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Hand & Wrist

Hand Center

Hands are our interface with the world. As a result, hand injuries are common, and can drastically affect day-to-day life. Function of the hand is dependent on precise interaction of the many bones, tendons, nerves, and blood vessels that compromise the human hand. These structures allow us to care for our children, complete a day’s work, or enjoy our pastimes and passions.

Our physicians are highly trained in treatment of injuries to the hand and wrist. They have all received additional fellowship instruction in the care of these specialized, and critical structures. Commonly treated hand and wrist conditions are:

Many upper extremity ailments including carpal tunnel, trigger finger, and hand arthritis can be treated with wide awake surgery. These procedures are performed in our office under local anesthesia. Performing many procedures in this manner allows quicker recovery as well as decreased procedural risk. In many conditions, wide awake surgery can be performed at lower cost, without compromising results. Our experienced physicians treat a variety of upper extremity ailments in this manner. For patients with non-participating insurance plans, discounted cash rates are available for these procedures.

Wrist Joint Replacement

Wrist Joint Replacement

Wrist joint replacement surgery, also referred to as total wrist arthroplasty, involves the replacement of a severe arthritic wrist joint with an artificial joint made of metal and plastic components. It relieves pain and restores function when conservative treatment fails to provide relief.

Carpal Tunnel Release Surgery

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release surgery. Traditional surgery involves an incision of up to 2 inches in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope.

Endoscopic Carpal Tunnel Surgery

Endoscopic Carpal Tunnel Surgery

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.

Hand Fracture Surgery

Hand Fracture Surgery

The 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, lacerations and amputations while operating machinery, bracing against a fall and sports-related injuries.

Peripheral Nerve Repair

Peripheral Nerve Repair

The peripheral nerves are the nerve fibers that compose the area from head to toe, connecting the brain and spinal cord with the rest of the body parts. Nerves transmit electrical impulses and signals to and from the brain.

Wrist Arthroscopy

Wrist Arthroscopy

Wrist arthroscopy is a minimally invasive surgical procedure performed to view, diagnose and treat problems of your wrist joint.

Wrist Fracture Fixation

Wrist Fracture Fixation

When the fractured ends are significantly displaced, surgery is necessary for wrist fracture fixation. Surgical treatment options include open reduction and internal fixation (ORIF) which involves the use of pins, plates, and screws to properly align the fractured ends and stabilize the fracture from the inside.

Wrist Ligament Reconstruction

Wrist Ligament Reconstruction

Surgical treatment in the form of wrist ligament reconstruction may be indicated in cases where the wrist ligament is completely torn. The ligament will usually need to be reconstructed when ligament damage is noted after a period of 6 months or more after the initial injury.

Non-Surgical Treatment of Hand and Wrist

Non-Surgical Treatment of Hand and Wrist

The hand is one of the most flexible and useful parts of our body that enable us to perform many of our daily activities. The hands and wrists are prone to injuries or certain orthopedic conditions and can range from minor cuts or burns to severe arthritis or injuries of nerves, bones, and tendons.

Artificial Finger Joint Replacement

Artificial Finger Joint Replacement

Artificial finger joint replacement is a surgical procedure that involves the removal of an arthritic or damaged finger joint and replacement with an artificial prosthesis.

Sports Injury Management of Hand, Wrist and Elbow

Sports Injury Management of Hand, Wrist and Elbow

Sports injuries are injuries that most commonly occur during sports and exercises. These injuries may result from accidents, poor training practices, and use of improper protective gear, lack of conditioning, and insufficient warm-up and stretching.

Surgery for Thumb and Digit Arthritis

Surgery for Thumb and Digit Arthritis

Arthritis is an inflammatory condition of the joints. There are several types of arthritis; the most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years.

LRTI (Ligament Reconstruction and Tendon Interposition) for Thumb CMC Arthritis

LRTI (Ligament Reconstruction and Tendon Interposition) for Thumb CMC Arthritis

LRTI (ligament reconstruction and tendon interposition) is a surgical procedure that is most commonly conducted to treat thumb CMC (carpometacarpal) arthritis where the damaged joint surfaces are removed and replaced with a cushion of tissue that keeps the bones separated.

Total Wrist Arthrodesis

Total Wrist Arthrodesis

Arthrodesis is the surgical immobilization of a joint by the fusion of the adjacent bones.

Finger Joint Fusion

Finger Joint Fusion

Finger joint fusion is performed under local or general anesthesia and usually takes about 2 hours to complete.

Arthroscopic Partial Wrist Fusion

Arthroscopic Partial Wrist Fusion

Arthroscopic partial wrist fusion is a minimally-invasive surgery that uses tiny incisions to immobilize selected bones of the wrist.

