Hand and Wrist Surgery

Healthy hand motion is vital to your everyday life. You use your hands constantly on a daily basis to manage just about everything. From writing to eating, from cooking to cleaning, your hands help navigate you through this complex world with dexterity and ease. When you suffer from hand pain or wrist pain, your hands become immobile. This has significantly negative effects on your life.

Symptoms of Wrist and Hand Conditions:

Both wrist pain and hand pain can be caused by any number of problems. Oftentimes, these issues affect various parts of your wrist and hands, including your bones, tendons and muscles. If you experience any of the following symptoms of wrist or hand conditions, it’s time to seek medical treatment from an orthopedic specialist:

  • Increased hand and arm pain

  • Finger joint pain when carrying, gripping, grasping or twisting objects

  • Swelling and discomfort in the hand or around the affected joint

  • Changes in the surrounding joints, including thumb joint pain

  • Hand, palm and fingers may feel warm or appear red in color

  • Sensation of grating or grinding in the affected joint

  • Developing cysts on the end joints of your fingers

  • Hand numbness, tingling or throbbing while resting or sleeping

Hands are a vital part of everyday activities and lifestyles. We use them to eat, communicate, work, play, and drive. From birth we use them to reach, grasp, and hold on to objects and loved ones. When our hands are not functioning properly, simple things become difficult to accomplish. If your hands, fingers, or wrists are causing pain, it is wise to seek medical attention. Many hand conditions do not go away naturally, but require hand surgery. Dr. Robert Afra, of San Diego Orthopedic Surgery, has many years of providing successful hand surgeries to his patients. He is renowned in his expertise in wrist and hand conditions and surgeries. He, and his expert team, will guide you from beginning to end of your medical process to ensure you have the very best care. Hand surgery at San Diego Orthopedic Surgery has helped reduce hand and wrist pain and gain mobility to many conditions, including:

  • Carpal Tunnel Syndrome

  • Tendinitis

  • Hand and Thumb CMC Arthritis

  • Ganglion Cysts

  • Finger and Wrist Lumps

  • Trigger Finger

  • De Quervain and Extensor Tenosynovitis

If you would like to schedule a hand or wrist surgery consultation, please contact us to learn about your options.

The Hand:

The hand is comprised of 27 bones; 14 of which are phalanges, 5 are metacarpals, and 8 are carpal bones. The phalanges are the finger bones, which you can count be separating each knuckle. The fingers each have 3 and the thumb has 2. The metacarpals connect the fingers and the wrist, while the carpal bones are a group of bones in the wrist. Human hands are grasping hands, as we have opposable thumbs that allow us to pinch, grasp, and grab. Only primates have this feature. The hand includes the palm, heel, five digits (fingers), and the wrist. The muscles of the hands are either extrinsic or intrinsic. Extrinsic muscles are flexors, which bends the fingers, and the extensors, which essentially straighten the fingers. Intrinsic muscles are the thenar, hypothenar, interossei, and lumbrical which are the thumb, little finger, metacarpal, and flexing muscles, respectively.

Warning Signs of Hand and Wrist Injury:

  • Pain

  • Swelling

  • Stiffness

  • Weakness

  • Lumps

  • Tingling or numbness

  • Paralysis

  • Crunching or grinding feeling

Many hand or wrist conditions do not heal naturally and need medical intervention.

Types of Hand and Wrist Injuries:

Hand and wrist injuries can involve tendons, nerves, bones, and ligaments. Age and overuse are common contributors to hand and wrist injuries. The most common types of hand and wrist injuries or conditions are:

  • Carpal Tunnel Syndrome

  • Tendinitis

  • Hand Arthritis

  • Thumb CMC Arthritis

  • Trigger Finger

  • Ganglion Cysts

  • Finger Lump

  • Wrist Lump

  • De Quervain Tenosynovitis

  • Extensor Tenosynovitis

  • Tendon Rupture

  • Wrist Osteoarthritis

Carpal Tunnel Syndrome:

