crystal clinic orthopaedic center summit hand

Hand

Hand Anatomy

The human hand is made up of the wrist, palm, and fingers and consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, and many blood vessels and nerves.

Hand Anatomy

The hands enable us to perform many of our daily activities such as driving, writing and cooking. It is important to understand the normal anatomy of the hand to learn more about diseases and conditions that can affect our hands.

Bones

The wrist is comprised of 8 carpal bones. These wrist bones are attached to the radius and ulna of the forearm to form the wrist joint. They connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger at a joint called the metacarpophalangeal joint or MCP joint. This joint is also commonly referred to as the knuckle joint.

The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two interphalangeal joints, except for the thumb, which only has 2 phalanges and one interphalangeal joint.

The first joint close to the knuckle joint is called the proximal interphalangeal joint or PIP joint. The joint closest to the end of the finger is called the distal interphalangeal joint or DIP joint.

The MCP joint and the PIP joint act like hinges when the fingers bend and straighten.

Soft tissues

Our hand bones are held in place and supported by various soft tissues. These include: articular cartilage, ligaments, muscles and tendons.

Articular cartilage is a smooth material that acts as a shock absorber and cushions the ends of bones at each of the 27 joints, allowing smooth movement of the hand.

Muscles and ligaments function to control the movement of the hand.

Ligaments are tough rope-like tissue that connect bones to other bones, holding them in place and providing stability to the joints. Each finger joint has two collateral ligaments on either side, which proddts the abnormal sideways bending of the joints. The volar plate is the strongest ligament in the hand.  It joins the proximal and middle phalanx on the palm side of the joint and proddts backwards bending of the PIP joint (hyperextension).

Muscles

Muscles are fibrous tissues that help produce movement. Muscles work by contracting.

There are two types of muscles in the hand, intrinsic and extrinsic muscles.

Intrinsic muscles are small muscles that originate in the wrist and hand. They are responsible for fine motor movement of the fingers during activities such as writing or playing the piano.

Extrinsic muscles originate in the forearm or elbow and control the movement of the wrist and hand. These muscles are responsible for gross hand movements. They position the wrist and hand while the fingers perform fine motor movements.

Each finger has six muscles controlling its movement: three extrinsic and three intrinsic muscles. The index and little finger each have an extra extrinsic extensor.

Tendons

Tendons are soft tissues that connect muscles to bones. When muscles contract, tendons pull the bones causing the finger to move. The extrinsic muscles attach to finger bones through long tendons that extend from the forearm through the wrist. Tendons located on the palm side help in bending the fingers and are called flexor tendons, while tendons on top of the hand help in straightening the fingers, and are called extensor tendons.

Nerves

Nerves of the hand carry electrical signals from the brain to the muscles in the forearm and hand, enabling movement. They also carry the senses of touch, pain and temperature back from the hands to the brain.

The three main nerves of the hand and wrist are the ulnar nerve, radial nerve and median nerve. All three nerves originate at the shoulder and travel down the arm to the hand.  Each of these nerves has sensory and motor components.

Ulnar Nerve:  The ulnar nerve crosses the wrist through an area called Guyon’s canal and branches to provide sensation to the little finger and half of the ring finger.

Median Nerve: The median nerve crosses the wrist through a tunnel called the carpal tunnel. The median nerve provides sensation to the palm, thumb, index finger, middle finger, and part of the ring finger. 

Radial Nerve: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the middle finger.

Blood Vessels

Blood vessels travel beside the nerves to supply blood to the hand. The main arteries are the ulnar and radial arteries, which supply blood to the front of the hand, fingers, and thumb. 

The ulnar artery travels next to the ulnar nerve through the Guyon’s canal in the wrist.

The radial artery is the largest artery of the hand, traveling across the front of the wrist, near the thumb. Pulse is measured at the radial artery. 

Other blood vessels travel across the back of the wrist to supply blood to the back of the hand, fingers, and thumb.

Bursae

Bursae are small fluid filled sacs that decrease friction between tendons and bone or skin. Bursae contain special cells called synovial cells that secrete a lubricating fluid.

Conditions

  • CMC Joint Arthritis

    The carpometacarpal joint attaches the base of the thumb to the wrist. It is formed from two bones, the metacarpal and trapezium.

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  • Trigger Finger

    Trigger Finger

    The ability to bend the fingers is governed by supportive tendons that connect muscles to the bones of the fingers.

