Hand and Upper Extremity Surgery  
Tendonitis
Tendonitis occurs due to overuse of tendons, connective tissue made of collagen fibers. Acute tendonitis can occur when use of the tendon is rapidly increased over a short period of time. This type of tendonitis normally fades with rest, but can become chronic tendonitis if untreated. Chronic tendonitis can be caused by increased activity, lowered recovery time between exertion, new footwear, or weakened muscles.

Symptoms
  • Pain increasing over time
  • Pain at the beginning of exercise, but disappearing slowly during the activity
  • Injured area is tender to touch
Treatment
  • Rest and apply ice to injury
  • Anti-inflammatory medication if necessary
  • Sports massage or ultrasound
Bursitis
Burae are small fluid-filled sac-like structures that allow tendons to glide over bones or under the skin to facilitate movement. These structures provide a low-friction surface for tendons to move without getting irritated. Bursitis occurs when the bura is irritated due to trauma, overuse, infection, or systemic disorders like arthritis.

Symptoms
  • Affected area may be red or warm
  • End-range of motion will be restricted moderately
  • Tenderness at the location of the injury
Treatment
  • Rest and protection following the injury
  • Draining of the bursa by a physician if necessary
  • Cortisone injection to limit inflammation and create a permanent solution to the injury if necessary
  • Anti-inflammatory medication may be prescribed if necessary
  • Surgery if the bursitis does not respond to other treatment options
Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs in the wrist when the surrounding tendons, ligaments, and muscles compress the median nerve, causing pain. The carpal tunnel, which is the passageway where the median nerve is located, is narrow and the nerve can be irritated easily.

Symptoms
  • Burning, tingling, and numbness in the palm of the hand and fingers
  • Decreased grip strength
  • Decreased sensitivity to hot and cold
Treatment
  • Rest and ice
  • Immobilization of the wrist
  • Anti-inflammatory medication when necessary
  • Cortisone injections when necessary
  • Surgery to cut the ligament that forms the roof of the carpal tunnel
Rotator Cuff Injuries
Rotator cuff injuries are caused by overuse of overhead arm movements, and can be quite painful. Aching pain occurs when arms are used over the head or directly to the side of the body.

Symptoms
  • Pain associated with arm movement, especially overhead arm movement
  • Pain in shoulder when slept on at night
  • Tenderness over general area
Treatment
  • Rest and ice are very important
  • Anti-inflammatory medication when necessary
  • Continuous movement of the arm with rest periods to avoid reduction of mobility
Symptoms of Chronic Rotator Cuff Tear
  • Occurs on dominant side
  • Weakness throughout range of motion
  • Eventual loss of mobility
Treatment of Chronic Rotator Cuff Tear
  • Rest and ice
  • Steroid injection when necessary
  • Shoulder exercises prescribed by physician
Symptoms of Acute Tear
  • Sudden tearing feeling in shoulder
  • Radiating pain down arm
  • Limited mobility
  • Tenderness in specific area of the rotator cuff
  • Abduction of arm not possible
Treatment of Acute Tear
  • Ice to reduce swelling
  • Medications when necessary
  • Surgery to repair tendons and ligaments
  • Resting of arm in sling if necessary
Impingement Syndrome
Impingement syndrome occurs when the tendons over the shoulder become inflamed from rubbing in the subacromial space. This irritation thickens these tendons, causing more pain.

Symptoms
  • Pain located in the front and side of the shoulder during forceful overhead motions
  • Pain at the back and front of the joint during abduction or ER (external rotation)
Treatment
  • Rest and ice
  • Slow return to sport
  • Anti-inflammatory medication when necessary
  • Injection of steroids when necessary
  • Stretching exercises
  • MRI or ultrasound
Arthritis
Arthritis is inflammation of the joints that causes pain and restricts movement. Arthritis is caused by the breakdown of cartilage that normally protects the joint and facilitates smooth movement. Without cartilage, bones rub together, which creates inflammation, pain, and stiffness. There are a variety of different types of arthritis, but some common causes are autoimmune disease, broken bones, age-related wear and tear, and infection.

Symptoms
  • Pain
  • Joint swelling
  • Reduced ability to move the joint
  • Redness of the skin
  • Stiffness
Treatment
  • Low-impact aerobic activity
  • Range of motion exercises for flexibility
  • Strength training for muscle tone
  • Avoid placing extra stress on your affected joints
  • Modify your home to make activities easier
  • Medications
  • Surgery
Fractures
Fractures can occur for a number of reasons related to trauma to the bone. Traumatic injuries, including those sustained during falls, car accidents, or fights, can cause bone to break.

