Hand / Wrist​​ Surgery

The Anatomy and Function of Our Hands and Wrists

The human hand is a marvel of evolutionary engineering, capable of performing an astonishing range of functions that require stability, strength, and fine motor control. The main components of your hand and wrist include:

• Bones: Your wrist includes eight small carpal bones that connect your hand to the two bones of your forearm (radius and ulna). Five metacarpal bones form your palm, and 14 bones called phalanges make up your fingers and thumb.
• Muscles: Numerous muscles control your hand movements. Some are located in your hand itself (intrinsic muscles), while others extend from your forearm (extrinsic muscles).
• Tendons: These cord-like structures connect muscles to bones and transfer the force needed for movement. Tendons glide through sheaths that keep them properly aligned.
• Ligaments: Ligaments are tough bands that connect bones to other bones. They give your joints stability while allowing for movement.
• Cartilage: This smooth tissue covers the ends of your bones at joints. Cartilage reduces friction between bones so the joints move freely and painlessly.
• Nerves: Nerves carry signals between your brain and muscles to enable movement and sensation. Three main nerves are responsible for hand and wrist movement: radial, median, and ulnar.

These components come together to allow for a large range of motion. You can perform tasks that require a powerful grip, like lifting weights or carrying heavy grocery bags, as well as tasks that require precision, like threading a needle or drawing. The basic movements of your hands include:

• Flexion: Decreasing the angle between bones or parts of the body. In the hand, this typically refers to bending your wrist forward (palm towards the forearm) or bending your fingers towards the palm.
• Extension: Increasing the angle between bones or parts of the body. In the hand, this means straightening your wrist back to a neutral position or straightening your fingers.
• Adduction: Moving a body part towards the midline of the body or, in the case of fingers, towards the middle finger.
• Abduction: Moving a body part away from the midline of the body or, in the case of fingers, away from the middle finger.
• Opposition: A unique movement of the thumb where it moves across the palm to touch the fingertips. This is critical for grasping and manipulating objects.

Traumatic injuries, repetitive motions, inflammatory conditions or the aging process can disrupt this delicate system. When problems arise, seek expert care from a hand surgeon to preserve or restore these vital capabilities.

“Every time that I have been to O.I.O., everyone has been not only professional and efficient, but also extremely helpful and polite. I feel very secure being under their care.” — Alan F.

Common Conditions and Injuries of the Hand and Wrist

Some of the injuries and conditions we treat include:

Carpal Tunnel Syndrome

This common and painful condition affects the median nerve in the wrist and is typically caused by repetitive motions like typing. Symptoms of this condition might include numbness or tingling in your hand, particularly at night. Mild cases of carpal tunnel syndrome may be treated with nonsurgical methods like medication or splinting the wrist at night. However, when patients do not achieve enough relief from these measures, surgery may be necessary to release the ligament that forms the root of the carpal tunnel to relieve the pressure on the median nerve.

Cubital Tunnel Syndrome

This condition affects the ulnar nerve on the inside of the forearm, also known as the “funny bone” nerve. The disorder can lead to numbness or tingling of the small finger and the forearm. Weakness in the hand is also a symptom. Cubital tunnel syndrome may be treated with rest and stabilizing the area at night in some cases. Severe conditions may require surgical intervention, which involves releasing or moving the nerve or removing a portion of the bone to relieve pressure.

Gamekeeper’s Thumb/Skier’s Thumb

This condition is commonly associated with work or sports injuries and occurs when the thumb is pushed away from the index finger, causing ligament tearing. It was dubbed skier’s thumb because the damage often occurs to skiers as they take a fall while holding onto their pole. The condition can lead to significant pain and disfigurement, as the thumb can appear as though it is out of its normal position. In some instances, the injury will heal without surgical intervention, but some patients will require surgery to achieve full correction.

Trigger Finger

Trigger finger is a sometimes painless but often disfiguring condition that results in a finger “locking” into a bent position. The culprit in trigger fingers is the sheath on the palm side of the hand, which the tendons of the thumb and fingers pass through. Some diseases and overuse activities can cause a thickening of this sheath, irritating the tendon and causing it to swell. Pain, catching and eventual locking of the finger will occur. If anti-inflammatory medications and cortisone injections fail to provide relief, surgery to open the sheath can also be done.

