Treatments & surgeries for hand and wrist conditions
Recipients of a Top Doctors Awards in 2012 for hands and upper extremities, our talented surgeons are pillars in the orthopedic community. Using better materials and designs, and pioneering new surgical techniques improves the quality of life for our patients.
Nerves don't heal as well as other tissues, so surgery is most successful in the earlier stages of the condition before permanent nerve damage has occurred. If you think you may have this condition, you should schedule a consultation as soon as possible.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome occurs when a nerve (the Median nerve) becomes compressed in the wrist.
Carpal tunnel syndrome is often caused by overuse of the hands and wrists, wrist arthritis, and even pregnancy. The most common symptoms include numbness, tingling, and burning in the thumb, index and middle fingers that is often worse at night. If left untreated, most of the hand will lose sensation and grip strength will be lost permanently.
Carpal Tunnel Syndrome can be treated by relieving compression on the nerve. Unlike traditional carpal tunnel surgery — which involves a long incision across the hand and wrist — Dr. Penello's minimally invasive technique requires only a ½ inch incision. The results are superior to traditional open or endoscopic carpal tunnel release.
The success of the procedure is dependent on the severity of the nerve compression.
Carpal Tunnel Surgery
Our minimally invasive carpal tunnel release surgery requires a much smaller incision than traditional — only ten to fifteen millimeters. This procedure relieves pressure on the median nerve which releases the pain of carpal tunnel syndrome.
Carpal Tunnel Surgery is performed on an outpatient basis and allows for a quick recovery.
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome occurs when a nerve (the ulnar nerve) becomes compressed in the elbow. Since the ulnar nerve also controls many of the small muscles in the hand, symptoms such as hand cramping and loss of grip strength and dexterity can occur in the later stages.
If left untreated, the hand will develop a claw deformity and hand function may deteriorate permanently. The condition can be treated, however, with a simple procedure to relieve the compression on the nerve.
In contrast to the treatment of Carpal Tunnel Syndrome, minimally invasive techniques for Cubital Tunnel Syndrome have a higher complication rate across the country. Dr. Penello prefers the traditional and safer procedure performed through a 2-3 inch incision behind the elbow. The success of the procedure is dependent on the severity of the nerve compression.
Tendonitis of the Hand, Wrist, Elbow and Shoulder
Tendons are like ropes that connect a muscle to bone. Tendonitis describes when the tendons become irritated and inflamed.
There are dozens of tendons in the upper extremity and each one of them is susceptible to developing tendonitis.
Repetitive and/or strenuous use of muscles is the most common cause of tendonitis. The most common types of tendonitis in the upper extremity are:
- Rotator cuff
- Tennis elbow (lateral epicondylitis)
- Golfer’s elbow (medial epicondylitis)
- DeQuervain’s (along the thumb side of wrist)
- Extensor carpi ulnaris (along the little finger side of wrist)
- Trigger fingers (palm of the hand)
It is important to determine the underlying cause of tendonitis when creating a treatment plan. Our physicians and physical therapists will identify the factors in your specific case of tendonitis, treat the condition and develop a personalized plan to strengthen your body and minimize the chance of relapse or recurrence.
Each treatment plan is personalized to meet our patients' needs. Treatments may include:
- Physical Therapy
- Activity modification recommendations
- Anti-inflammatory medications
- Splints and braces
- Cortisone injections
- Regenerative Medicine injections including PRP, stem cells and growth factors
In cases of severe tendonitis or in the presence of tendon tears, Dr. Penello may recommend surgical repair to expedite healing.
Arthritis of the Hand, Wrist, Elbow and Shoulder
Arthritis results in the progressive destruction of the joint, leading to pain, swelling, and loss of motion. Eventually, your function can become quite compromised.
When fingers and wrists are affected, simple activities such as cutting food, opening jars, turning keys, writing, typing, cooking, gardening, or personal grooming become difficult and painful.
Types of Arthritis:
- Osteoarthritis: Genetic, and associated with aging.
- Post-traumatic: Following an injury to a joint.
- Septic: Due to infection of a joint
- Inflammatory: Due to an autoimmune condition such as rheumatoid arthritis, psoriasis, and lupus.
We have many treatments available for the management of arthritis affecting the upper extremity, ranging from simple non-operative procedures to state-of the art joint replacement procedures.
Joint replacements in the fingers, wrist, elbow and shoulder eliminate the pain associated with arthritis while preserving motion of the joint. In the upper extremity, the reduction of pain and preservation of motion can drastically improve your function, comfort and overall quality of life.
Lumps, Bumps and Other Lesions
When it comes to lumps and bumps, one can never be too careful. Although cancer in the hand and upper extremity is uncommon, it does occur. An incorrect diagnosis or inappropriate treatment can have serious consequences. It's important to schedule a consultation with a knowledgeable and experienced upper extremity specialist.
"Lesions" is used to describe a variety of conditions, such as:
- Ganglion cysts
- Mucous cysts
- Nerve tumors
- Squamous cell carcinoma
- Giant cell tumor of tendon sheath
- Glomus tumors
- Bone spurs
Finding a lump or lesion can be a stressful experience. Our team of physicians, radiologists and pathologists use advanced diagnostic imaging, biopsy techniques and delicate surgical excision to accurately diagnose and treat your condition, so you can feel informed and confident of your diagnosis and treatment plan.
The Xiaflex injection involves a revolutionary injection which dissolves diseased connective tissue, allowing the patient to avoid surgery.
With an impressive 90% success rate, this procedure is commonly used for Dupuytren’s Contracture.
The procedure requires special training and certification. Dr. Penello is one of the few hand specialists in the area that administers Xiaflex injections. The procedure is done right in the comfort of our office, and patients can return to daily life afterward.
Total Wrist Replacements
A total wrist replacement involves removing certain bones of the wrist that are no longer functioning or causing pain due to arthritis or other condition. Prosthetics replace the damaged bones. The surgery allows a patient to maintain the motion in their wrist and relieves pain.
We are one of the few practices that performs total wrist replacements. This is an outpatient surgery at our practice.
Joint arthroplasty involves resurfacing the bones of the joint or replacing the joint with an artificial prosthesis. Arthroplasty of the hand or wrist eliminates pain and allows the patient to retain movement in their finger.
This procedure involves using redundant tendons from one part of the hand or arm to supplement another that has been lost due to stroke, injury, trauma or autoimmune disorders.
Dr. Penello is one of the few surgeons in the country who performs complicated tendon transfers.