Nerve Decompression of the Upper Extremities

Nerve Decompression of the Upper Extremities

Nerve decompression of the upper extremities, also called peripheral nerve decompression, is a minimally invasive surgical procedure employed to relieve pressure on an entrapped or pinched nerve (neuroma) for the treatment of conditions such as carpal tunnel syndrome and cubital tunnel syndrome, the two most common nerve compression syndromes.

Distal Radioulnar Joint Arthroscopy

Distal Radioulnar Joint Arthroscopy

The distal radioulnar joint (DRUJ) is a pivot type synovial joint located between the radius and the ulna just proximal to the wrist joint and assists in pronation and supination of the forearm.

Fractures of the Hand and Fingers

Fractures of the Hand and Fingers

A fracture is a break in the bone, which occurs when force greater than the bearable limit is applied against a bone. The most common symptoms of any fracture include severe pain, swelling, bruising or bleeding, deformity and discoloration of the skin and limited mobility of the hand.

Wrist Fracture

Wrist Fracture

The wrist is comprised of two bones in the forearm, the radius and ulna, and eight tiny carpal bones in the palm. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more of these bones.

Arthritis of the Hand and Wrist

Arthritis of the Hand and Wrist

Arthritis is an inflammatory condition of the joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body and the arthritis in the hand affects the joint at the base of the thumb. Arthritis may also affect the joints of other digits.

Arthritis of the Thumb

Arthritis of the Thumb

Arthritis is an inflammatory condition of the joints. There are several types of arthritis. The most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years.

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.

Wrist Injuries

Wrist Injuries

The wrist is a commonly injured joint in the body. Problems include sprains and strains as well as fractures that can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries.

Wrist Ligament Tear and Instability

Wrist Ligament Tear and Instability

A ligament is a strong, flexible band of fibrous tissue. The wrist has many ligaments that help to keep the wrist bones in proper position providing stability to the joint. A torn ligament causes the wrist bones to move out of their position, which in turn leads to wrist instability as the sprained (torn) ligament can no longer support the wrist bones.

Wrist Sprain

Wrist Sprain

Injuries caused due to stretching or tearing of the ligaments in the wrist are called wrist sprains. Sprains can range from mild to severe, based on the extent of injury to the ligament.

Thumb Fracture

Thumb Fracture

A break or a crack in the bones of the thumb is known as a thumb fracture. Fractures may occur anywhere on the thumb, but a fracture at the base of the thumb, near the wrist, is considered the most serious.

Fingertip Injuries

Fingertip Injuries

A fingertip injury is a wound or damage caused to the most distal portion of the finger. It can be a crush, a sharp cut, a tear or a combination of these, and can result in damage to the skin, nail or nailbed, tendon, pulp, bone, and nerve endings.

Pediatric Forearm Fracture

Pediatric Forearm Fracture

The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm.

Mallet Finger

Mallet Finger

A mallet finger is a condition where the end of the finger is bent and does not straighten.

Finger Sprain

Finger Sprain

Injuries that involve tearing or stretching of the ligaments of your fingers are termed as sprains.

Scaphoid Fracture

Scaphoid Fracture

Scaphoid fracture occurs due to a fall on an outstretched hand with complete weight falling on the palm.

Industrial Hand Trauma

Industrial Hand Trauma

The 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, lacerations and amputations while operating machinery, bracing against a fall and during sports.

Finger Dislocation

Finger Dislocation

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

Boutonniere Deformity

Boutonniere Deformity

Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger at the joint when the muscles contract.

Dupuytren's Contracture

Dupuytren's Contracture

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

Trigger Finger

Trigger Finger

Inflammation in the tenosynovium leads to a condition called trigger finger, also known as stenosing tenosynovitis or flexor tendonitis, where one of the fingers or thumb of the hand is caught in a bent position.

Congenital Defects of the Hand and Wrist

Congenital Defects of the Hand and Wrist

The hand and wrist are formed during the 8th week of gestation. This process consists of various steps and failure in any one or more of these steps may cause congenital or birth defects.

Gamekeeper's Thumb

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.

Skier's Thumb

Skier's Thumb

Skier's thumb can result from sports activities (while stopping a ball with a bare hand) or a fall on your outstretched thumb (especially while holding onto something like a ski pole).

Boxer's Fracture

Boxer's Fracture

A boxer’s fracture is a break in the neck of the fifth metacarpal bone of the hand (below the pinky finger) close to the knuckle.

Swan Neck Deformity

Swan Neck Deformity

The finger joint is a hinge joint that allows the bending and straightening of the fingers. Each finger is composed of 3 phalange bones joined by 2 interphalangeal joints (IP joints).

Wrist Pain

Wrist Pain

Wrist pain is defined as any ache or discomfort in the wrist. The wrist is comprised of two bones in the forearm, the radius and ulna, and eight tiny carpal bones in the palm.

