tears.
The radius is the larger of your two forearm bones. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the radius breaks near the wrist.
If your fracture is stable, usually immobilization of the joint either through a cast or splint is done. Following healing and cast or splint removal, a period of rehabilitation for recovery of strength and range of motion is necessary. Nonsurgical treatment depends on many factors, such as your fracture severity, age and activity level as well as the treatment your doctor recommends will work best for you.
There are many ways of performing surgery on a distal radius fracture. Your hand specialist will determine what is best in your situation. Even if the fracture is treated in the operating room, it may be possible to put the bones back together without making an incision. In other cases, your doctor might need to make an incision to put your broken bones back into place.
Depending on the fracture, there are several ways to holding the bone in the correct position, including:
- A cast
- Tiny metal pins
- A plate and screws
- An external fixator (a piece of equipment like a brace that you wear outside your body)
- A combination of these
Our doctors are experienced at using the latest technology to help you heal.
If you think a broken (fractured) finger is a minor injury, think again. Without proper treatment, a fractured finger can cause major problems.
The bones in a normal hand line up precisely and let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can put your whole hand out of alignment. Without treatment, your broken finger might stay stiff and painful.
Your doctor will put your broken bone back into place, usually without surgery. You'll receive a splint or cast to hold your finger straight and protect it from injury while it heals. Sometimes, your doctor may splint the fingers next to the broken one to give it support. Your doctor will let you know how long to wear the splint. Usually, a splint on a fractured finger is worn for about three weeks. You may need more X-rays as you heal, so your doctor can check on how your finger is healing.
Depending on the type of fracture and how severe it is, you may need surgery. Your doctor can use tiny pins, screws or wire to put the broken bones back together.
If you have carpal tunnel syndrome, you may have numbness or tingling in the hand, sometimes with pain up the arm. This is caused by pressure on a nerve that passes through a narrow space in your arm called the carpal tunnel. Pressure can build up inside the tunnel for many reasons; including irritation and swelling of the tissue that covers the tendons.
If your carpal tunnel syndrome does not get better with nonsurgical treatment, our hand specialists can do surgery for this condition. Your doctor will make the carpal tunnel larger to take pressure off the nerve and relieve your symptoms.
The scaphoid is one of the small bones in your wrist. It is the one most likely to break.
Treatment of scaphoid fractures depends on the location of the break in the bone.
Most scaphoid fractures heal well when they are placed in a cast. Depending on where the bone is broken, you will probably wear the cast below or above the elbow.
When the scaphoid is broken in the middle or close to your forearm, your doctor might recommend surgery. A screw or wire might be used to stabilize the scaphoid while it heals.
Shoulder and elbow surgical treatments
Shoulder replacement surgery, also called shoulder arthroplasty, works well for many people to relieve shoulder pain.
In this procedure, your doctor will replace the worn-out shoulder joint with artificial implants. This will relieve pain and help your shoulder work better. Arthroplasty is usually done only after you have tried nonsurgical treatment such as such as physical therapy or taking anti-inflammatory medicines.
In arthroscopy, your doctor looks inside the joint with a tiny camera to diagnose and treat joint problems. With shoulder arthroscopy, the doctor can see inside the shoulder without making a large incision. The latest cameras provide higher resolution, so this procedure is even more effective. If needed, our shoulder specialists can perform complex surgery through the scope.
Your doctor may recommend arthroscopy for shoulder problems including:
- Damaged cartilage
- Shoulder instability
- Torn ligaments or tendons
- Torn rotator cuff
- Bone spur or inflammation around the rotator cuff
- Shoulder impingement syndrome
This procedure is often called a reverse shoulder replacement. It uses a ball-and-socket joint, but the ball is placed on the shoulder blade and the socket is placed on top of the arm bone. This is the reverse of our normal anatomy.
The reverse shoulder replacement is designed for patients who do not have a functioning rotator cuff, and so do not have normal shoulder anatomy. The reverse shoulder replacement is a good option for taking care of this complicated problem.
Your rotator cuff is a collection of tendons around the shoulder that allows the arm to reach forward and up. When these tendons are torn, it becomes painful or impossible to reach overhead.
Surgery on the tendons can often restore full arm movement and reduce pain. In most cases, your doctor can do arthroscopic surgery using a tiny camera to see inside the area without making a large incision.
Fracture repair of the arm
Open reduction internal fixation is a way of repairing a fractured (broken) bone with surgery. It usually involves using plates and screws or a rod to stabilize the bone.
Shoulder and elbow fractures can be very difficult to repair. Our surgeons have the technical skills needed to repair these fractures and have also developed many devices that can help in treating these conditions.
If you fall on your shoulder, a broken clavicle could be the result. Our doctors often see people who break their clavicles in bicycling, skiing and snowboarding accidents.
Clavicle fractures do not always heal well on their own because the shoulder cannot be placed in a cast. Many clavicle fractures can be treated without surgery, but you may need surgery if the bones are pushed very far out of place or you are very active.
Physical therapy helps patients move better after illness, injury or disability. Exercise, skilled massage and other therapies are used to regain function. Physical therapy can help hand and upper extremity patients:
- Improve range of motion, strength, flexibility and endurance.
- Manage pain, reducing the need for medication.
- Avoid, prepare for and recover from surgery.
- Manage age-related health issues.
- Return to optimal sports form.
Injections are used to treat a variety of conditions. For example, steroid injections can be used to treat inflammatory conditions such as De Quervain's tendonitis, trigger finger (stenosing tenosynovitis), carpal tunnel syndrome, arthritis, tennis elbow (Lateral Epicondylitis), and rotator cuff tendonitis.
This therapy helps you do everyday activities (occupations) after an illness or injury. These might include eating, cooking, using a computer, grooming and taking part in hobbies. By including meaningful activities in your rehabilitation, occupational therapy enables you to do the tasks you need or want to do at work, home and elsewhere.
Orthopaedic manipulation is the planned and carefully managed manual movement of the musculoskeletal system, extremities, and spine to produce increased motion. It is often used to release tightening and increase range of motion.
Electromyography, or EMG, is a diagnostic test that measures the electrical activity inside your muscles. Because muscles produce electrical signals when they contract, electromyography can help your doctor see if they’re working correctly.
You might have an EMG if an imaging test such as an MRI doesn’t adequately explain your symptoms or if the doctor thinks more than one health problem could be causing your symptoms.
Nerve conduction studies measure how quickly electrical signals travel along your nerves. The studies, also called NCS, offer one way to test how well your nerves are working. You might have NCS if an imaging test such as an MRI doesn’t adequately explain all your symptoms or if the doctor thinks more than one health problem could be causing your symptoms.
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Adam Mirarchi, M.D. earned his M.D. at Temple University, completed a residency at University Hospitals in Cleveland and completed a fellowship in Hand /Upper Extremity Surgery at Brigham and Women's Hospital in Boston. He specializes in caring for the hand, shoulder and elbow.
Robert Orfaly, M.D. received his M.D. from McGill University, completed his residency at the University of British Columbia and completed fellowships in hand and upper extremity surgery and shoulder surgery. He specializes in hand, shoulder and elbow treatment.
Omar Nazir, M.D. received his M.D. from Northeast Ohio Medical University and completed his residency at Wake Forest University Baptist Medical Center. He has advanced training in hand upper extremity surgery as well as microsurgery. His fellowship training involved principles of both plastics and orthopaedic surgery, offering him a unique viewpoint for upper extremity problems.