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Hand Upper Extremity

Our hand and upper extremity surgeons and therapists work together with the goal of reducing or eliminating pain, and restoring as much normal form and function as possible. At Cleveland Clinic, the Department of Plastic Surgery has a team of surgeons specializing in the prevention, diagnosis and treatment of disorders of the skin and nails, muscle and tendons, nerves and vessels and bones, joints, and ligaments of the hand and upper extremity. Our hand and upper extremity specialists work with both adults and children, and treat a variety of hand injuries, disorders and conditions.

As a team, our plastic surgeons collaborate with physicians from other medical and surgical specialties to give our patients comprehensive care of their hand and upper extremity needs. These include specialists in Pediatrics, Emergency Medicine, Vascular Medicine, Rheumatology, Hand Therapy and Dermatology. Additionally, our plastic surgeons work closely with Orthopaedic Surgeons and the Orthopaedic Surgery Department's Upper Extremity Center to provide patients with the best treatment or surgical plan to optimize look, as well as return to function.

Cleveland Clinic surgeons apply minimally invasive techniques when possible to reduce postoperative pain and quicken the return to function. This includes endoscopic carpal tunnel release and arthroscopic joint procedures.

Our Plastic Surgery Specialists

Hand surgery and rehabilitation is commonly done for injuries and cumulative problems. This is most often performed as an outpatient surgery, except in the case of a major reconstructive procedure.

For a hand injury, a Cleveland Clinic hand surgeon will first examine you to review the extent and severity of the problem. Together with your family, the surgeon will discuss possible treatment options, as well as details and expectations for recovery. Our goal is to restore the form, function and appearance of the hand as much as possible, as well as reduce or eliminate any pain being experienced by the patient. Before your surgery, the surgeon will review with you an estimated recovery time length and rehabilitation process, as well as help answer any questions you might have regarding desired outcomes or when you will be able to return to your normal activities.

If hand therapy is required after your surgery, our hand therapists will work with you to help you restore the normal function of your hand, as well as minimize pain. At Cleveland Clinic, our hand therapists must meet education and experience requirements to become Certified Hand Therapists through the Hand Therapy Certification Commission.

There can be many types of cancers of the upper extremity, such as of the skin. This could include basal and squamous cell carcinomas as well as melanomas, and those arising from muscle and bone which, many times, are various forms of sarcomas.

Our specialists not only remove these cancers but are capable of returning the area back to normal. Although all of our plastic surgeons have hand training, a number have had additional training focusing on the upper extremities. These specialists not only work closely with specialized oncologists and radiation oncologists, but also hand and physical therapists to ensure our patients received the best chance of functional recovery.

Both adult and child patients can be evaluated and treated for skin, bone or soft tissue masses of the upper extremity. If a concern is determined through clinical exam, specific imaging is performed prior to biopsy to help determine the nature and extent of the tumor. These studies can include x-rays, CT scan, ultrasound or MRI. A biopsy may then be performed to determine the nature of the tumor.

Treatment

As a team, our plastic surgeons collaborate with physicians from other medical and surgical specialties to give patients comprehensive care of their hand and upper extremity needs. This team includes specialists in:

  • Pediatrics
  • Medical Oncology
  • Radiation Oncology
  • Pediatric Oncology
  • Orthopaedic Surgery
  • Dermatology
  • Hand Therapy

Management of a tumor may involve surgery, chemotherapy and/or radiation therapy. Surgery may be performed on the tumor or regional lymph node.

Carpal tunnel syndrome is caused by nerve compression. Nerves that run between muscles, ligaments, bones and tendons through narrow channels, such as the wrist, are more likely to become constricted or compressed. When compressed over a period of time, the nerve sustains permanent damage

In early stages of carpal tunnel syndrome, conservative treatment can be applied, such as the use of a wrist brace and anti-inflammatory medications. In advanced stages, however, surgery to release the compression of the nerves is usually required. By releasing the pressure, blood flow to the nerve is improved and further damage prevented.

Protect Your Hands Against Repetitive Stress Injuries

By Mark Hendrickson, M.D., Head, Section of Hand Surgery

Hands are a complex array of nerves, muscles, tendons and bones—we have more than 25 bones in each hand! Hands are engineering marvels that enable us to move our fingers in ways machines cannot match. Yet those very components that enable us to play the piano or simply to get dressed also make our hands susceptible to numerous injuries, particularly repetitive strain injuries (RSI). Although not life threatening, these injuries, such as carpal tunnel syndrome, tendonitis and bursitis, can be painful and debilitating.

Frequently Asked Questions

What types of repetitive strain injuries are most common?

Tendonitis, an inflammation of the tendons, is the most common repetitive use injury we treat. Tendons connect muscle to bones, and they can be inflamed or injured along their course by repetitive movements. “Trigger finger” and “tennis elbow” are two common maladies that are actually tendonitis. Uncommonly, tendonitis is caused by a disease.

What are the symptoms of repetitive use injury?