The muscles that bend the fingers and wrist are provided by the median nerve. The median nerve is the source of feeling in the palm and eight of the fingers (pinkies not included), along with the muscles used to bend the thumb. This nerve and the tendons, called flexor tendons, used to bend the fingers are protected by the carpal tunnel. The carpal tunnel (which as its name suggests is a tunnel-like area) contains wrist bones and carpal ligaments. When the tissue around the flexor tendons are inflamed, it puts pressure on the median nerve. Over time, the tissues can fill the carpal tunnel, causing the nerve to become irritated. Carpal tunnel syndrome can be hereditary, and occurs more often with older age. Consistent use of the hand over time such as playing an instrument, or a job that requires routine hand motions can also cause carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include numbness, weakness, and tingling in the hand, along with feelings of electric shock in the fingers. Symptoms are usually gradual, and can occur at any time. Carpal tunnel syndrome is diagnosed by one or more of the following: a physical exam, x-ray, electromyogram, which measures the amount of electrical discharge in your muscles, and a nerve conduction study which studies if the carpal tunnel slows the shocks that are sent through the median nerve.


Bones are connected to muscles by tendons. Tendons are flexible, yet tough, and can be small or large depending on their location in the body. When tendons are overused through repetitive motion such as pinching with the thumb, or overloaded too quickly with weight or activity, they can become inflamed or tear. Symptoms of tendinitis include joint pain or weakness, pain at the back of the wrist by the base of the thumb, and can also feel hot to the touch. Redness and swelling can also occur with tendinitis. Tendinitis is diagnosed based on symptoms, medical history, and a physical exam.

Hand Arthritis:

Arthritis is a gradual disease that occurs when the cartilage in the joints wear down. Cartilage is a cushion between the joints that allow them to move freely. When cartilage begins to wear away, the bones begin to rub together which can cause pain, bone spurs, and possible deformity. Arthritis can occur in any of the hand and finger joints, but most often are seen in the base of the thumb, the joints closest to fingernails, and the middle join of the finger. Symptoms of arthritis can include pain, stiffness, and swelling. A crunching or grinding feeling in the joints, and lowered range of motion can also occur. Arthritis is diagnosed by the patient’s medical history and a physical exam. X-rays and bone scans can also be used.

Thumb CMC Arthritis:

This is a condition that affects the carpometacarpal (CMC) joint of the thumb. The CMC is where the base of the thumb and the wrist bone meet. As with any type of arthritis, the cartilage gradually wears away causing bones to rub together. This kind of arthritis can cause the thumb to slip out of place and fall into the palm. Symptoms of CMC arthritis include pain that occurs when attempting to grasp, pinch, or hold something smaller. Grinding pain from pressure put on the joint and swelling can also occur with CMC arthritis. CMC Arthritis occurs most in females between the ages of 50 and 70. Diagnosis of CMC arthritis is done by physical exam, medical history, and x-ray.

Trigger Finger:

Trigger finger is aptly named as this condition causes a finger or thumb to be stuck in a bent position. When trying to straighten the bent finger it will snap back into place. Trigger finger is caused by the irritation of the flexor tendons, which are attached to the muscles in the forearm. The tendons go from the wrist to the bones in the fingers. When the fingers move, the flexor tendon slides back and forth through a tendon sheath, which is a protective tunnel that keeps the tendon in place. When the flexor tendon becomes irritated it thickens making it difficult to slide through the tendon sheath. Trigger finger occurs when the tendon becomes stuck at the tip of the sheath. When it is able to move through, the tendon will pop. Women are more likely to have trigger finger than men, and it occurs most often between the ages of 40 and 60 years. Those with rheumatoid arthritis are also prone to trigger finger. Symptoms of trigger finger are swelling, pain, and a popping feeling when bending the joints. For this particular ailment, a diagnosis can be made pretty quickly by a quick examination of the hand.

Ganglion Cyst:

Ganglion cysts are usually found on the hands or the back of the wrists. They appear as a swelling or lump under the skin near a joint or tendon. The fluid inside the cyst is jellylike and thick. Some cysts are hard while others have some give to them when pressed on. About 65% of all ganglion cysts are painful. Others are just noticeable due to their appearance. Science is still unclear as to what specifically causes ganglion cysts, but they are more common in those aged 15-40, and affect more women than men. Gymnasts who use repetitive motion and stress to their wrists often have ganglion cysts. Symptoms of ganglion cysts is the appearance of soft, stationary lump that can change in size, and is accompanied by a constant ache. Doctors can diagnose a ganglion cysts by a physical exam. Some doctors may take a fluid sample of the cysts for confirmation.