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  • Dupuytren's Contracture

    Dupuytren’s Contracture is a hand condition where thickening of the underlying fibrous tissues of the palm cause the fingers to bend inward.

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  • De Quervain's Tenosynovitis

    De Quervain's Tenosynovitis

    The muscles and bones of the hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin soft sheath of tissue known as synovium.

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  • Sport Injuries

    Sports injuries are the injuries that most commonly occur during sports and exercises. These injuries may result from accidents, poor training practices,

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  • Arthritis of The Hand

    Arthritis of The Hand

    Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis.

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  • Boutonniere Deformity

    Boutonniere Deformity

    Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger...

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  • Finger Fractures

    The hand is made up of 27 bones that form the wrist, palm, and fingers. Fingers can easily injure from daily activities...

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  • Finger Dislocations

    Finger dislocation is a condition in which the bone of your finger has moved away from its normal position.

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  • Hand Fractures

    Hand Fractures

    he hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations

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  • Cold Hand

    Cold hands may indicate decreased blood flow which can occur due to blockage or constriction of the blood vessels and vascular disorders.

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  • Raynaud’s Disease

    Raynaud’s disease is a condition which affects the blood vessels causing the hands and feet to not receive enough blood supply during certain periods. During these attacks, the extremities feel cold and numb.

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  • Finger Contractures

    Finger contractures are a feature of Dupuytren’s disease, a condition in which the fascia underneath the skin of the palm and fingers becomes abnormally thick. This causes bumps cords and pits on the hand and the fingers tend to bend towards the palm.

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  • Intrinsic Tightness

    The intrinsic muscles are present deep within the hand and control finger movements. Inflammation or spasms of the hand muscles can lead to tightness of the intrinsic muscles which may be accompanied by pain, stiffness and weakness of the fingers.

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  • Carpal Tunnel Syndrome

    Carpal Tunnel Syndrome

    Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

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  • Hand Pain

    Hand pain is characterized by distress in the joints and tissues of the hand or fingers. Hand pain can be depicted...

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  • Animal Bites

    Animal Bites

    Pets and stray animals often bite people when they feel threatened, or when infected with rabies.

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  • Hand Infections

    Hand Infections

    Hands become infected more frequently as it is one of the commonly injured parts of our body.

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  • Hand Tumors

    Abnormal growths of tissue can occur on the hand forming a lump, mass or tumor. The mass may be benign or malignant and may develop from any of the tissues such as the skin, muscle, bone, or blood vessels.

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  • Skier’s Thumb

    A skier’s thumb is an injury to the ligament that connects the bones of the thumb.

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  • Gamekeeper's Thumb

    Gamekeeper's thumb, also known as skier's thumb, is a tear of the ulnar collateral ligament, a band of tissue that supports the joint at the base of the thumb.

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  • Nerve Injuries

    Nerve Injuries

    Nerves form the central nervous system and are involved in conducting messages from the brain to other parts of the body.

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  • Glomus Tumor

    Glomus tumors are benign tumors that develop in glomus bodies which are temperature regulating vascular structures usually found at the finger tips. The tumor often develops in the tissue under the fingernail.

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  • Tendon Laceration

    A laceration is a tear or ragged opening in the skin usually caused by an injury or trauma.

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  • Median Nerve Palsy

    The median nerve runs through the forearm and supplies the hand with motor and sensory functions. An injury to the arm can damage the median nerve affecting functions such as gripping as well as sensation.

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  • Radial Nerve Palsy

    Radial nerve palsy can occur following injury to the radial nerve in the arm which controls movement and sensation of the wrist and fingers. It is characterized by pain, tingling, numbness and difficulty with hand and wrist movements.

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  • Ulnar Nerve Palsy

    The ulnar nerve runs from through the forearm to the little finger helping you grip, make fine finger movements and providing sensation. It may be injured along its course resulting in loss of sensation, weakness and difficulty with certain hand movements.

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  • Carpometacarpal Boss

    A carpometacarpal boss is a bony overgrowth at the lower end of the metacarpal bones of the index or middle fingers where they join the carpal bones. It appears as a lump at the back of the wrist.

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  • Burns

    A burn occurs when living cells or tissues get damaged due to contact with heat or certain chemicals. The severity of the burn depends on the intensity of the heat, the caustic nature of the chemical and the length of time the tissues remained in contact with either.

