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Division of
Plastic Surgery

Hand Surgery

Comprehensive care for both bony and soft-tissue disorders of the hand, wrist, and forearm. Treatment is not limited to surgery and may involve medication, splinting, therapy, injections or arthroscopy. Areas of special interest include microsurgery, melanoma, congenital deformities, and wrist fractures. On-site therapy is available.

Common Hand Problems
Arthritis
  • What is it? Arthritis is the wearing away of the cartilage in joints caused by wear and tear, injury, or inflammation (such as rheumatoid arthritis). Symptoms include pain, swelling, stiffness, weakness, and deformity. The base of the thumb is commonly affected.
  • How is it diagnosed? Arthritis can usually be diagnosed by interview and physical examination, but an x-ray should be obtained to confirm the diagnosis before treatment.
  • What is the treatment?Most arthritis can be managed by your medical doctor with medications, therapy, and activity modification. More severe symptoms often respond to splinting or cortisone injection. If the pain is debilitating and does not respond to these treatments, surgery can improve function and relieve pain.
Carpal Tunnel Syndrome
  • What is it?Carpal tunnel syndrome is a pinched nerve in the hand which can cause numbness, tingling, pain, and weakness. These symptoms may wake you up at night or may be brought on by certain activities such as driving.
  • How is it diagnosed? Most cases can be diagnosed by an interview and physical examination. Nerve conduction tests may also be helpful.
  • What is the treatment? Most patients with carpal tunnel syndrome are initially treated with splinting and ant-inflammatory medication. Some may benefit from cortisone injection. Surgery may be necessary for severe cases.
Dupuytren’s Contracture
  • What is it? Dupuytren’s Contracture is a thickening of the fibrous tissue in the palm. It starts as a firm nodule in the palm and can progress to a thick band. The condition is usually painless but can prevent the fingers from straightening. It is most often found in middle-aged men of northern European ancestry.
  • How is it diagnosed? The diagnosis is usually obvious on examination.
  • What is the treatment?Advanced Dupuytren’s Contracture that prevents the fingers from straightening completely is treated by surgery to remove the diseased fascia. Medication, injection, and splinting are ineffective, although splinting is important after surgery.
Ganglion Cyst
  • What is it? A ganglion cyst is a sack filled with fluid and is often located over the wrist or fingers. It has a firm rubbery consistency and is fixed in location. It is benign and may fluctuate in size. It may be painful.
  • How is it diagnosed?Most ganglion cysts can be diagnosed by physical examination.
  • What is the treatment? Small ganglion cysts that are not painful should be left alone. Some may disappear spontaneously. Cysts that are large or painful can be sucked out with a needle (aspirated) or removed with surgery.
Infection
  • What is it? Infections of the hand can involve the skin (cellulites), deeper soft tissues (abscess), tendons (tenosynovitis), joints (septic arthritis), or bone (osteomyelitis). Symptoms include pain, swelling, redness, drainage of pus, red streaks up the arm, and fever.
  • How is it diagnosed? The diagnosis is usually clear based on your symptoms and physical examination. Additional tests such as x-ray or MRI are sometimes helpful. A culture is usually performed to identify the cause of the infection and the best antibiotic to treat it.
  • What is the treatment? Infections of the hand are emergencies and should be treated promptly with appropriate antibiotics. Surgery to drain and wash out the infected area may be necessary.
Skin Cancer
  • What is it? Skin cancers are malignant growths on the skin. Common types include basal cell, squamous cell and melanoma.
  • How is it diagnosed? Many skin tumors can be diagnosed by your medical doctor or dermatologist by physical examination. Any suspicious growth on the skin or any mole that has changed in size, color or contour should undergo biopsy.
  • What is the treatment? Most skin cancers of the hand should be removed or destroyed. This can be done by your dermatologist or hand surgeon. Reconstructive surgery by a hand surgeon is often necessary and may include skin grafts, flaps, or microsurgery.
Tendinitis
  • What is it? Tendinitis is inflammation of a tendon resulting in pain with motion, weakness, and swelling. De Quervain’s tenosynovitis is a common tendinitis that causes pain on the thumb side of the wrist.
  • How is it diagnosed? Tendinitis can usually be diagnosed by interview and physical examination alone.
  • What is the treatment? Most cases of tendinitis respond to rest and splinting. Anti-inflammatory medications or a cortisone injection may be helpful. Surgery is reserved for tendinitis which does not respond to this treatment.
Trigger Finger
  • What is it?Trigger finger is clicking or locking of the finger when you bend it. You may have pain and feel a pop when you straighten the finger.
  • How is it diagnosed? Trigger finger can usually be diagnosed by physical examination.
  • What is the treatment? Splinting or cortisone injection is the initial treatment. Surgery may be necessary for unresponsive cases.
Tumors
  • What are they? Tumors are abnormal growths which may arise from soft tissues or bone. Although most tumors of the hand are benign, some are malignant and may spread to other areas of the body or even cause death.
  • How are they diagnosed? Some tumors can be diagnosed by physical examination, but a biopsy should be performed if there is any uncertainty.
  • What is the treatment?Benign tumors can be observed or removed depending on the specific type of tumor. Malignant tumors are most often treated by surgical excision (removal) but may also require radiation or chemotherapy. Every effort is made to save the and restore function with reconstructive surgery.
 
