Upper Extremity

Arthroscopic Wrist Surgery

Wrist is also called as carpus, a complex joint comprised of bones and joints, ligaments and tendons, nerves, blood vessels, and muscles that hold the bones together. A fibrous cartilage present between the radius and ulna (forearm bones of the hand) separates the radioulnar joint from the rest of the wrist. Wrist connects the forearm to the hand and allows it to move. Carpal tunnel is an opening in the wrist through which the nerves and blood vessels pass.

Find out more about Arthroscopic Wrist Surgery from the following links.

Carpal tunnel syndrome and surgical release

Cubital tunnel release surgery is the surgery to correct the cubital tunnel syndrome. Cubital tunnel syndrome, also called ulnar nerve entrapment is a condition caused by compression of the ulnar nerve in an area of the elbow called the cubital tunnel. The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed leading to various symptoms.

Find out more about Carpal tunnel syndrome and surgical release from the following links.

Congenital Hand Deformities

Congenital hand deformities are deformities of the hand or any part of hand that are present at birth. These deformities can be particularly disabling as the hands are important for the child for its interaction. Congenital hand deformities may be as simple as digital disproportion or may be the complete absence of a bone.Congenital deformities may be developed because of injury, diseases conditions or may be present during birth because of any abnormalities during the growth in womb. It should be treated at an early stage before the problem becomes severe.

Find out more about Congenital Hand Deformities from the following links.

Trigger Finger

Trigger Finger, also known as stenosing tenosynovitis or flexor tendonitis, is a condition where one of the fingers or thumb of the hand is caught in a bent position. The affected digit may straighten with a quick snap, similar to pulling and releasing the trigger on a gun, hence the name trigger finger.

Find out more about Trigger Finger from the following links.

Dupuytren’s Contracture

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. It is caused due to the excessive production of collagen which gets deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased age may increase the risk of developing the condition. It commonly occurs in the ring finger and little finger. Occasionally the middle finger is affected but the thumb and index finger are rarely affected. Dupuytren’s contracture is a condition that usually progresses slowly over many years and is not painful. However, some cases progress rapidly and may be painful to the patient.

Find out more about Dupuytren’s Contracture from the following links.

Amputation and Prosthetics

What is amputation?

Amputation is the removal of an injured or diseased body part. An amputation may be the result of a traumatic injury, or it may be a planned operation to prevent the spread of the disease in an infected finger or hand. Some traumatically amputated fingers may be replanted or reattached. In many cases, reattachment of the amputated finger is not possible or advisable because the patient will be more comfortable and have better function if the part is not reattached.

Find out more about Amputation and Prosthetics from the following links.

Animal and Human Bites of the Hand

Bites are extremely common and can cause significant pain and other problems, especially when associated with an infection. Early recognition of warning signs and appropriate treatment are key in minimizing potential problems from the bite.

When an animal bites, bacteria from its mouth can contaminate the wound. These bacteria may grow within the wound and cause an infection. The consequences of infection range from mild discomfort to life-threatening complications.

Find out more about Animal and Human Bites of the Hand from the following links.


What happens in burns?

When the skin comes in contact with something hot, it may be damaged, with death of cells in the skin. The depth of the injury depends on the intensity of the heat and the length of time that it is applied. If sufficiently severe, the full thickness of the skin can be destroyed, as well as tissues under it. Burns can also result from contact with certain chemicals.

Find out more about Burns from the following links.

Fractures in Children

Among the most common injuries to the hand and wrist in children are broken bones, also known as fractures. Children are not just small adults. Their bones have a different consistency and quality, like soft, fresh wood, as compared to when we age, our bones become more dried-out and brittle. Because children are still growing, their injuries need different evaluation, and sometimes different treatment.

Find out more about Fractures in Children from the following links.

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a pain condition that is constant over a long period of time and is believed to be the result of dysfunction in the central or peripheral nervous systems. CRPS is characterized by pain, swelling or stiffness in the affected hand or extremity. The pain may be out of proportion to the injury that triggered it. CRPS is usually associated with an injury, which can sometimes be as minor as a paper cut or small bruise. It causes the nervous system to misfire and send frequent or constant signals to the brain that are interpreted as painful. The nervous system becomes overactive, causing intense burning or aching pain, along with swelling and changes in skin color and moisture.