Finger Lump:

Finger lumps can occur to a variety of reasons. Some are caused by overactive cellular activity, while others are caused by an abnormal amount of calcium salts causing calcification. Injuries of the nerve cells, gout, and arthritis can also cause finger lumps. Lumps are usually benign but some can be cancerous. Finger lumps do not dissipate on their own and will grow larger over time causing pain and more difficult surgery. Doctors diagnose finger lumps through a physical examination, x-rays, blood tests, and often EMG’s. Finger lumps require surgical removal.

Wrist Lump:

A wrist lump can develop on anyone. They usually occur due to an injury or repetitive motion. Broken bones, swelling, infections, arthritis, gout, and other conditions can cause wrist lumps. While most are benign, some lumps can be cancerous. If there is no pain or discomfort with the wrist lump, surgery is not necessary. Wrist lumps that occur due to swelling can be helped with pain medication or cortisone injections. Serious symptoms of a wrist lump that will most likely require surgery include: fever, deformity, paralysis, loss of mobility, and prolonged pain.

De Quervain Tenosynovitis:

De Quervain Tenosynovitis is a painful ailment, mostly caused by overuse, which surrounds the tendons of the thumb’s base. The tendons become irritated causing swelling of the area. Swelling causes pain, tenderness, and loss of mobility and range of motion. The ability to pinch, grasp, grab, or make a fist will cause noticeable pain. In order for the thumb to move properly, the tendons covered in a soft tissue called synovia slide through a passageway or sheath. When the sheath swells or becomes irritated, the tendons cannot move freely which causes pain in the thumb. Symptoms of De Quervain Tenosynovitis include pain, sudden or gradual, at the base of the thumb by the wrist. Pain can radiate up the forearm and is worse when attempting to use the hand. Swelling, snapping sensations, and even cysts can appear with this condition. Doctors diagnose De Quervain Tenosynovitis by a physical examination. Treatments vary from splints and pain relievers to possible surgery.

Extensor tenosynovitis:

The tendons pass through a sheath that houses lubricant for the tendon, called synovial fluid. Due to injury, overuse, or other activities that causes stress for the tendons, the synovial fluid may not work as it should. This causes friction for the tendons, which in turn causes pain and inflammation when moving the joint. While De Quervain Tenosynovitis affects the thumb at the base, Extensor tenosynovitis occurs when the tendons on the back of the wrist become swollen and inflamed. Symptoms for extensor tenosynovitis are pain on the back of the wrist, redness, swelling, and limited mobility. Doctors can diagnose this condition by physical examination.

Tendon Rupture:

While athletes who use rotate, flex, grasp, or repetitively use their wrist muscles are more prone to tendon ruptures, older people can be at risk for them, also. A tendon rupture is when the tendon tears or separates from its fibers. This painful condition causes inability to use the joint. Symptoms of a tendon rupture include a snapping or popping sound, inability to use the affected part, severe pain, bruising, or weakness. If any of these occur, seek emergency medical help. A diagnosis of a tendon rupture is made using x-rays and possibly an MRI. Wrist Osteoarthritis Wrist osteoarthritis is usually caused by the wear and tear of time and occurs more frequently after the age of 45. Arthritis can be hereditary, but can also be caused by repetitive motions and injuries. Those who have had wrist injuries in the past could be prone to wrist osteoarthritis. Cartilage, which covers the ends of the bones, degrades over time. This causes friction within the joints, which causes pain to the patient. Symptoms of wrist osteoarthritis are pain, stiffness, usually in the morning that could last up to 30 minutes. Swelling, instability, crackling, and locking can also occur with this condition. Doctors can diagnose wrist osteoarthritis by physical examination, x-rays, and past medical history. Treatments Many hand and wrist problems can be helped or relieved by splints, pain relievers, needle aspiration for cysts, and rest, doctors often use wrist arthroscopy to diagnose and treat problems. Wrist arthroscopy is a procedure orthopedic surgeons use to diagnose and treat many wrist joint problems. The arthroscope is a fiber optic instrument that contains a camera that allows the doctor to view the problem area in the joint. Small incisions, less than half an inch long, are made around the joint. The arthroscope, which is about the size of a ball point pen is placed into the incision. The images inside the joint are sent to a monitor for the doctor to view. While watching the monitor the doctor moves the arthroscope around the area. The tip of the arthroscope holds small instruments such as knives and shavers to fix problems the surgeon views in the monitor. Wrist arthroscopy is not done after a physical exam, tests, MRIs, or X-rays have been taken to find the root of the problem.


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