Hand and Wrist Injuries
Amputation
  • What is it? An amputation is a complete separation of a part from the body and can occur at any level in the hand and arm.
  • How is it diagnosed? The diagnosis is obvious, but x-ray is usually obtained to look at the extent of the bony injury.
  • What is the treatment? Although most patient would prefer to have an amputated part reattached (replantation surgery), the extent of injury may make replantation impossible. We make every effort to replant amputated parts, taking into account the patient’s desires, the extent of injury, and the ultimate functional outcome. If replantation is not possible, other reconstructive surgery can often improve function and appearance.
Dislocation
  • What is it? A dislocation is an injury that causes a joint to slip out of alignment. The ligaments in the joint are usually torn. There may also be an associated fracture.
  • How is it diagnosed? If an injury causes pain, swelling, bruising, and a deformity at a joint, a dislocation has probably occurred. An x-ray will confirm the diagnosis and identify any associated fracture.
  • What is the treatment? Most dislocations can be realigned in the office or emergency room after numbing the area. Complex or unstable dislocations may require surgery.
Fracture
  • What is it? A fracture is a broken bone. The most common fractures we treat are of distal radius (wrist), scaphoid (wrist), metacarpal (palm), and phalanges (fingers).
  • How is it diagnosed? If an injury causes pain, swelling, and bruising, a fracture may have occurred. A deformity or malalignment is sometimes evident. If you can move the part, it may still be fractured. An x-ray is the only way to tell for sure.
  • What is the treatment? Most fractures can be treated in the office or emergency room by numbing the area and setting the bone followed by splinting or casting. Fractures that are unstable, open, or involve a joint often require surgery. Pins, metal plates, or screws may be used to stabilize certain types of fractures.
Nerve Injury
  • What is it? Nerves provide sensation and movement (in conjunction with muscles, tendons, and joints). A nerve injury is usually caused by a cut and is often associated with injuries to blood vessels.
  • How is it diagnosed? Loss of normal sensation or inability to contract a muscle may indicate a nerve injury. Nerve conduction tests may be helpful.
  • What is the treatment? Cut nerves are best treated by microsurgical repair. This technique utilizes a binocular operating microscope and very fine instruments to sew the cut ends of the nerve together and allow the nerve to grow back. Nerves grow about one inch a month; therefore, it is essential that proper immobilization and therapy be instituted after surgery while awaiting return of nerve function.
Tendon Injury
  • What is it? Tendons in the hand connect the muscles in the forearm to the bones and provide for movement. A tendon injury is usually caused by a cut and is often associated with injuries to nerves and blood vessels.
  • How is it diagnosed? If a tendon is completely cut, movement of the bone connected to the tendon may be lost. Surgery is the only way to diagnose a partially cut tendon reliably.
  • What is the treatment?Tendon injures should be repaired with surgery. Hand therapy after surgery is often essential to optimize results.
 
Inpatient Facilities:
Hospital University of Pennsylvania (HUP)
Children's Hospital of Philadelphia (CHOP)
 
Office Visit Locations:
Perelman Center for Advanced Medicine
Center for Human Appearance, Suite 1-150E (HUP)
34th Street and Civic Center Boulevard (CHOP)
 
Making an Office Visit Appointment:
1-800-789-PENN (HUP) or 215-590-2208 (CHOP)
 
Dr. Ben Chang
Dr. Chang
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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