Find out more about Complex Regional Pain Syndrome from the following links.

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a pain condition that is constant over a long period of time and is believed to be the result of dysfunction in the central or peripheral nervous systems. CRPS is characterized by pain, swelling or stiffness in the affected hand or extremity. The pain may be out of proportion to the injury that triggered it. CRPS is usually associated with an injury, which can sometimes be as minor as a paper cut or small bruise. It causes the nervous system to misfire and send frequent or constant signals to the brain that are interpreted as painful. The nervous system becomes overactive, causing intense burning or aching pain, along with swelling and changes in skin color and moisture.

Find out more about Complex Regional Pain Syndrome from the following links.

Cubital Tunnel Syndrome

What many people call the “funny bone” really is a nerve. This ulnar nerve runs behind a bone in the elbow through a space called the “cubital tunnel” (Figure 1). Although “banging the funny bone” usually causes temporary symptoms, chronic pressure on or stretching of the nerve can affect the blood supply to the ulnar nerve, causing numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. This is called “cubital tunnel syndrome.”

Find out more about Cubital Tunnel Syndrome from the following links.

Cumulative Trauma Disorder and Repetitive Strain Injury

The American Society for Surgery of the Hand is concerned that patients with upper extremity pain are being assigned specific diagnoses on the basis of subjective complaints without objective physical findings. There is also a tendency to assign a causal relationship to work for this pain when there is a lack of epidemiological evidence. As part of our normal process of providing the best care for our patients, it is important that the diagnosis be accurate and the assignment of causation be correct.

Find out more about Cumulative Trauma Disorder and Repetitive Strain Injury from the following links.

Extensor Tendon Injuries

What is an extensor tendon?

Extensor tendons, located on the back of the hand and fingers, allow you to straighten your fingers and thumb (see Figure 1). These tendons are attached to muscles in the forearm. As the tendons continue into the fingers, they become flat and thin. In the fingers, smaller tendons from small muscles in the hand join these tendons. It is these small-muscle tendons that allow delicate finger motions and coordination.

Find out more about Extensor Tendon Injuries from the following links.

Fingertip Injuries

What gets injured in a fingertip injury?

Injured components may include skin, bone, nail, nailbed, tendon, and the pulp, the padded area of the fingertip (see Figure 1). The skin on the palm side of our fingertips is specialized in that it has many more nerve endings than most other parts of our body. These nerve endings enable the fine sensation we have in our fingertips, and they can also be damaged. When this specialized skin is injured, exact replacement may be difficult.

Find out more about Fingertip Injuries from the following links.

Flexor Tendon Injuries

The muscles that bend (flex) the fingers are called flexor muscles. These flexor muscles move the fingers through cord-like extensions called tendons, which connect the muscles to bone. The flexor muscles start at the elbow and forearm regions, turn into tendons just past the middle of the forearm, and attach to the bones of the fingers (see Figure 1). In the finger, the tendons pass through fibrous rings called pulleys, which guide the tendons and keep them close to the bones, enabling the tendons to move the joints much more effectively.

Find out more about Flexor Tendon Injuries from the following links.

Ganglion Cysts

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons. The most common locations are
the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the far joint of the finger (see Figure 2). The ganglion cyst often resembles a water balloon on a stalk (see Figure 3), and is filled with clear fluid or gel. These cysts may change in size or even disappear completely, and they may or may not be painful. They are not cancerous and will not spread to other areas, but some people form cysts at multiple locations.

Find out more about Ganglion Cysts from the following links.

