From common to complex disorders of the hand, wrist, elbow and shoulder, if you’re experiencing debilitating pain or limited function, we can help.

If you’ve had an injury or fracture, or are experiencing symptoms of a disease or condition such as osteoarthritis or tendinitis in your fingers, hands or upper extremity, you’ll find expert, comprehensive care at the Hand and Upper Extremity Center at The Ohio State University Wexner Medical Center.

From diagnosis and treatment to surgery and rehabilitation, our orthopedic physicians and clinicians, plastic surgeons, neurologists, anesthesiologists and occupational therapists offer state-of-the-art clinical services, hand therapy and outpatient surgery, all in one convenient location.

Diagnosis

At our Hand and Upper Extremity Center, you will see one of our board-certified and fellowship-trained surgeons to begin the diagnostic process. Our diagnostic process includes a thorough history and physical exam, along with diagnostic imaging such as X-ray or magnetic resonance imaging (MRI). An MRI provides a detailed, high-resolution image of your bones, joints and surrounding soft tissues, such as tendons, ligaments and muscles. It can show your doctor if you have any damage, deterioration or abnormalities.

Your doctor also may order additional testing, such as a blood test or nerve conduction study with electromyogram (EMG). An EMG uses tiny electrodes to send signals to your muscles and records the response. This test helps your doctor evaluate the health of your muscles and nerve cells.

Conditions We Treat

Arthritic Shoulder and Elbow

If you feel pain and stiffness in your body, have trouble moving around or have swelling in your joints, you might have arthritis.

Arthritis of the shoulder is an uncommon problem. In almost every case, the shoulder has been injured months or years earlier, leading to an abnormal wearing down of the cartilage. Injuries include bony fracture, dislocation or heavy blow to the outer shoulder.

Fortunately, arthritis of the shoulder progresses slowly. Treatment focuses on reduction of inflammation, physical therapy stretching exercises to preserve motion, shoulder muscle strengthening exercises and avoidance of certain activities to prevent further wear and arthritic flare-ups.

Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed. Symptoms usually start gradually and include tingling or numbness or a sharp, piercing pain that shoots through the wrist and up your arm. As they worsen, grasping objects can become difficult.

Often, the cause is having a smaller carpal tunnel than other people do. Other causes include performing assembly line work, wrist injury or swelling due to certain diseases, such as rheumatoid arthritis. Women are three times more likely to have carpal tunnel syndrome than men.

Early diagnosis and treatment are important to prevent permanent nerve damage. Your doctor diagnoses carpal tunnel syndrome with a physical exam and special nerve tests. Treatment includes resting your hand, splints, pain and anti-inflammatory medicines and sometimes surgery.

NIH: National Institute of Neurological Disorders and Stroke


Distal Radial-Ulna

Fractures of the distal radius and ulnar styloid have the potential to disturb the normal function of the distal radio-ulnar joint (DRUJ), resulting in loss of motion, pain, arthritis or instability.

Hand and Upper Extremity Dislocations

Dislocations are joint injuries that force the ends of your bones out of position. You can dislocate your ankles, knees, shoulders, hips, elbows and jaw. You can also dislocate your finger and toe joints. Dislocated joints often are swollen, very painful and visibly out of place. You may not be able to move it.

Treatment depends on which joint you dislocate and the severity of the injury. It might include manipulations to reposition your bones, medicine, a splint or sling and rehabilitation. When properly repositioned, a joint will usually function and move normally again in a few weeks. Once you dislocate a shoulder or kneecap, you are more likely to dislocate it again. Wearing protective gear during sports may help prevent dislocations.


Hand and Upper Extremity Fracture

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are:

  • Out-of-place or misshapen limb or joint
  • Swelling, bruising or bleeding
  • Intense pain
  • Numbness and tingling
  • Limited mobility or inability to move a limb

You may need to wear a cast or splint to help a fracture heal. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.


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Hand and Upper Extremity Joint Replacement

In finger and wrist bone joint replacement, the abnormal bone and lining structures of the involved joint are removed surgically, and new parts are inserted in their places.

These new parts may be made of special metal or plastic (certain forms of polyethylene) or specific kinds of carbon-coated implants. The new parts allow the joints to move again with little or no pain.

What kind of joints can be replaced?

  • Finger joints (the “first” joint, called the PIP joint)
  • “Knuckle” joints (called MP joints, where the finger joins the hand)
  • Wrist joints

Artificial joints may help:

  • Reduce joint pain
  • Restore or maintain joint motion
  • Improve the look and alignment of the joint(s)
  • Improve overall hand function

American Society for Surgery of the Hand


Hand and Upper Extremity Severed Nerves

Pressure or stretching injuries can cause fibers within the nerve to break. This may interfere with the nerve’s ability to send or receive signals, without damaging the cover.

When a nerve is cut, both the nerve and the insulation are severed. Sometimes, the fibers inside the nerve break while the insulation remains intact and healthy. If the insulation has not been cut, the end of the fiber farthest from the brain dies. The end that is closest to the brain does not die. After some time, it may begin to heal. New fibers may grow beneath the intact insulating tissue until it reaches a muscle or sensory receptor.

If both the nerve and insulation have been severed and the nerve is not fixed, the growing nerve fibers may form a painful nerve scar, or neuroma.

For surgical treatment, the insulation around both ends of the injured nerve is sewn together. The goal in fixing the nerve is to save the insulating cover so that new fibers can grow and the nerve can work again.

If a wound is dirty or crushed, surgery may be delayed until the skin has healed.