Dupuytren’s Contracture

This disorder occurs when the ligament in the palm thickens and develops nodules. When the problem becomes severe, it makes it impossible to straighten the fingers completely. The ring and small fingers are the most common ones involved. When the deformity is mild, and there is no functional loss, surgery is not generally required. However, when the contracture is significant and interferes with function, surgical removal of a portion of the ligament is the optimal treatment to restore function and prevent further deformity.

Ganglion Cysts

Ganglion cysts are benign growths that form in the joints of the fingers and hand. They are commonly seen on the wrist or around a finger joint. While the lumps are usually painless and harmless, if they grow large enough, they can interfere with the function of the hand. Cysts that press on a nerve can also cause pain, and the lumps can become a cosmetic concern. In these instances, treatment may be required to eliminate the bump. Treatment may include aspiration of the cyst or surgical incision.

De Quervain’s Tenosynovitis

This condition occurs when the tendons to the thumb become inflamed as they pass under the ligament, leading to pain with even the slightest movement of the wrist. Treatment may consist of rest, medication and possibly, a periodic steroid injection. When these treatments do not produce the desired relief, surgery may be necessary to release the inflamed tendons.

Fractures 

Hand and wrist fractures commonly occur from falls, sports injuries or direct impacts. Symptoms include pain, swelling, bruising, limited mobility, and deformity. Treatment depends on the fracture’s location and severity. Stable fractures may only require immobilization with a cast or splint, while displaced fractures typically need surgery to realign the bones.

Arthritis 

Arthritis can develop from normal wear and tear (osteoarthritis), immune system dysfunction (rheumatoid arthritis) or previous injuries (post-traumatic arthritis). The condition causes joint inflammation that leads to pain, stiffness, swelling, and reduced grip strength. Early-stage management includes anti-inflammatory medications, splinting, activity modification, and joint protection techniques. For advanced cases, surgical options depend on which joints are affected and your specific functional needs.

Dislocation

Dislocations occur when bones are forced out of their normal positions at a joint. Finger dislocations, particularly at the knuckle joints, are most common. Some minor dislocations can be realigned without surgery, but many require anesthesia and precise manipulation to restore proper alignment. After treatment, the joint is usually immobilized while the ligaments heal, followed by physical therapy to restore strength and mobility. 

When to Seek Treatment for a Hand or Wrist Issue

Hand and wrist problems can make it difficult to work, enjoy your hobbies, or perform routine self-care activities. Knowing when to seek medical attention can help prevent long-term complications and unnecessary suffering.

Consider consulting a hand specialist if you experience:

• Persistent pain that doesn’t improve with rest or over-the-counter pain relievers
• Numbness, tingling, or weakness in your fingers or hand, particularly if it’s getting worse or waking you at night
• Visible deformity after an injury, such as an obviously crooked finger or wrist
• Significant swelling that doesn’t subside within a few days
• Stiffness that limits your normal range of motion
• Difficulty performing routine tasks like opening jars, buttoning shirts, or typing
• A finger that locks or catches when you bend or straighten it

Experiencing one or more of these symptoms doesn’t automatically mean you have a serious condition, but getting it checked by a specialist can help ensure you receive the right diagnosis and treatment. Schedule a consultation with the hand experts at OIO today.

“I had a great experience with everybody working there. They informed me of everything that was going on and exactly what they were doing each step of the way, from my first appointment to my MRI to my results and then finally when they did the injection in my wrist! I would highly recommend family and friends to go to Orthopaedic Institute of Ohio!” — Sarah S.

How We Diagnose Hand and Wrist Conditions 

Getting an accurate diagnosis is the first and most important step in treating any hand or wrist issue. 

During your first appointment at the Orthopaedic Institute of Ohio, you will have a detailed conversation about your symptoms. Your specialist will ask you when they started, how they’ve changed over time, and if you’ve ever injured your hand or wrist before. You will also talk about your work, hobbies, exercise routine, and anything else that might be contributing to your condition.