Golfing Injuries

For most golfers, the hand and/or wrist is the 3rd most common body region injured, after the back and elbow. The wrist is injured 3 times more frequently than the hand. In golf, the action of the wrist is important for the “snap” of the shot in long shots, and the precision “feel” in short shots. Golfers who lack strength in their forearms are more prone to wrist and hand injuries. The leading wrist/hand (left side for right-handed players, right side for lefties) is most at risk. Injuries result either gradually from overuse, or from a traumatic blow (hitting a root or a rock, or hitting a fat shot off hardpan) causing sprains (ligament injuries) or fractures (“broken bones”).

Find out more about Golfing Injuries from the following links.

Hand Fractures

What is a fracture?

The hand is made up of many bones that form its supporting framework. This frame acts as a point of attachment for the muscles that make the wrist and fingers move. A fracture occurs when enough force is applied to a bone to break it. When this happens, there is pain, swelling, and decreased use of the injured part. Many people think that a fracture is different from a break, but they are the same (see Figure 1). Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable and the bone fragments tend to displace or shift. Some fractures occur in the shaft (main body) of the bone, others break the joint surface. Comminuted fractures (bone is shattered into many pieces) usually occur from a high energy force and are often unstable. An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.

Find out more about Hand Fractures from the following links.

Hand Therapy

What is a Hand Therapy?

Hand Therapy is a type of rehabilitation performed by an occupational or physical therapist on patients with conditions affecting the hands and upper extremities. Such therapy is performed by a provider with a high degree of specialization that requires continuing education and, often, advanced certification. This enables the hand therapist to work with patients to hasten their return to a productive lifestyle.

Find out more about Hand Therapy from the following links.

Tumors of the Hand & Wrist: Lumps and Bumps

What is a Tumor?

Any abnormal lump or bump, or “mass”, is considered a tumor. The term “tumor” does not necessarily mean it is malignant or that it is a cancer. In fact, the vast majority of hand and wrist tumors are benign or non-cancerous. Any lump or bump in your hand or wrist is a tumor regardless of what causes it.

Tumors can occur on the skin, such as a mole or a wart, or can occur underneath the skin in the soft tissue or even the bone. Because there are so many tissue types in the hand (e.g. skin, fat, ligaments, tendons, nerves, blood vessels, bone, etc) there are many types of tumors that can occur. However, only a few of them are seen commonly.

Find out more about Tumors of the Hand & Wrist from the following links.

Hand Infections

Urgency of treatment

Hand infections can cause severe problems that persist even after the infection has resolved, such as stiffness, loss of strength, and even loss of tissues such as skin, nerve and even bone. Thus early and aggressive treatment of hand infections is essential. When seen early, some types of infection can be treated with antibiotics and local rest and soaking. However many infections begin to cause severe problems, even after a day or two, if not treated with antibiotics, surgical drainage, and removal of infected tissues. Any drainage or pus should be sent for laboratory testing to determine the type of bacteria causing the infection and the appropriate antibiotic for treatment.

Find out more about Hand Infections from the following links.

Mallet Finger (Baseball Finger)

What is Mallet Finger?

A mallet finger is a deformity of the finger caused when the tendon that straightens your finger (extensor tendon) is damaged. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that straightens the finger (see Figure 1a and 1b). The force of the blow may even pull away a piece of bone along with the tendon (see Figure 2). The finger or thumb is not able to straighten. This condition is also sometimes referred to as baseball finger.

Find out more about Mallet Finger (Baseball Finger) from the following links.

Nail Bed Injuries

What is involved?

Injuries to the nail are often associated with damage to other structures that are in the same location. These include fractures of the bone (distal phalanx), and/or cuts of the nailbed, fingertip skin (pulp), tendons that straighten or bend the fingertip, and nerve endings.

Find out more about Nail Bed Injuries from the following links.

Nerve Injuries

What are nerves?

Nerves are the “telephone wiring” system that carries messages from the brain to the rest of the body. A nerve is like a telephone cable wrapped in insulation. An outer layer of tissue forms a cover to protect the nerve, just like the insulation surrounding a telephone cable (see Figure 1). A nerve contains millions of individual fibers grouped in bundles within the “insulated cable.”

Find out more about Nerve Injuries from the following links.

Numbness and Tingling Not Carpal Tunnel Syndrome

Numbness and tingling?

