Plastic Surgery

Arthritis in the hand occurs when joints are inflamed and may occur at the base of the thumb (the trapeziometacarpal joint), the middle joint of a finger, (the PIP joint) or in the metacarpophalangeal (MP) joint. The most common forms include osteoarthritis, post-traumatic arthritis and rheumatoid arthritis. Arthritis in the hand may be quite painful and greatly affect normal everyday activity. Symptoms of arthritis include stiffness, swelling and pain.

Treatment of arthritis may include anti-inflammatory medications, cortisone injections and individualized hand therapy involving a combination of exercises and splints. Surgery is indicated when these more conservative treatments fail and the patient has too much pain or cannot function well. Surgery can involve joint fusion or joint reconstruction. Your hand surgeon will help determine the best course of treatment for you.

The brachial plexus is a network of nerves that begins in the spinal cord in the neck and controls the hand, wrist, elbow and shoulder. These nerves may be damaged when they are stretched too far, as occurs in accidents or sometimes in infants as they pass through the birth canal. Some brachial plexus injuries can be treated with therapy. However, more severe brachial plexus injuries require surgical treatment.

In infantile brachial plexus injury, timely assessment and intervention is necessary for an optimal recovery. Evaluation should occur within the first four weeks of life. During treatment, nerve studies are conducted to determine which nerves are damaged and which are still functional.

A multidisciplinary team of physicians and therapist at The Hand Center specialize in the evaluation and treatment of brachial plexus injuries. Our therapists employ specific range of motion exercises to prevent the muscles and joints from tightening and strengthening to restore functional use.

Drs. Matloub and Sanger specialize in brachial plexus injury treatment and accept new patients and referrals from the greater Milwaukee metropolitan area as well as from throughout the United States.

Additional information about Brachial Plexus injury.

Nerves are fragile and can be damaged by pressure, stretching, or cutting. Often, damaged nerves can be repaired, either by suturing two ends back together, or, if a piece is missing or badly damaged, by using a nerve graft to fill a gap. After surgical repair of the nerves, the fibers can begin to heal and re-grow. This process can take weeks to months, and proper follow up and hand therapy is generally necessary to ensure acceptable results.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is essentially a pinched nerve at the wrist. The carpal tunnel is the space where the median nerve and tendons pass from the forearm to the hand. Carpal tunnel syndrome occurs when there is swelling in this tunnel putting pressure on the median nerve. Symptoms include numbness, tingling and pain. Symptoms may be relieved through therapy or wearing wrist splints. Steroid injections are also an option. If these treatments do not improve the condition, surgery may be required to release the carpal tunnel and take away pressure on the median nerve.

Cubital Tunnel Syndrome

Cubital tunnel syndrome is characterized by increased pressure on the ulnar nerve at the elbow (this is sometimes called the “funny bone”). Pressure on the ulnar nerve can cause numbness, tingling and pain in the elbow, arm, hand and/or fingers. Depending on the severity of this condition, it can be treated non-surgically with therapy. If therapy does not improve the condition, surgery may be required to relieve the pressure on the ulnar nerve.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is essentially a pinched nerve at the wrist. The carpal tunnel is the space where the median nerve and tendons pass from the forearm to the hand. Carpal tunnel syndrome occurs when there is swelling in this tunnel putting pressure on the median nerve. Symptoms include numbness, tingling and pain. Symptoms may be relieved through therapy or wearing wrist splints. Steroid injections are also an option. If these treatments do not improve the condition, surgery may be required to release the carpal tunnel and take away pressure on the median nerve.

De Quervain's Tendonitis

De Quervain’s tendonitis is irritation or inflammation of the wrist tendons at the base of the thumb. This condition makes grasping or holding objects or making a fist painful. Some treatments for this condition include wearing a splint, cortisone injections or making adjustments in movements which aggravate the condition. If these treatments do not improve the condition, surgery may be recommended to make more space for the inflamed tendons.

Epicondylitis

There are two types of epicondylitis: lateral and medial. Lateral epicondylitis, also known as tennis elbow, is the more common of the two. Both are typically overuse injuries, causing pain and inflammation of the tendons near the elbow that attach to the humerus (the upper arm bone). Treatment can include activity modification, medications, splinting, therapy, and/or surgery.

Trigger Finger (Tenosynovitis)

Trigger finger is an irritation of the sheath that surrounds the flexor tendons, sometimes causing the tendon to catch and release like a trigger. It can be corrected during an outpatient procedure under local anesthetic, and it generally takes less than one hour.

At The Hand Center – Plastic Surgery we can provide treatment for many types of sports injuries which affect the hand and upper extremity, including “tennis elbow,” “skier’s thumb,” rotator cuff injuries, sprains and fractures.

A tumor or mass in the hand can range from those on the skin, such as a mole or wart, to those underneath the skin in the soft tissue or bone. The most common tumor in the hand and wrist is the ganglion cyst.

Vascular disorders may cause a lack of blood flow to the hand and/or fingertips. Vascular disorders in the hand may result from trauma such as knife wounds which damage blood vessels, from aneurysms or blocked blood vessels, Raynaud’s disease, or vascular malformations. Symptoms include pain, color changes in the fingertips, and numbness or tingling in the fingertips. Treatment depends upon the severity of the problem, and ranges from medical therapy to surgical repair.

Traumatic hand injuries include fractures and tendon injuries and may result from motor vehicle accidents, industrial accidents or other work-related injuries. Traumatic injuries can be treated by grafting, or transferring nerves, skin or tissue from a healthy area of the body to the injured area, or by flap surgery, with involves moving fat, blood vessels, muscle and skin from a healthy area of the body to the injured hand.

Replantation is the surgical reattachment of a finger, hand or arm that has been severed from a person’s body. Replantation is accomplished by removing damaged tissue, rejoining bone with pins or plates and then reconnecting severed muscles, tendons, nerves and veins. Revascularization involves restoring function to an affected body part by restoring blood flow to the area. These are precise microvascular procedures that are performed under microscopes and which require exact and accurate surgical techniques.

If it is determined that a body part cannot be replanted, an amputation is performed, which is completely removing the injured body part. Sometimes amputation is the best option when a body part is cancerous or too damaged to work properly. Amputations are performed to preserve the remaining body part for future use of a prosthetic device to restore function.

The challenges of birth defects of the hand and upper extremity can be managed with expert treatment and care. Hand Center surgeons and therapists collaborate with Children’s Hospital of Wisconsin to give patients with congenital conditions the best possible treatment. Our staff is trained to treat and support patients with absent fingers, shortened limbs, absent (aplastic) thumb, radial club hand, polydactyly and syndactyly through surgery, splinting or casting, range of motion therapy and age appropriate play.

Our Plastic Surgery Training in Birth defects include congenital deformities such as deformed or shortened limbs, thumb and/or finger duplication (polydactyly), webbed fingers (syndactyly) and absence of fingers and can be treated with reconstructive surgery such as grafts, free tissue flaps, or toe-to-thumb flaps. Our plastic surgery training allows us to take steps to ensure that the hand will have an appearance that is as close to normal as possible. All of our hand surgeons have surgical privileges at Children’s Hospital of Wisconsin and are trained in pediatric hand surgery. Reconstructive surgery can be performed in infancy in order to allow the hand to develop normally and minimize growth irregularities and limitations in motion.