If there is a space between the ends of the nerve, it may be necessary to take a piece of nerve (nerve graft) from a donor part of the body to fix the injured nerve. This may cause permanent loss of feeling in the area where the donor nerve graft was taken.

Once the insulating cover of the nerve is repaired, the nerve generally begins to heal three or four weeks after the injury. Nerves usually grow one inch every month, depending on the patient’s age and other factors. With an injury to a nerve in the arm above the fingertips, it may take up to a year before feeling returns to the fingertips. The feeling of pins and needles in the fingertips is common during the recovery process. While this can be uncomfortable, it usually passes and is a sign of recovery.

Source: American Academy of Orthopaedic Surgeons


Hand and Upper Extremity Sports Injuries

The most common sports injuries seen at our Hand and Upper Extremity Center are:

  • Dislocations
  • Fractures
  • Rotator cuff injuries
  • Sprains and strains
  • Swollen muscles

If you get hurt, stop playing. Continuing to play or exercise can cause more harm. Treatment often begins with the RICE (Rest, Ice, Compression and Elevation) method to relieve pain, reduce swelling and speed healing. Other possible treatments include pain relievers, keeping the injured area from moving, rehabilitation and sometimes surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


Hand Crush Injuries

Damage related to crush injuries includes:
  • Bleeding
  • Bruising
  • Compartment syndrome (increased pressure in an arm or leg that causes serious muscle, nerve, blood vessel and tissue damage)
  • Fracture
  • Laceration (open wound)
  • Nerve injury
  • Secondary infection
  • Smashed fingers
  • Wounds

Hand Fracture

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are:

  • Out-of-place or misshapen limb or joint
  • Swelling, bruising or bleeding
  • Intense pain
  • Numbness and tingling
  • Limited mobility or inability to move a limb

You may need to wear a cast or splint to help a fracture heal. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.


Rotator Cuff Injuries

Problems with the rotator cuff are common. They include tendinitis, bursitis and injuries such as tears.

Rotator cuff tendons can become inflamed from frequent use or aging. Sometimes they are injured from a fall on an outstretched hand. Sports or jobs with repeated overhead motion can also damage the rotator cuff. Aging causes tendons to wear down, which can lead to a tear.

Some tears are not painful, but others can be. Treatment for a torn rotator cuff depends on age, health, how severe the injury is and how long you’ve had the torn rotator cuff.

Treatment for torn rotator cuff includes:

  • Rest
  • Heat or cold to the sore area
  • Medicines that reduce pain and swelling
  • Electrical stimulation of muscles and nerves
  • Ultrasound
  • Cortisone injection
  • Surgery

NIH: National Institute on Arthritis and Musculoskeletal and Skin Disease


Shoulder or Elbow Joint Replacement

Joint replacement surgery is removing a damaged joint and putting in a new one. Sometimes, the orthopedic surgeon will not remove the whole joint, but will only replace or fix the damaged parts.

Tendon Lacerations

A deep cut can affect tendons, muscles, ligaments, nerves, blood vessels or bone.

Tendon surgery repairs damaged or torn tendons. The surgeon makes a cut on the skin over the injured tendon. The damaged or torn ends of the tendon are sewn together.

If the tendon has been severely injured, a tendon graft may be needed. In this case, a piece of tendon from the foot, toe or another part of the body is often used. If needed, tendons are reattached to the surrounding tissue. The surgeon examines the area to see if there any injuries to nerves and blood vessels. When complete, the wound is closed.

If the tendon damage is too severe, the repair and reconstruction may have to be done at different times. The surgeon will perform one operation to repair part of the injury, and then allow the hand to heal for a few weeks. Another surgery will be later done to complete the reconstruction and repair the tendon.

The goal of tendon repair is to bring back normal function of joints or surrounding tissues following a tendon laceration.


Treatments

Our program extensively researches the best nonoperative treatments for hand and upper extremity injuries. This experience positions us to better differentiate those injuries that do not need surgery and instead can be treated conservatively. We find that many injuries can be treated nonsurgically to relieve symptoms with procedures like activity modification, splinting, anti-inflammatory medication and/or corticosteroid injections.

However, if it is determined that your injury would be best fixed with surgery, know that we utilize the most cutting-edge, minimally invasive surgical techniques, such as microsurgery, reconstructive surgery, joint replacement surgery, labral surgery, instability surgery and rotator cuff surgery.

We fix all fractures of the entire shoulder girdle, perform surgeries on the acromioclavicular joint (such as shoulder separation surgery), perform all types of shoulder replacements (including total and reverse shoulder replacements), perform revision shoulder surgery and perform complex and technically challenging shoulder surgeries for instability such as surgeries requiring bone augmentation or bone grafting techniques.

Additionally, we can provide occupational therapy services that range from injury prevention education to wound care to range-of-motion exercise programs to post-operative care.


Why Choose Ohio State?

Why choose Ohio State for hand injury treatment?

Comprehensive Care: At the Hand and Upper Extremity Center, you receive expert evaluation, diagnosis, treatment and rehabilitation in a single, convenient location.

Diagnostic Expertise: We have experts in orthopedic and plastic surgery, occupational therapy, anesthesiology and outpatient rehabilitation services.

Surgical Expertise: Ohio State’s fellowship-trained hand surgeons perform more than 3,500 surgeries, treatments and procedures each year, including minimally invasive (endoscopic) carpal tunnel surgery.

Trauma Expertise: Designated a Level 1 Trauma Center by the American College of Surgeons, Ohio State’s trauma services provide care for all levels of trauma, from the complex multiple-injury patient to isolated limb injury and fracture. 

Our Doctors

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