About Hands

From common hand problems to those requiring specialized expertise, the hand and microsurgery specialists at the University Orthopaedic Center are available to provide you with the care you need.

Our surgeons have expertise in hand and upper extremity care from microsurgery to total elbow arthroplasty and sophisticated grafts to congenital hand surgery. The hand team performs over 2,500 surgical cases each year and works closely with certified hand therapists to ensure quality patient care.

Hand Therapy

Contact Us

(801) 587-7109

Hand Pain and Problems

Anatomy of the hand

The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

  • Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal); the thumb only has 2.

  • Metacarpal bones. The 5 bones that compose the middle part of the hand.

  • Carpal bones. The 8 bones that create the wrist. The carpal bones are connected to 2 bones of the arm, the ulnar bone and the radius bone.

Numerous muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

What are some common hand problems?

There are many common hand problems that can interfere with activities of daily living (ADLs), including the following:

Arthritis

Arthritis is joint inflammation and can occur in multiple areas of the hand and wrist. Arthritis of the hand can be very painful.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the hands and may be caused by normal use of the hand or it may develop after an injury. Osteoarthritis usually develops in one of 3 places: the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger.

Signs and symptoms of osteoarthritis include: 

  • Stiffness

  • Swelling and pain

  • Bony nodules at the middle or end joints of the finger

  • Pain and possibly swelling at the base of the thumb

  • Loss of strength in the fingers and the grip of the hand

Treatment for osteoarthritis includes:

  • Nonsteroidal anti-inflammatory drugs

  • Resting  the affected hand

  • Wearing splints at night

  • Using heat to soothe the pain

  • Using ice to reduce swelling

  • Possible cortisone injections

  • Possible surgery when no other treatments work 

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel in the wrist, a narrow confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result.
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

  • Trouble gripping objects with the hand(s)

  • Pain or numbness in the hand(s)

  • "Pins and needles" feeling in the fingers

  • Swollen feeling in the fingers

  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers

The symptoms of carpal tunnel syndrome may look like other conditions such as tendonitis, bursitis, or rheumatoid arthritis. Always see your healthcare provider for a diagnosis.

Treatment may include:

  • Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)

  • Oral or injected (into the carpal tunnel space) anti-inflammatory medicines (to reduce the swelling)

  • Surgery (to relieve compression on the nerves in the carpal tunnel)

  • Changing position of a computer keyboard, or other ergonomic changes

Ganglion cysts

Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts — the most common, benign (noncancerous), soft-tissue tumor of the hand and wrist.

The following are the most common symptoms for ganglion cysts include:

  • Wrist pain that is aggravated with repeated use or irritation

  • A slow growing, localized swelling, with mild aching and weakness in the wrist

  • An apparent cyst that is smooth, firm, rounded, or tender

The symptoms of ganglion cysts may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

Initially, when the cyst is small and painless, treatment is usually not needed. Only when the cyst begins to grow and interferes with the functionality of the hand is treatment usually necessary. Treatment may include:

  • Rest

  • Splinting

  • Nonsteroidal anti-inflammatory medicines

  • Aspiration

  • Cortisone injections

  • Surgery

Tendon problems

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon, but is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease (such as, diabetes or rheumatoid arthritis).

Common tendon disorders include the following:

  • Lateral epicondylitis (commonly known as tennis elbow). A condition characterized by pain in the back side of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.

  • Medial epicondylitis (commonly known as golfer's or baseball elbow). A condition characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.

  • Rotator cuff tendonitis. A shoulder disorder characterized by the inflammation of the shoulder capsule and related tendons.

  • DeQuervain's tenosynovitis. The most common type of tenosynovitis disorder characterized by the tendon sheath swelling in the tendons of the thumb.

  • Trigger finger/trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened, thus preventing the smooth extension or flexion of the finger/thumb. The finger/thumb may lock or "trigger" suddenly.

Treatment for most tendon problems may include:

  • Activity modification

  • Ice

  • Splinting or immobilization

  • Steroid injections

  • Nonsteroidal anti-inflammatory medicines

  • Surgery

Overview of Hand Surgery

What is hand surgery?

Hand surgery is a broad term that covers many different types of procedures. Plastic surgeons who perform hand surgery seek to restore hand and finger function. But they also try to make the hand look as normal as possible, as well. Hand surgery may be done for many reasons, including:

  • Hand injuries

  • Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage the structures in the hand

  • Degenerative changes to the structures in the hand

  • Problems or defects that are present at birth, or congenital

  • Infections

What are the different types of hand surgery?

Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:

Skin grafts

Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area.

Skin flaps

Like a skin graft, a skin flap involves taking skin from another part of the body. But this procedure uses skin that has its own blood supply. That’s because the section of skin that is used includes the underlying blood vessels, fat, and muscles. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of the location, damage to the vessels, or extensive tissue damage.

Closed reduction and fixation

This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.

Tendon repair

Tendons are the fibers that join muscle to bone. Tendon repair is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.

  • Primary repair of an acute or sudden injury is often done within 24 hours of the injury.  This is usually a direct surgery to fix the injury.

  • Delayed primary repair is usually done a few days after the injury, but while there is still an opening in the skin from the wound.

  • Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in place of the damaged tendon. Or other more complex procedures may be used.

Nerve repairs

An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. This is the best time for nerve repairs that are linked with other more complicated injuries.

In cases where nerve damage is not linked to more complicated injuries, surgery to check the damaged nerve is usually done soon after the injury. This increases the chance of a full recovery. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. Or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

Fasciotomy

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

Surgical drainage or debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

Joint replacement 

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint. This artificial joint may be made of metal, plastic, silicone rubber, or your own body tissue, such as a tendon.

Replantation

This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In some severe cases, more than 1 surgery may be needed.

What are the risks of hand surgery?

Most surgery carries the risks of anesthesia and bleeding. Additional risks associated with surgery depend greatly on the type of surgery being performed and may include:

  • Infection

  • Incomplete healing

  • Loss of feeling or movement of the hand or fingers

  • Blood clots may form

Don Coleman, M.D.

Patient Rating:

4.4

4.4 out of 5

Dr. Donald Coleman, Associate Professor, trained at the University of Utah, completed his residency at the University of Iowa, a fellowship at the University of Edinburgh Arthritis Unit in Scotland, and a fellowship in hand and microvascular surgery at Duke University. His active clinical practice is exclusively restricted to upper extremity and mi... Read More

Douglas T. Hutchinson, M.D.

Patient Rating:

4.6

4.6 out of 5

Dr. Doug Hutchinson, Associate Professor In Department of Orthopaedics, specializes in hand and microvascular surgery. Dr. Hutchinson currently serves as the hand fellowship director at the University of Utah and chief of Hand Surgery at Primary Children’s Medical Center, the Veterans Affairs Medical Center, and Shriners Intermountain Hospital. He... Read More

Specialties:

Congenital Hand, Hand Surgery, Orthopaedic Surgery, Orthopaedic, Hand Upper Extremity & Microvascular Surgery, Pediatric Hand

Locations:

Primary Children's Hospital (801) 662-5600
University Orthopaedic Center (801) 587-7109

Nikolas H. Kazmers, M.D., M.S.E.

Nikolas H. Kazmers, M.D. M.S.E. is a Clinical Instructor of Orthopedic Hand Surgery at the University of Utah Hospital and Clinics who exclusively specializes in hand and upper extremity (elbow / forearm / wrist) problems, and microvascular surgery. He treats upper extremity disorders such as fractures, dislocations, lacerations to nerves and tendo... Read More

Andrew Tyser, M.D.

Patient Rating:

4.8

4.8 out of 5

Andrew R. Tyser M.D. is an Assistant Professor of Orthopedic Surgery at the University of Utah Hospital and Clinics who exclusively specializes in hand, upper extremity (elbow / forearm), and microvascular surgery. He treats upper extremity disorders such as fractures, dislocations, lacerations to nerves and tendons, and all other injuries of the h... Read More

Angela A. Wang, M.D.

Patient Rating:

4.3

4.3 out of 5

Dr. Angela Wang, Associate Professor, specializes in hand, upper extremity, and microvascular surgery in children and adults. Dr. Wang currently practices at the Orthopaedic Center, as well as the Primary Children's Center, and the Shriners Hospital. Her particular interests include both obstetric/birth and adult traumatic brachial plexus surgery,... Read More

University Orthopaedic Center 590 Wakara Way
Salt Lake City, UT 84108
Map
801-587-7109
South Jordan Health Center 5126 W. Daybreak Parkway
South Jordan, UT 84095
Map
801-213-4500
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