Marc J. Elkowitz, M.D., F.A.C.S - Harry H. Intsiful, M.D., F.A.C.S - Sophie Bartsich, M.D., F.A.C.S
Aksana Jensen, Aesthetician
Tendons are long flat pieces of tissue that attach muscle to bone. When a tendon is injured, movement can be limited, and when it is completely cut, movement does not occur. Some partial tendon injuries can be managed without surgery, but they require several weeks to heal. Cut tendons require repair, and sometimes grafting to re-establish length.
Whether treated surgically or not, tendon healing often produces significant scar tissue. Scarring can lead to stiffness and pain. Often, extensive hand therapy and a high level of patient participation are required for successful outcomes. Timely management and compliance with activity limitations, as well as strict adherence to physical therapy guidelines are crucial to achieve good function of the injured hand.
Nerves/Nerve Injuries/Compression Syndromes
Carpal Tunnel Syndrome (CTS) is a condition brought on by increased pressure on the median nerve at the wrist. When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hand and fingers. Electrodiagnostic studies may be done to confirm the diagnosis of carpal tunnel syndrome as well as to check for other possible nerve problems.
Symptoms may often be relieved without surgery. Identifying and treating medical conditions, changing the patterns of hand use, or keeping the wrist splinted in a straight position may help reduce pressure on the nerve. Wearing wrist splints at night may relieve the symptoms that interfere with sleep. A steroid injection into the carpal tunnel may help relieve the symptoms by reducing swelling around the nerve.
When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve. Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.
Hand fractures are common. A fracture may cause pain, stiffness, and/or loss of movement. Some fractures will cause an obvious deformity, such as a crooked finger, but many fractures do not.
Medical evaluation and x-rays are usually needed so that your doctor can tell if there is a fracture and to help determine the treatment. Depending upon the type of fracture, your hand surgeon may recommend one of several treatment methods.
A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Some displaced fractures may require realignment of the bone fragments. Once set, the bone may need to be held in place with wires, pins, or metal plates and screws.
Once the fracture is healed, physical therapy is often required to relieve stiffness. Successful bony healing and good functional outcomes depend largely on patient compliance and adherence to prescribed wound care, activity limitations, and physical therapy.
Roughly one in every one thousand babies born has an abnormality in hand or arm development. These malformations can range from extra fingers, to webbed hands, to full absence of bones or other structures. In some cases, surgical treatment is best performed in infancy, while in others, it is preferable to wait until the child is older.
Ultimately, hand function is critical to all children and adults, and early involvement of a skilled hand surgeon is critical to achieving maximal outcomes and a working limb. In many cases, the patient will require multiple procedures and extensive physical therapy. Having an experienced team of therapists, surgeons, and pediatricians offers the best chance of ultimate success.