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  • Finger Tip Injuries

    The finger tips are commonly injured as the hands are used for various activities. The finger tips may be crushed or jammed or cut with a sharp object.

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  • Golf/Baseball Injuries to Hand Wrist and Elbow

    The hand and wrist may get injured while playing golf or baseball due to overuse or poor technique. Injuries can occur to the ligaments, tendons bone or blood vessels.

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  • Gout and Pseudogout

    Gout is a very common, painful form of arthritis which causes swelling, redness and stiffness of the joints.

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  • Jersey Finger

    Jersey finger is an injury in which the tendon that flexes the tip of the finger is avulsed from its insertion in the bone. The ring finger is commonly affected.

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  • Mallet Finger

    mallet-finger.png

    Mallet finger is a condition where the end of the finger is bent and does not straighten. It occurs when the extensor tendon...

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  • Nail Bed Injuries and Deformity

    A nail is the hard covering at the end of the dorsal side of your fingers and toes. The nail is composed of a nail plate...

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  • Jammed (Stoved) Finger

    A jammed finger is an injury caused by forced flexion of the finger which often occurs during sports. It can cause damage to the ligaments, tendons and bone and may lead to permanent problems if not treated.

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  • Osteoarthritis

    Arthritis or joint inflammation can affect the bones and joints in the hand. Osteoarthritis is a type of arthritis where inflammation is produced as cartilage at the joint surface wears away or is injured.

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  • Numb Hand

    Hand numbness can result from nerve compression due to conditions such as carpal tunnel syndrome; neuropathy from conditions such as diabetes, myofascial pain syndrome or certain medications.

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  • Psoriatic Arthritis

    Psoriatic Arthritis

    Psoriatic arthritis (PsA) is an autoimmune disease that includes both psoriasis and a related form of arthritis.

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  • Rheumatoid Arthritis

    Rheumatoid arthritis is an autoimmune condition which means that the body’s immune system attacks its own tissues. It affects the lining of joints resulting in pain, swelling, bone loss and deformity and can affect other tissues as well.

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  • Swan Neck Deformity

    This is a deformity in which the middle joint of a finger is abnormally bent backwards while the end joint bends forwards. This occurs due to a ligament or tendon injury or deficit on the palm side of the hand.

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  • Vascular Disorders

    Disorders of the arteries and veins affect blood flow and can rarely in the upper extremities. They may be associated with conditions such as diabetes and high blood pressure and can cause pain, wounds and loss of a part of the hand.

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  • Systemic Lupus Erythematosus

    SLE is a chronic auto-immune disorder affecting mainly joints, kidneys and skin.

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  • Infectious Arthritis

    Infectious arthritis is a condition in which a joint becomes inflamed due to infection. The infection is commonly caused by bacteria and spreads from another part of the body through the bloodstream.

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  • Post Traumatic Arthritis

    Post-traumatic arthritis is inflammation of the joint that occurs due to cartilage loss following an injury to the joint. The injury changes the joint structure and mechanics causing cartilage to wear off more quickly.

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  • Snow blower And Lawnmower Injuries

    Proper safety precautions should be maintained while operating snow blowers and lawnmowers as you can suffer injuries to the hands and fingers while trying to remove objects that get stuck in them. Injuries can range from mild surface cuts to deep tissue damage affecting function.

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  • Juvenile Rheumatoid Arthritis

    Juvenile rheumatoid arthritis, also called juvenile idiopathic arthritis is an autoimmune condition in which the joint becomes inflamed and arthritic in children and adolescents below the age of 16.

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  • Polymyalgia Rheumatica

    Polymyalgia Rheumatica is a rheumatic disorder characterized by pain, swelling, and inflammation in the joints.

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  • Fibromyalgia

    Fibromyalgia is a complex chronic disorder characterized by widespread body pain that affects individuals physiologically, mentally and socially.

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  • Polymyositis

    Polymyositis is a rare connective tissue disorder that causes inflammation and weakness of muscles.

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  • Mucous Cysts

    Mucous cysts are sacs filled with fluid that develop on the fingers. It usually affects people with arthritis between the ages of 50 to 70 years.

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  • Sagittal Band Injuries

    This injury which is also referred to a boxer’s knuckle is caused by dislocation of an extensor tendon in the hand. It usually affects the middle and index fingers which are typically injured during boxing.