Symptoms
  • Sharp, intense pain
  • Popping or snapping sounds
  • Swelling and inflammation near or around injury location
  • A visible, unnatural bend in a bone
Treatment
  • Casting or bracing
  • Surgery
  • Locking plate technology
Lateral Epicondylitis (Tennis Elbow)
Tennis elbow is an overuse injury that occurs from repetitive use of the forearm and arm muscles. The tendons fray due to the impact of the ball and racket, causing inflammation.

Symptoms
  • Pain on outside of elbow
  • Gripping and lifting objects becomes difficult
  • Sometimes radiating pain down arm
Treatment
  • Resting the elbow joint
  • Rest, Ice, Compression, Elevation (R.I.C.E.) method
  • Wrapping the forearm right below the elbow joint will enhance recovery
  • Anti-inflammatory medication may also be prescribed as necessary
Frozen Shoulder
Frozen shoulder is caused by the inflammation, scarring, and shrinking of the shoulder capsule. Any type of injury to the joint may lead to a frozen shoulder. Athletes with diabetes are more susceptible to being affected by this injury.

Symptoms
  • Aching shoulder pain
  • Limited movement of the joint
  • Pain during sleep, especially when sleeping on injured side
Treatment
  • Anti-inflammatory medication
  • Cortisone injections when necessary
  • Exercise program and therapy
  • Surgery for severe cases
Brachial Plexus Injuries
The brachial plexus is a network of nerves that transmit signals from the spinal cord to the shoulder, arm, and hand. Brachial plexus injuries usually include stretching or tears to the network of nerves in the neck and shoulder.

Symptoms
  • Pain
  • A limp or paralyzed arm
  • Decreased muscle control in the arm, hand, or wrist
  • Loss of feeling or sensation in the arm or hand
Treatment
  • Medications
  • Physical therapy exercises
  • Surgery including nerve grafts or nerve transfers
Dupuytren's Contracture
Dupuytren's contracture is an abnormal thickening of the fibrous layer of skin beneath the palm and fingers that causes the finger to curl. This disorder is uncommon, and only causes severe pain in rare cases.

Symptoms
  • Thickening of the skin on the hand
  • A lump of tissue under the palm
  • Fingers that curl toward the palm
  • Most often affects the ring and pinky fingers
Treatment
  • Steroid injections
  • Hand therapy
  • Percutaneous cordotomy
  • Xiaflex injection
  • Surgery
Arthroscopy
There are a variety of procedures that can be conducted using arthroscopic techniques. Arthroscopy uses a few small incisions to insert a small camera attached to a scope, called an arthroscope, which captures images of internal tissues and transmits the images back to large monitors in the operating room. This provides surgeons a complete view of the body's tissues without having to make large open incisions; because of this, these procedures are considered minimally invasive. Arthroscopy can be used to diagnose and treat orthopaedic conditions affecting the shoulder, elbow, hip, knee, and ankle.
Surgical Repair for Tendons and Ligaments
Tendons and ligaments, called connective tissues, are made of collagen fibers that provide strength and stability to a joint. Torn or damaged tendons and ligaments can be repaired surgically. A surgeon can use sutures to connect the ends of torn connective tissues. When the tissue is too damaged and cannot be repaired with sutures, a graft may be used to replace the injured tendon or ligament.
Lavage or Debridements
This procedure is used to "clean" unnecessary tissue, like flaps of cartilage, fibrous tissue, scar tissue, or bone chips out of a joint. If an injury heals by producing an excess amount of scar tissue that inhibits the ability to move, or causes pain, a surgeon can use an arthroscope to help remove the scar tissue without having to re-open the entire injury site. Surgeons can also remove loose bodies, like bone chips that can come loose during a fracture or other trauma, using arthroscopic tools to avoid open surgery.
Cartilage Repair or Removal
Cartilage is a firm and flexible connective tissue located throughout the body in joints, between bones, in the intervertebral discs, in the rib cage, and in the ear, nose, elbow, knee, and ankle. Like other connective tissues, cartilage is made of collagen fibers, but unlike other connective tissues, it does not contain blood vessels. This causes cartilage to repair and re-grow slowly. Cartilage can be damaged or degenerate due to a number of different disorders, most notably osteoarthritis. When cartilage is damaged, arthroscopy may be used to repair or remove the damaged tissue to facilitate motion in joints.
Nerve Conduction Study (NCS)
NCS, a diagnostic test, identifies the presence of peripheral nerve damage by assessing how well and how quickly nerves can transmit electrical signals to other parts of the body. It involves sending small electric impulses over the nerves and muscles in the affected area and then recording the response.