Next, your specialist will perform a physical examination. They will gently examine the affected area, checking for any tenderness, swelling, or changes in shape. They will also assess how well you can move your hand and wrist, how strong your grip is, and whether you have any changes in sensation. If necessary, you may also undergo imaging such as X-ray, MRI or ultrasound.

The combination of information we gather from talking with you, the physical exam, and any additional tests gives us a clear picture of the cause of your hand or wrist problem. Then, we can create a treatment plan tailored to your needs so you can get back to feeling your best.

Nonsurgical Treatment Options for the Hand and Wrist

Our providers start with the least invasive treatment approaches whenever possible. Many hand and wrist conditions respond well to nonsurgical interventions, which can offer relief while avoiding the risks and recovery time associated with surgery.

Medications and Injections

Over-the-counter anti-inflammatory medications like ibuprofen or naproxen help to reduce swelling and ease pain. For more targeted relief, corticosteroid injections deliver powerful anti-inflammatory medication directly to the affected area. These injections can provide months of symptom improvement for conditions like trigger finger, De Quervain’s tenosynovitis, and carpal tunnel syndrome.

Splinting and Bracing

Splints and braces immobilize and protect injured structures so they can heal properly. Your doctor will give you clear instructions on when and how long to wear your splint to get the best results.

Hand Therapy

A physical therapy program helps improve strength, flexibility, and function while reducing pain. Hand therapy might include gentle stretching exercises, strength training with putty or other resistance tools, and techniques to improve fine motor control. Hand therapists also provide education about activity modification and ergonomics to prevent your symptoms from coming back.

Assistive Devices

Simple tools can make daily tasks easier and reduce strain on your hand and wrist. These are called assistive devices. There are many different kinds, ranging from specially designed jar openers and ergonomic keyboards to tools that help with dressing and more.

Lifestyle Modifications

Ergonomic adjustments to your workstation, proper lifting techniques, and regular breaks during repetitive activities can all help reduce strain on your hands and wrists. Your OIO provider will recommend specific modifications based on your condition and lifestyle needs.

Surgical Treatment Options for the Hand and Wrist

When conservative measures don’t provide adequate relief, or in cases of severe injury or disease, surgical intervention may be necessary. Our board-certified orthopaedic surgeons specialize in both traditional and minimally invasive surgical techniques for hand and wrist conditions.

Carpal Tunnel Release

This surgery relieves the pressure on the median nerve in your wrist by cutting a ligament that forms the roof of the carpal tunnel. The surgery can be performed using either an open technique with a small incision in the palm or an endoscopic approach using a thin, flexible tube with a camera. Most people feel immediate relief from numbness and tingling, though it can take a few weeks or months to fully recover your strength.

Trigger Finger Release

This procedure involves making a small incision in the palm to cut the constricted portion of the tendon sheath, so the tendon can glide smoothly again. Most patients can begin gentle movement of the finger immediately after surgery, with a return to normal activities within one to two weeks. 

Dupuytren’s Contracture Surgery

Surgical treatment for Dupuytren’s contracture may involve a fasciotomy (cutting the tight cords) or a more extensive fasciectomy (removing the diseased tissue). Surgery can significantly improve finger position and function. However, it does not cure the underlying condition, and contractures may recur over time. 

De Quervain’s Release

This procedure relieves the constriction of the tendons that control thumb movement by opening the compartment through which they pass. This gives them more room to move without rubbing and causing pain. Most patients experience immediate pain relief. Complete recovery takes four to six weeks.

Fracture Repair

Hand and wrist fractures may require surgical fixation using pins, plates, screws, or wires to stabilize the bones. Ensuring the bones heal in the correct place is critical for preserving function. Recovery typically involves a period of immobilization, followed by hand therapy to regain strength and mobility.

Arthroscopic Wrist Surgery

Arthroscopy is a minimally invasive surgical technique. Instead of making a large incision, we make a few smaller incisions and insert a tiny camera and small instruments. This allows us to perform the surgery with less damage to the surrounding tissues. For patients, this often translates to less pain and a quicker recovery compared to traditional open surgery. 