Although carpal tunnel syndrome is common, it is not the only cause of numbness, tingling, and pain in the forearm and hand. Most of the lay public and some of the medical community are not aware of other causes, so numbness, tingling and pain may be mistakenly thought to be coming from carpal tunnel syndrome (see the Patients and Public page of the www.assh.org website for a description of CTS). These symptoms can be caused by many other conditions.

Find out more about Numbness and Tingling from the following links.

Power Saw Injuries

What is it?

Power saws are extremely useful tools, enabling all types of materials to be cut and shaped. However, they also have the potential to cause serious hand injuries. The hands are used to guide pieces into the saw, and thus they can be vulnerable.

Find out more about Power Saw Injuries from the following links.

Psoriatic Arthritis of the Hand

What is Psoriatic Arthritis?

Psoriasis is a skin disease in which patients have dry, red and scaly skin rashes that can occur on any part of the body. Between 5-20% of patients with psoriasis may develop an associated arthritis. Arthritis means inflamed joint. A normal joint consists of two cartilage-covered bone surfaces that glide smoothly against one another. In psoriatic arthritis, the lining of the joint—the synovium—becomes inflamed and swollen. The swollen tissues stretch supporting structures of the joints, such as ligaments and tendons. As these supporting structures stretch out, the joints become deformed and unstable. The gliding surface wears out, and joint cartilage and bone erode. In addition to the hands, psoriatic arthritis can affect joints in the spine, feet, and jaw.

Find out more about Psoriatic Arthritis of the Hand from the following links.


What is replantation?

“Replantation” refers to the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body (see Figure 1). The goal of replantation surgery is to give the patient back as much use of the injured area as possible. In some cases, replantation is not possible because the part is too damaged. If the lost part cannot or should not be reattached, you may have the alternative of a completion amputation with or without a prosthesis, a device that substitutes for a missing part of the body. In some cases, this option will give you better and faster recovery than a replantation. See section on “Amputations and Prosthetics”.

Find out more about Replantation from the following links.

Rheumatoid Arthritis of the Hand

What is it?

Arthritis literally means “inflamed joint.” Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don’t fit together well anymore and essentially “wear out.” Arthritis can affect any joint in the body, but it is most noticeable when it affects the hands and fingers. Each hand has 19 bones, plus 8 small bones and the two forearm bones that form the wrist. Arthritis of the hand can be both painful and disabling. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.

Find out more about Rheumatoid Arthritis of the Hand from the following links.

Rotator Cuff Pathology

What is the rotator cuff and rotator cuff pathology?

The rotator cuff is the group of four muscles and tendons that surround the shoulder joint, providing strength and stability. Above the rotator cuff there is a bursa, or sac of tissue, that covers and protects the rotator cuff as it comes into close contact with bones around the shoulder (see Figure 1). When the rotator cuff is injured or damaged, it can lead to inflammation of the bursa, called bursitis, which causes pain and loss of motion. Thickening of the rotator cuff and its bursa can lead to an impingement syndrome where these tissues impinge against the bones around the shoulder. This can cause pain and damage to the rotator cuff. While some rotator cuff injuries occur in younger people secondary to trauma, most injuries result from aging and degeneration of the cuff. Damage to the rotator cuff can vary from microscopic tears to large irreparable tears, and symptoms include pain, weakness, restricted motion, catching, locking and a feeling of instability. Rotator cuff pathology ranges from a normal, asymptomatic aging process to endstage arthritis and instability caused by absence of the rotator cuff.

Find out more about Rotator Cuff Pathology from the following links.

Scaphoid Non-union

What is scaphoid non-union?

The scaphoid bone is one of the eight small bones that comprise the wrist joint. The two rows of small wrist bones act together to allow the wide variety of wrist positions and motions that we take for granted. The scaphoid bone spans or links these two rows together and, therefore has a special role in wrist stability and coordinating wrist motion

Find out more about Scaphoid Non-union from the following links.

Scaphoid Fractures

What are scaphoid fractures?

