Diagnosis & Treatment
Comprehensive hand and wrist care
Whether you are facing a debilitating hand condition, have sustained an injury to your hand or wrist, or are seeking treatment for your child’s hand deformity, you can rest assured that you will be treated by an experienced, compassionate surgical team. The Rochester General Hand Center diagnoses and treats a full range of adult and pediatric hand and wrist conditions.
How are hand conditions diagnosed?
Hand disorders have a number of underlying causes, and which procedure is best for diagnosing your condition may be determined based on these causes. We may collect your past medical history, including your tetanus immunization status and medications, or conduct a physical examination. A typical physical exam will help us understand your hand preference, occupation, age and any other relevant history or problems with the affected extremity. For injuries, we may also need to know the following:
- Type of trauma that occurred
- When and where the trauma occurred
- Other circumstances about the trauma (i.e., was it work related, with a contaminated piece of machinery or chemical)
- Position of the hand or wrist during the injury
In some cases, we may be able to make a diagnosis simply based on a physical examination. However, we may also use the following tests to help confirm the diagnosis, or the extent of the problem:
- Arthrography – A contrast dye is injected into the hand to allow for better visualization of the joints on x-ray.
- Bone Scintigraphy – A dye is injected into a vein and images are obtained to show the distribution of activity of the dye in various tissues and structures. The study is usually conducted in phases, with images of the hand taken at different times after the injection of the dye.
- Computed Tomography Scan (CT or CAT scan) – A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.
- Electromyogram (EMG) – A test that measures the electrical activity of a muscle or a group of muscles. An EMG can detect abnormal electrical muscle activity due to diseases and neuromuscular conditions.
- Magnetic Resonance Imaging (MRI) – A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. This allows for visualization of the tendons, ligaments, vessels and nerves in the hand.
- Ultrasound (sonography) – A diagnostic imaging technique, which uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In the hand, ultrasound is useful for locating fluid collections, such as cysts.
- Video Fluoroscopy – A diagnostic test that allows visual examination of the movement of the hand that can be recorded on a video for repeated viewing. A fluoroscope is a device that takes an x-ray and allows for immediate projection of the image on a screen for examination.
- X-ray – A diagnostic test which uses invisible electromagnetic energy beamsto produce images of internal tissues, bones and organs onto film.
We perform a variety of different hand surgeries, depending on the underlying cause of the problem. The following are some of the types of surgery we may recommend to treat your condition:
- Skin grafts – Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. The most common type of injury requiring a skin graft is a fingertip amputation or injury. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area.
- Skin flaps – Similar to a skin graft, a skin flap uses part of the skin from another area, however, with a skin flap, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat and muscles. Flaps may be used when an area that is missing the skin does not have a good supply of blood because of the location, damage to the vessels or extensive damage to the tissue.
- Closed reduction and fixation – This technique may be used when there is a fracture in part of the hand, including the fingers. This type of surgery attempts to realign the fractured bone and then immobilize the area during the healing phase. Immobilization can be done with internal fixtures, such as with wires, rods, splints or casts.
- Tendon repair – Tendons are the fibers that attach muscle to bone, and surgery to repair tendons remains a challenge because of the structure of the tendon. Tendon injuries can occur from infection, trauma and other diseases, or may just spontaneously rupture. Repair of a tendon may be classified as primary, delayed primary, or secondary. Primary repair of an acute injury is usually completed within 24 hours of the injury. Delayed primary repair is performed one to 14 days after the injury, while there is still an opening in the skin from the wound. Secondary repairs may occur 2 to 5 weeks or more after the injury. Primary repairs usually involve direct surgical correction of the injury, while secondary repairs may include tendon grafts (inserting tendons from other areas of the body in place of the damaged tendon) or other more complex procedures.
- Nerve repairs – Approximately 1,500,000 people annually seek medical attention related to a nerve injury of the upper extremity. There are 3 main nerves that innervate the hand, including the ulnar nerve, the median nerve and the radial nerve. Damage to these nerves from injury may result in a decreased ability to move the hand and experience feeling. Some nerve injuries may heal on their own, while others require surgery. Overall, the best time to repair nerves that are associated with other, more complicated, injuries is approximately 3 to 6 weeks after the injury occurs. Surgery to investigate a damaged nerve that is not complicated by other injuries is usually performed shortly after the trauma in order to increase the likelihood of a full recovery. The nerve may be repaired by reattaching it directly to the other end of the nerve or by using a nerve graft (inserting nerves from other areas of the body in place of the damaged nerve) to repair the damaged section.
- Fasciotomy – This procedure is performed to help treat compartment syndromes. A compartment is a three-dimensional anatomic space in the body that is surrounded by fascia or bone and contains arteries, nerves and veins. A compartment syndrome is a condition that arises when there is an increase in intracompartmental tissue pressure within a space in the body, usually caused by trauma, which can interfere with the circulation to the body tissues and destroy function. In the hand, a compartment syndrome may lead to severe and increasing pain, muscle weakness and, eventually, a change in color of the fingers or nail beds. Fasciotomy is the treatment for the early stage of compartment syndromes. Surgical incisions are placed in the hand or arm to allow a release of the pressures that are increasing inside the body. Any tissue inside the body that is already damaged may be removed at this time. A fasciotomy will help prevent a further decrease in function and damage of the affected extremity.
- Surgical drainage and/or debridement – Our hands are constantly at risk for injury and infection. Infections of the hand are a common reason people seek treatment; about 25% of people treated by hand surgeons have infections. The treatment for infections to the hand may include rest, use of heat, elevation, antibiotics, and surgery. Surgical drainage may be used if there is an abscess in the hand to help remove the collection of pus. Debridement, or cleansing of a wound to prevent further infection and to help promote healing, may be used if the infection or wound is severe.
- Joint replacement – Also called arthroplasty, this type of surgery may be used in people with severe arthritis of the hand and involves replacing a joint that has been destroyed by the disease process with an artificial joint. This artificial joint may be made out of metal, plastic, silicone rubber or a patient’s own body tissue (such as a tendon).