Joint Reconstruction or Replacement

For severely damaged joints, reconstruction or replacement may be necessary. Techniques range from removing damaged bone and creating a flexible scar joint (arthroplasty) to implanting artificial joint components. 

OIO: Complete Care for Hand and Wrist Conditions

At the Orthopaedic Institute of Ohio, we’ve established ourselves as the region’s premier destination for comprehensive hand and wrist care. 

Our team includes board-certified orthopaedic surgeons with advanced training in hand surgery, supported by certified physical therapists, physician assistants, and nurses. You have access to all the experts you need in one practice, eliminating the hassle of seeing different specialists working in different locations.

Our providers complete thousands of procedures each year, and we often hear from our patients about how dramatically their lives have improved as a result. From helping musicians regain the dexterity required for their craft to enabling construction workers to return to their livelihoods, we help patients achieve what might once have seemed impossible.

“They are a well oiled machine from the moment you walk in until you walk out. Everyone I had contact with was extremely helpful and friendly. Would not think twice about going back if I had the need.” — Mike E.

Find the Right Solution for Your Hand or Wrist Pain

Injuries and conditions of the hand and wrist can be painful, debilitating, and unsightly. With a variety of treatments available, these concerns can be effectively addressed to reduce discomfort and restore form and function to the limb. To learn more about your options in hand and wrist procedures, contact the Orthopaedic Institute of Ohio today at 419-222-6622.

Hand / Wrist Surgery FAQ

How long does it take to recover from hand surgery?

The recovery time after hand or wrist surgery depends on the type of surgery you have. 

After a minimally invasive procedure, you might be able to start using your hand for light activities within a few days and return to more normal activities within a couple of weeks.

More complex or invasive procedures often require a longer recovery. You’ll likely need to wear a cast or splint for a while, followed by a physical therapy program to regain strength and movement. Full recovery can take three to six months.

How can I prevent hand and wrist pain?

Be mindful of how you use your hands and wrists. You might find it helpful to make adjustments to your habits and environment, such as:

• Practice good posture
• Use proper techniques for activities like typing, lifting, or using tools
• Take frequent breaks when doing repetitive tasks 
• Do not keep your hands or wrists in bent or twisted positions for long periods
• Strengthen your hand and wrist muscles with gentle exercises 

What are some good exercises for hand and wrist pain?

Gentle exercises can help improve flexibility, strength, and range of motion. Some common exercises include:  

• Wrist stretches: Gently bend your wrist up and down, and then side to side.
• Finger stretches: Extend your fingers straight out, then make a fist. You can also spread your fingers wide and then bring them together.
• Thumb stretches: Gently stretch your thumb away from your hand, and then across your palm to touch your pinky.
• Grip strengthening: Squeeze a soft ball or hand exerciser to build strength.  

Check with your doctor or therapist before starting new exercises. Start slowly and gradually increase the number of repetitions. Stop if you feel any sharp pain.

What are ergonomic tips for preventing hand and wrist problems?

Ergonomics focuses on designing workspaces and tools to fit the human body, reducing strain and the risk of injuries. Here are some ergonomic tips for your hands and wrists:  

• Keep your wrists straight: Avoid bending your wrists up, down, or sideways while working.  
• Use a neutral posture: Keep your forearms parallel to the floor when typing or using a mouse.  
• Position your keyboard and mouse correctly: Place them so you don’t have to reach or stretch. Consider using an ergonomic keyboard or mouse.
• Take breaks: Stand up and move around every 20-30 minutes, and take short breaks to stretch your hands and wrists.
• Use a light touch: Avoid gripping tools or writing utensils too tightly.  
• Consider voice recognition software: If typing is a major part of your job, voice recognition software can reduce the strain on your hands.

Are you awake for hand surgery?

Surgery on the hand and wrist is usually performed using regional anesthesia and intravenous (IV) sedation, or general anesthesia. 

Regional anesthesia blocks the feeling in your arm and hand. IV sedation helps you relax and feel sleepy, but you are still able to respond if needed. You might not remember the surgery afterwards.

General anesthesia is what most people think of as “being put to sleep.” You are completely unconscious.