The scaphoid bone is one of the eight small bones that make up the “carpal bones” of the wrist. There are two rows of bones, one closer to the forearm (proximal row) and the other closer to the hand (distal row). The scaphoid bone is unique in that it links the two rows together (see Figure 1). This puts it at extra risk for injury, which accounts for it being the most commonly fractured carpal bone.

Find out more about Scaphoid Fractures from the following links.

Skin Cancer of the Hand & Upper Extremity

What Is Skin Cancer?

Skin cancer is a change in some of the cells of your skin such that they grow abnormally to form a malignant tumor. These abnormal cells can invade through the skin into adjacent structures or travel throughout your body and become implanted in other organs and continue to
grow, a process called metastasis. The skin is the most common part of the body in which cancer develops. In the hand, squamous cell
carcinoma is the most common type of skin cancer, followed by basal cell carcinoma and melanoma. There are other, more rare forms of skin
cancer, such as Kaposi’s sarcoma, dermatofibrosarcoma protuberans, sweat gland tumors, and Merkel cell carcinoma, to name a few.

Find out more about Skin Cancer of the Hand & Upper Extremity from the following links.

Ski and Snowboard Injuries

Skiing Injury

Skiing and snowboarding have become some of the most popular winter sports. Injuries to the upper extremity occur in a relatively predictable pattern. Fortunately, there are some ways to decrease the chance for injury.

Find out more about Ski and Snowboard Injuries from the following links.

Stiffness in the Hand

Why are steroid injections used in the upper extremity?

The hand and fingers seem to work effortlessly when healthy. Normal joints have considerable motion, enabling us to perform many different activities with our hands for work, leisure, communication, and more. A variety of problems can cause stiffness in the hand, limiting the use and function that we often take for granted.

Find out more about Stiffness in the Hand from the following links.

Hands in Systemic Diseases

Hands in Systemic Diseases

The hands, being composed of many types of tissue, including blood vessels, nerves, skin and skin-related tissues, bones, and muscles/tendons/ligaments, may show changes that reflect a disease that affects other parts of, or even the whole body (systemic
diseases). The hands may show changes noticed by the patient or his/her hand surgeon even before the systemic disease is detected.
Below are a number of examples.

Find out more about Hands in Systemic Diseases from the following links.

Lateral Epicondylitis (Tennis Elbow)

What is it?

Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. Tendons anchor the muscle to bone. The muscle involved in this condition, the extensor carpi radialis brevis, helps to extend and stabilize the wrist (see Figure 1). With lateral epicondylitis, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area. This can then lead to pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis are commonly associated with this, but the problem can occur with many different types of activities, athletic and otherwise.

Find out more about Lateral Epicondylitis from the following links.

Thumb Sprains

What are sprains?

A sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones across a joint.

How do thumb sprains occur?

These types of injuries are common in sports and falls. The thumb is jammed into another player, the ground, or the ball. The thumb may be
bent in an extreme position, causing a sprain. The thumb will usually swell and may show bruising. It is usually very painful to move.

Find out more about Thumb Sprains from the following links.

Vascular Disorders of the Upper-Extremity

Vascular Disorders

Vascular disorders of the upper-extremity are uncommon, but ones that may have lasting implications.


Arteries bring oxygenated blood from the heart to the fingertips and veins return the used blood back to the heart and lungs. At the level of the wrist 2 major arteries bring blood into the hand: the radial and ulnar arteries (see Figure 1). Variations in the anatomy are common, though, which may affect the way blood flow ultimately reaches each finger.

Find out more about Vascular Disorders of the Upper-Extremity from the following links.

Wrist Fractures

What is a wrist fracture?

The wrist is made up of eight small bones and the two forearm bones, the radius and ulna (see Figure 1). The shape of the bones allows the wrist to bend and straighten, move side-to-side, and rotate, as in twisting the palm up or down. A fracture may occur in any of these bones when enough force is applied, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or a fall off a roof or ladder. Osteoporosis, a common condition in which the bone becomes more brittle, may make one more susceptible to getting a wrist fracture.

Find out more about Wrist Fractures from the following links.