Distal Radioulnar Joint (DRUJ) Instability

Distal Radioulnar Joint (DRUJ) Instability

Distal radioulnar joint instability is the abnormal orientation or movement of the radius and ulna bones at the wrist in relation to one another.

Work Related Hand Injuries

Work Related Hand Injuries

The hand is one of the most flexible and useful parts of our body that assist us in most workplace activities. Hand injuries can range from minor cuts or burns to severe injuries.

Metacarpophalangeal Joint Arthritis

Metacarpophalangeal Joint Arthritis

The bones of the hand are called metacarpals and the bones of the fingers are called phalanges. The metacarpophalangeal joint or MP joint, also known as the first knuckle, is the large joint in the hand where the finger bones meet the hand bones.

Malunion of a Fracture

Malunion of a Fracture

Malunion of a fracture is a condition where the fractured ends of a bone heal in a misaligned position resulting in bone deformity. Malunions may occur in any bone fractures in the body often due to trauma.

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.

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 of the Hand

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 (MCP joint). This joint is 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 has only 2 phalanges and one interphalangeal joint.

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

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

Soft Tissues of the Hand

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

Articular cartilages are smooth material that act as shock absorbers and cushion 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 tissues 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 prevents 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 prevents backward bending of the PIP joint (hyperextension).

Muscles of the Hand

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

There are two types of muscles in the hand:

  • Intrinsic muscles are small muscles that originate in the wrist and hand. They are responsible for fine motor movements of the fingers during activities such as writing or playing the piano.
  • Extrinsic muscles that originate in the forearm or elbow 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 of the Hand

Tendons are soft tissues that connect muscles to bones. When muscles contract, tendons pull the bones, causing the finger to move. The extrinsic muscles are attached 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 called extensor tendons help in straightening the fingers.

Nerves of the Hand

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 include:

  • 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.

All three nerves originate at the shoulder and travel down the arm to the hand. Each of these nerves has sensory and motor components.

Blood Vessels of the Hand

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 of the Hand

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

You have just had surgery. The following are some general instructions that you may find helpful.

Swelling

  • Swelling is natural after surgery for the first week. Reducing swelling helps speed recovery and will decrease pain.
  • Elevation is the best remedy for swelling. The best way do to this is to elevate your hand above the level of your heart for 3-5 days. While sitting in a chair or lying in bed, place your arm on pillows raised above your heart.
  • Ice packs can be particularly helpful to reduce swelling and inflammation for the first week after surgery.

Wound Care

  • You may remove the dressing 3-5 days post-surgery but keep the stiches in until post-op visit. You may shower but do not submerge the affected limb.
  • If swelling is occurring in the fingers and is not responding to elevation, you are welcome to loosen the outer compression (ace bandage), but please do not remove the entire dressing or adjust the cast or splint.
  • Place a large plastic bag over your dressing/splint when you shower or bathe to prevent it from getting wet.

Medications

  • Pain medications have been prescribed. Please follow the instructions regarding these medications.
  • Your pharmacist may be able to provide information about drug interactions with other medications that you are taking.
  • Pain medication can often cause nausea, constipation, and itching. These are common side effects of the medication. Please do not drink alcohol or drive while taking these prescribed medications.

Activities

  • Some or all of your fingers may have been left free of the dressing so that you can move them. Gentle hand movement is encouraged. Finger movement can reduce stiffness and swelling.
  • If physical therapy is needed, a prescription will be written for you and can be addressed at your post-op visit.

Special Instructions

Call your doctor or go to the closest emergency room if:

  • You have any signs of infection. (Increased pain, drainage, redness or swelling, foul odor, fever over 101º F.)
  • You have signs of dehydration. (Dry mouth, little urine, or no tears)
  • You are not able to urinate by 8-12 hours after surgery.

Go to the closest emergency room right away or call 911 if:

  • You have chest pain
  • You have shortness of breath
  • You have hard time breathing
  • You have too much bleeding
  • You cannot wake the patient

Follow-up appointments are scheduled for 10-14 days after surgery. Please call our office a few days after surgery to schedule an appointment.

If you had a fracture or distal bicep repair the following wound care should be followed:

Wound Care

  • The postoperative dressing, splint, or cast is a very important part of your treatment. The dressing should be left alone until your postoperative visit unless specified by your surgeon.
  • If swelling is occurring in the fingers and is not responding to elevation, you are welcome to loosen the outer compression (ace bandage), but please do not remove the entire dressing or adjust the cast or splint.
  • Place a large plastic bag over your dressing/splint when you shower or bathe to prevent it from getting wet.

If you had a tendon repair you will need to make sure that you have a physical therapy appointment scheduled 3-5 days post surgery.

5848 South 300 East
Suite 110
Salt Lake City, UT 84107

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Parking Directions

We are located in the South East blue parking lot. Entrance #3 shown in Blue is the closest parking to our clinic