Hand & Upper Extremity

The hand and upper extremity area involve everything from the bones, nerves, joints, and muscles of the hand, to the wrist, forearm, elbow and shoulder. Collectively, they are imperative for daily activity.


The hand has several minor joints that function together to create motion. When there is degeneration and breakdown along with inflammation around one or more joints within the hand or wrist, it is diagnosed as hand arthritis. There are many areas within the hand that are susceptible to arthritis and often it has more than one cause. If the ailment is not treated over time the joint can lose its normal shape causing more pain and even less motor function.

The more common forms of arthritis are osteoarthritis and rheumatoid arthritis which cause cartilage to slowly wear away. The end result is loss of the normal joint anatomy and wear, causing pain and inflammation. Another cause of arthritis is pre-existing trauma, such as a fracture or dislocation, which has a direct effect on the joint surface resulting in post-traumatic arthritis.

General symptoms of arthritis include pain, swelling, changes in surrounding joints, warmth, a loose (or unstable) support of the joints, a rough or grinding sensation in the affected joints, and cysts which may develop around the joints.

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The thumb is a vital digit as it is responsible for 40 percent of hand function. The thumb’s primary functions consist of pinching, grasping and gripping, and it is necessary for activities like writing, texting and buttoning pants.


Motion and strength in the thumb are necessary for everyday living and over time the thumb can suffer from symptoms of arthritis, which is inflammation around joints. There are several forms of arthritis that affect the thumb with the most common being basal joint arthritis. Arthritis is caused by degeneration of the joint cartilage, and the term “basal” is simply referencing the base of the thumb.

Arthritis of the thumb is most often due to normal wear and tear that comes with aging, more specifically when the cartilage begins to deteriorate at the base of the thumb joint. The cartilage becomes thinner creating direct contact between the bony surfaces which causes friction. When this occurs the joints begin to feel pain, swell and grow progressively weak; making normal activities increasingly difficult.

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The wrist is a joint comprised of eight small bones that connect the hand to the forearm. Injuries or conditions of the wrist can be treated either primarily with arthroscopy or with the assistance of wrist arthroscopy. Minimally invasive surgery is often recommended due to its minimal application of incisions as well as shorter recovery time. Arthroscopy is often used to diagnose and treat conditions afflicting the wrist.


Arthroscopy consists of small incisions in the joint through which small instruments, with a camera can be passed. The video screen displays images inside the joint, allowing the surgeon to make a proper diagnosis as well as well as provide proper treatment. The following list of condition includes, but is not limited to, what arthroscopy is used to treat: chronic wrist pain, wrist fractures, ganglion cysts, ligament tears, and carpal tunnel release. Typically, these procedures are performed on an outpatient basis.

The first few days post-surgery the wrist will be bandaged and should be iced to help reduce swelling. Basic exercises can be applied in order to reduce stiffness as well as return mobility and strength to the wrist and hand.


The median nerve, radial nerve, and ulnar nerve are the three main nerves that supply the hand and upper extremity. It is common for these nerves to become compressed in the extremity causing symptoms such as numbness, tingling, weakness and pain.


The wrist is one of the most common joints where nerve compression occurs. When the wrist flexes or extends for a long period of time it can cause compression in an area of the wrist known as the carpal tunnel. As pressure increases, symptoms can worsen leading to nerve damage.

Most cases of carpal tunnel syndrome are caused by a variety of causes or etiologies. It can be hereditary, present as a symptom of pregnancy or develop as the result of the position of the hand and wrist as well as repetitive use of the hand. Other health conditions such as rheumatoid arthritis and thyroid gland imbalance can also affect the development of carpal tunnel syndrome. 

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