What conditions can be diagnosed or confirmed with a Nerve Conduction Study?
Patients suffering from nerve and muscle disorders of the hand, such as carpal tunnel syndrome and cubital tunnel syndrome, can benefit from having NCS done at University Orthopaedic Associates (UOA).

Carpal tunnel syndrome is a progressively painful hand and arm condition caused by compression of the median nerve in the wrist; it can result from wrist fractures and dislocations, chronic illnesses like diabetes and rheumatoid arthritis, and repetitive or prolonged flexing of the wrist.

Cubital tunnel syndrome develops from excessive pressure on the ulnar nerve in the hand, primarily due to wrist and elbow abnormalities; it manifests in the pinkie and ring fingers and the back of the hand. Common symptoms for both syndromes include numbness, tingling, burning, and weakness in the hand.

How long does a Nerve Conduction Study take?
Gregory Roth, MA, OTR/L, CHT, UOA’s hand therapy specialist, conducts the studies in the practice’s New Brunswick location. The test is quick and convenient and, along with review of results, takes only about 20 minutes. UOA patients can have their NCS and results completed during a single appointment and, if necessary, arrange for treatment with a UOA specialist.
Total Shoulder Arthroplasty
When shoulder pain stemming from arthritis, degenerative joint disease, or traumatic injury cannot be alleviated by conservative treatments, total shoulder arthroplasty (or total shoulder replacement) can successfully restore comfort, as well as improve range of motion, function, and strength. The well-established surgical procedure involves replacing both the ball (humeral head) and socket (glenoid bone) of the shoulder joint with manufactured components made of either plastic or metal. The ball replacement contains a stem that attaches it to the arm bone (humerus), and the socket replacement is held in place with special cement. Patients undergoing total shoulder arthroplasty typically are in the hospital for two to three days, and begin rehabilitation on the day of surgery.
Partial Shoulder Arthroplasty
Also known as a hemi-replacement, partial shoulder arthroplasty is a proven surgical option for treating degenerative arthritis and, in some cases, severe fractures of the humeral head (the ball of the shoulder joint). Unlike total arthroplasty, which replaces both the humeral head and the glenoid bone (the joint socket), partial arthroplasty replaces only one joint component. The technique offers many benefits, including less pain, smaller incisions, and a more rapid return to normal lifestyle.
Reverse Shoulder Arthroplasty
A relatively new type of shoulder replacement, reverse shoulder arthroplasty is used for people who suffer from severe arthritis of the shoulder along with a completely torn rotator cuff, as well as individuals for whom previous shoulder surgeries or replacements have failed. In a healthy shoulder joint, the deltoid muscle and rotator cuff work together to enable a person to raise his/her arm overhead and to the side. When there is a large tear, lifting the arm may be impossible or quite hard to do. A reverse shoulder arthroplasty corrects this problem by not only replacing the socket and ball of the shoulder, but also switching them, so that the socket attaches to the upper arm bone and the ball attaches to the shoulder bone. With the new shoulder construction, the arm is lifted using the deltoid muscle rather than the rotator cuff.
Elbow Arthroplasty
Elbow arthroplasty replaces an elbow joint that is seriously injured or diseased with an artificial joint, typically made of metal and polyurethane. During the procedure, which can be performed under general or regional anesthesia, the surgeon removes the elbow joint ends of both the humerus (upper arm bone) and the ulna (lower arm bone), as well as any damaged tissue. Channels are then drilled into the humerus and ulna, and the replacement device, containing a hinge flanked by stems, is cemented into the channels. The new joint offers stability, wider range of motion, and pain relief.

Elbow arthroplasty often is used to treat such chronic conditions as degenerative osteoarthritis, end-stage rheumatoid arthritis, and post-traumatic arthritis, and occasionally severe elbow fractures. It is recommended highly for patients older than 65 who have minimal physical demands.
Wrist Arthroplasty
For people with limited, debilitating wrist movement due to arthritis or injury, wrist arthroplasty can help reduce discomfort and improve the ability to carry out normal daily activities. The procedure has become an increasingly popular solution for restoring mobility and stability, and frequently is done in conjunction with other surgeries addressing disorders of the nerves, tendons, and small joints of the fingers. Performed under general or regional anesthesia on an outpatient basis, wrist arthroplasty replaces the damaged or worn-out radius, ulna, and carpal bones in the wrist joint with a prosthetic joint made of metal and plastic that is held in place with screws and bone cement. After surgery, the wrist is immobilized in a cast and/or splint for several weeks to facilitate proper healing.