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  • Rheumatoid Hand

    Rheumatoid arthritis can lead to pain, swelling and joint deformities in the hand and wrist. This can lead to inability to grasp or pinch and make it difficult to perform daily activities.

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  • Midcarpal Instability

    There are 2 rows of small bones in the wrist called carpal bones. Midcarpal instability is a condition characterized by instability between these two rows of bones.

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  • Bowlers Thumb

    Bowler’s Thumb is a condition in which repeated friction or pressure on the inside of the thumb affects the ulnar nerve resulting in symptoms such as numbness, tingling and pain. It commonly affects bowlers, especially if they use bowling balls with tight thumb holes.

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  • Jersey Finger

    Jersey finger is an injury in which the tendon that flexes the tip of the finger is avulsed from its insertion in the bone. The ring finger is commonly affected.

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  • Paronychia, Felon, Collar Button Abscess, Pyogenic Flexor Tenosynovitis

    Paronychia is an infection of the nailfold or the skin the borders the nail. It is a common infection which usually affects children

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  • Fight Bite Injury

    A bite from another person may be mild to severe but the risk of infection is high as the human mouth contains many organisms.

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  • Epidermal Inclusion Cyst

    An epidermal inclusion cyst is a benign tumor filled with a cheese-like substance called keratin that can develop underneath the skin in areas of previous injuries such as a cut or puncture.

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  • Giant Cell Tumor of Tendon Sheath

    Tendon sheaths are membranous sheaths that protect and lubricate tendons allowing them to move freely. A giant cell tumor is a type of tumor that sometimes develops in the tendon sheaths of the hand and wrist.

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  • Enchondroma

    Enchondromas are tumors that arise from cartilage, the tissue from which most bones develop.

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  • Neuroma

    Neuroma is a painful tumor that develops on nerve tissue due to scarring following trauma or surgery.

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  • Sport Injuries

    Sports injuries are the injuries that most commonly occur during sports and exercises.

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  • Nerve Tumor

    Nerve tissue in the hand and wrist may show abnormal growth forming a mass or tumor. These tumors may be benign or malignant and can cause pain and loss of function.

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  • Acute Compartment Syndrome Hand and Forearm

    Compartment syndrome is a condition in which pressure develops within muscle tissue obstructing the flow of blood which carries oxygen and nutrients. A severe injury to the hand and forearm may cause an acute form of this condition which can result in permanent muscle damage if not treated emergently.

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  • Hook, Pincer, Split Nail Deformity

    The fingernails can sometimes grow abnormally. Common nail deformities include hook nail where the nail curves down towards the tip of the finger like a hook, pincer nail where the nail curves from side to side with the lateral edges directed into the nail bed, and split nail where scar tissue proddts a segment of nail from growing giving the remaining nail a split appearance.

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  • Frostbite

    Frostbite is an injury to the skin and underlying tissues when exposed to very low temperatures. It often affects the fingers and toes causing them to become hard, pale and numb.

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  • Hand Masses

    Abnormal growths of tissue can occur on the hand forming a lump, mass or tumor. The mass may be benign or malignant and may develop from any of the tissues such as the skin, muscle, bone, or blood vessels.

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Procedures

  • Thumb CMC Joint Arthroplasty

    Thumb arthroplasty is a surgical procedure to treat arthritis affecting the joint at the base of the thumb. This surgery helps restore mobility and function to the thumb.

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  • Endoscopic Carpal Tunnel Release

    The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form the bottom and sides of the carpal tunnel and a strong band of connecting tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.

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  • Tendon Repair

    Tendons of the hand attach muscles to bone and enable hand movements. A tendon repair procedure may be necessary to treat injured tendons by stitching torn tendons together or using a tendon graft.

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  • Open Carpal Tunnel Release

    The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form...

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  • Metacarpophalangeal Joint Arthroscopy

    The metacarpophalangeal joints are the joints between the finger bones and the hand bones. Problems with these joints can be treated by arthroscopic surgery which involves insertion of a narrow tube-like instrument through which the joint can be viewed and operated on.

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  • CMC Arthroscopy

    The carpometacarpal joints are the joints between the hand bones (metacarpals) and the wrist bones (carpals). Problems with these joints can be treated by arthroscopic surgery which involves insertion of a narrow tube-like instrument through which the inside of joint can be viewed and operated on. The procedure is commonly performed on the thumb CMC joint to treat arthritis.