In addition to pain, other common symptoms can include swelling, tingling, numbness, stiffness, weakness and sensitivity to cold or heat.

How soon should I seek treatment if I suspect a repetitive strain injury?

Don’t wait until the pain and functional loss is severe. In other words, if pain and loss of function are limiting your activities, seek medical help immediately. Even if you are experiencing mild discomfort and dysfunction, you may want to look at modifying your activities or work techniques to reduce further injury.

Should a patient with a hand injury see a plastic hand surgeon or an orthopaedic hand surgeon?

Hand surgeons can be trained primarily as general, plastic or orthopaedic surgeons. The history of hand surgery relates to WWII, when soldiers, sailors and airmen were treated by general, orthopaedic and plastic surgeons. A group of these surgeons became interested in hand surgery and formed an organization that grew into the American Society for Surgery of the Hand. This tradition continues today at Cleveland Clinic, where we have orthopaedic and plastic surgeons who specialize in treating every type of hand injury.

I spend a lot of time at my computer. Am I at high risk?

Repetitive strain injuries can be caused by a variety of work conditions, including computer use. For example, prolonged exposure to cold and vibration can be aggravating to the hands. So a construction worker who uses power tools every day or someone who works outside in the winter may be more prone to injury.

Carpal tunnel syndrome is a common RSI in many people, regardless of the type of work they perform. Although it has been suggested that people who use computers may be more prone to developing this condition, studies have shown otherwise.

Other factors may also predispose a person to developing carpal tunnel syndrome. For example, people with small wrists—particularly females—may be more prone to RSI. The smallness of their wrists limits the space for swelling, which is common in RSI. These same individuals also may be more sensitive when swelling does occur.

How is a repetitive stress injury treated?

We may treat the injury with rest, icing, splinting and elevation. Often an anti-inflammatory or, less frequently, a steroid injection may be used. A splint or wrap may help protect and rest the injured area.

If the injury is work-related, an occupational therapy program will help speed a patient’s recovery. Cleveland Clinic’s “work-hardening” program also helps the injured worker return to work by focusing closely and specifically at work requirements and designing a program to better prepare the worker for his or her job. The program might include hand exercises, stretching and light weightlifting, as well as changing work activities to lessen the stress on the affected area.

Can RSI be prevented?

You can minimize your risk of incurring an RSI by understanding the basic principles of good positioning (e.g., seating, standing, bending). You also should have appropriate physical conditioning for the type of work you’re doing. In addition, federal laws and guidelines exist to require employers to try to prevent RSI. No matter what job a person is doing, it should be fairly well designed ergonomically to minimize problems.

If injuries arise, Cleveland Clinic offers expert, specialty care

According to the American Society of Plastic Surgeons, more than 4.7 million people a year are bitten by man’s best friend. Of those, many require medical attention for their bites.

“Fortunately, dog bites are largely preventable,” says Mark Hendrickson, MD, a Cleveland Clinic plastic surgeon who specializes in hand surgery. When bites do occur, injuries are mainly to the face, neck and hands, he says. Immediate and proper treatment can help prevent complications, including infections and scarring.

If you or a child is bitten severely by a dog, go to the nearest emergency room or call 9-1-1 right away. Depending upon the location and extent of the injuries, most ER professionals will recommend you follow up with a qualified plastic or orthopaedic surgeon within several days. “ERs can be busy places,” warns Dr. Hendrickson, “so be sure to ask about specialty follow-up care if the ER professionals don’t make a specific recommendation.”

Dog bite injuries to the hands and arm are treated best using a team approach. At the Clinic’s Hand and Upper Extremity Center, of which Dr. Hendrickson is a member, patients are seen by skilled plastic and orthopaedic surgeons. “Following treatment, patients usually require rehabilitative therapy. We have a terrific team of hand therapists who works with patients to regain occupational and recreational skills.”

In addition to dog bite injuries, physicians within the center treat a variety of occupational, sports, and acute, traumatic injuries.

For an appointment at the Hand and Upper Extremity Center, call 216.444.HAND (4263).

Tips to Prevent Dog Bites

  • Never approach an unfamiliar dog. If an unfamiliar dog approaches you, stand still like a tree. Never run!
  • If you think a dog is about to attack you, put something between yourself and the dog, like a backpack or bicycle.
  • If a dog knocks you down, roll into a ball, cover your face and stay still.
  • Children should never approach a dog or play with a dog unless supervised by an adult. Be sure to let a dog see and sniff you first.
  • Children should tell an adult if they see a stray dog or a dog acting strangely.
  • Don't look a dog right in the eye.
  • Don't disturb a dog that is sleeping, eating or caring for puppies.
  • Never leave an infant or young child alone with any dog, not even the family pet.

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Call us for an Appointment

To schedule an appointment with a dermatologist or plastic surgeon, contact the Dermatology & Plastic Surgery Institute at 216.444.5725 (or toll-free 1.800.223.2273, ext. 45725).

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To arrange a same-day visit, call 216.444.7000

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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