Hand Procedures

Carpal Tunnel

The carpal tunnel is a narrow, fibrous passage in the wrist that protects the median nerve, which runs down the length of arm and through the wrist into the hand. It controls some hand movement, and sensation in the thumb, index and middle fingers, and half of the ring finger. Irritation or compression of the median nerve within the carpal tunnel can cause tingling and numbness in the fingers, a condition known as carpal tunnel syndrome (CTS).


Often, CTS can be effectively treated by avoiding or modifying the activity that is causing symptoms. Additional treatments may include the following:

  • Resting the hands
  • Applying cold packs
  • Taking anti-inflammatory medication
  • Getting corticosteroid injections
  • Wearing splints
  • Getting physical therapy

More severe cases of CTS, such as those that interfere with normal daily activities or are caused by nerve damage, may be treated surgically by cutting the ligament that is pressing on the median nerve. Either endoscopy or open surgery can be used. Postsurgery, activities known to have caused CTS should be stopped, or performed differently.

Trigger Finger

Trigger finger is a common and painful disorder of a finger's flexor tendon that causes the finger to "catch" or "lock" when bent or released. Trigger finger can be caused by repetitive motion of the finger, rheumatoid arthritis, diabetes and gout. Grasping something for an extended period of time can also result in trigger finger.

The fingers and thumb are able to bend and straighten because of tendons and muscles in the hands and arms. A tendon usually moves smoothly through the sheath (tissue) that covers it. However, when a finger's flexor tendon becomes inflamed, it may not be able to move smoothly through the sheath so that, when an attempt is made to bend or release the finger, the pulling of the enlarged tendon through the sheath results in the tendon's catching or locking.


Applying ice, stretching and taking nonsteroidal anti-inflammatory medications are recommended treatments for trigger finger. However, the quickest and most effective treatment is a cortisone injection into the affected tendon's sheath. If the trigger finger does not go away after two injections, and is not helped by ice, stretching or anti-inflammatories, surgery may be recommended.


Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is the most common form of arthritis and it commonly affects the hands because of their frequent use. Arthritis of the hand develops as the cartilage protecting the bones of the finger joints wears down over time. Over the years, as stress is put on the joints, cartilage wears thin and sometimes even erodes completely, resulting in stiffness and pain. Arthritis of the hand may cause the joints to lose their normal shape and limits the motion of the joints within the hand. It occurs more frequently in older individuals, as a result of normal wear and tear over time, that causes cartilage to wear away.

The definitive symptoms of arthritis of the hand are pain, swelling, stiffness and tenderness, although the pattern and intensity may vary. Some individuals feel that the inflamed joints may feel warm or hot to the touch and others may have cysts that develop on the ends of the joints. Damaged cartilage and bone rubbing together may cause a sensation of grating or grinding when the hand is moved.

Treatment for arthritis of the hand focuses on relieving pain and addressing symptoms. It is commonly treated with a combination of methods that may include medication for pain and discomfort such as:

  • Anti-inflammatory medication
  • Prescription pain relievers
  • Corticosteroid injections

Splints may also be used to help support the affected joint and to ease the stress placed on it during frequent use and activities. In severe cases, surgery may be required to smooth irregular tissue surfaces, or to reposition or replace joints through arthroscopy.

Dupuytren's Disease

Dupuytren's contracture is a rare hand deformity in which knots of tissue form under the skin that can pull fingers into a bent position. This makes it difficult for the fingers to straighten and can interfere with normal hand function. Dupuytren's contracture is not usually painful but can lead to other conditions such as plantar fibromatosis. Although the cause of this condition is not known, it may run in families and can be influenced by tobacco and alcohol use.

Mild cases of Dupuytren's contracture that do not have much of an effect on hand function may not require any treatment and can simply be monitored through regular checkups. More severe cases may benefit from steroid injections, radiation therapy, needle aponeurotomy or physical therapy. Surgery is also an option for people who may become disabled from this condition and may involve removing tissue or amputating the finger.


Like any other bone in the body, the bones of the hand and forearm are susceptible to breaks or fractures, often as a result of excessive force and causing pain, swelling and limited functioning. There are several different types of fractures which can affect the main body of the bone or just the surface, and can include a small crack, a shattering or a complete break through the skin. Fractures of the hand are common because of its many bones and frequent use,

After confirmation of a fracture through X-ray, the affected area is often protected and held in place with a splint or cast. Treatment depends on the type and location of the fracture, but often involves surgery to set or repair the bone. Wires, pins, plates or screws, which may or may not be removed at a later date, may be needed to hold the bone in place.

Tendon Repair

Tendon repair is a surgical procedure used to repair torn or damaged tendons for patients experiencing pain, swelling and limited function. Tendons are the cord-like structures made of fibrous tissue that help connect muscles to bones. Tendon injuries are common, and most frequently occur in the shoulder, elbow, knee and ankle joints.

The tendon repair procedure can be performed under local or general anesthesia on an outpatient basis. During the procedure, the torn ends of the tendon are sewn back together to relieve pain and restore function to the affected area. If the tendon has been severely damaged, a tendon graft may be needed, which is usually taken from the patient's foot or toe.

After the procedure, the treated area will be kept in a splint or cast for several weeks. Full healing usually takes six to 12 weeks, after which patients can enjoy full joint use once again.

While this procedure is considered safe for most patients, there are certain risks associated with any surgical procedure, including infection, bleeding, formation of scar tissue and partial loss of use within the affected joint. These risks are considered rare, with most patients achieving successful results from the tendon repair procedure.

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