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  • Tendon Transfers

    Tendon transfer surgery is a surgery to restore the lost functions of the hand by shifting functioning tendon from...

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  • Dupuytren's Release

    Dupuytren’s Contracture is a hand condition where thickening of the underlying fibrous tissues of the palm cause the fingers to bend inward.

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  • Xiaflex Injections for Dupuytren's Disease

    Dupuytren's contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands which leads to curving of the finger.

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  • Fracture Care for Hand and Fingers

    Stable fractures of the hand and fingers may be treated with a cast or splint. Unstable fractures in which the bones have shifted are treated by repositioning the bone fragments and stabilizing them with pins, screws and plates. A bone graft may be necessary if there is severe damage.

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  • Extensor Tendon Repair and Reconstruction

    The extensor tendons are present on the back of the hand and help extend or straighten the wrist and fingers. Severe extensor tendon injuries require surgical repair with stitches or reconstruction with a graft.

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  • Flexor Tendon Repair and Reconstruction

    The flexor tendons are present on the palm side of the hand and help bend the wrist and fingers. Severe flexor tendon injuries require surgical repair with stitches or reconstruction with a graft.

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  • DIP Arthrodesis

    Arthritis can affect the distal interphalangeal (DIP) joint or the end joint in a finger causing pain and deformity. Arthrodesis is surgery to fuse this joint so that it becomes less painful.

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  • PIP Arthrodesis and Arthroplasty

    Arthritis can affect the proximal interphalangeal (PIP) joint or the first joint in a finger causing pain, dysfunction and deformity. PIP joint problems may be treated by arthrodesis (fusion of the joint) to control pain or arthroplasty (replacement of the joint) to restore function.

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  • MCP Arthroplasty and Arthrodesis

    Arthritis or injury can affect the metacarpophalangeal (MCP) joints or the knuckle joints causing pain, dysfunction and deformity. Problems with the MCP joints are usually treated by arthroplasty (replacement of the joint) or arthrodesis (fusion of the joint).

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  • Wide Awake Surgery

    Wide awake hand surgery is performed using only local anesthesia, so the patient remains awake throughout the procedure. Several hand procedures such as carpal tunnel release or tendon surgery may be performed using this technique.

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  • Soft Tissues

    Our hand bones are held in place and supported by various soft tissues. These include articular cartilage, ligaments, muscles and tendons.

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  • Hemi Hamate Arthroplasty

    The hamate bone is a wrist bone which is often used to obtain a graft for treating avulsion fractures of the finger joints.

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  • Skin Grafting

    Hand injuries can result in severe skin loss requiring a skin graft which help cover wounds and proddt infection. They are usually obtained from the forearm or thigh.

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  • Finger Replantation

    Finger Replantation

    Finger replantation is reattachment of a severed finger to restore function and appearance. A severely damaged finger may not be replanted successfully.

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  • Masses Treatment

    Masses or tumors of the hand are usually treated by surgical removal and analysis in the laboratory. Those that are not cancerous or symptomatic may be left as is and monitored for changes.

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  • Finger Contracture Release

    Finger contracture is commonly caused by Dupuytren’s disease, a condition in which the fascia under the skin becomes thick and tight. Surgery may be performed to remove part of this tissue to improve the range of motion of the fingers.

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  • Hand Ultrasound

    Ultrasound imaging of the hand uses the reflection of sound waves to create images of the internal structures of the hand. It is very useful in identifying and evaluating tendon abnormalities, nerve abnormalities, masses, foreign bodies and other conditions affecting the hand.

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  • Neurolysis

    Neurolysis is a procedure that temporarily or permanently destroys nerve tissue using a chemical or physical agent. It is usually done to interrupt the transmission of pain signals.

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  • Scar Tissue Release (Tenolysis)

    Scar tissue can develop as part of the healing mechanism after an injury or surgery to the hand. Tenolysis is a procedure to free the tendons of the hand of scar tissue or adhesions that are restricting hand movements.

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  • The American Board of  Orthopaedic Surgery
  • Allegheny General Hospital
  • University of Pittsburgh  Medical Center
  • University of Cincinnati College of Medicine
  • American Society for Surgery of the Hand
  • American Association for Hand Surgery: AAHS
  • Alpha Omega Alpha