Conditions of the Hand & Upper Extremity
Dr. Chen’s unique training in plastic surgery and orthopedic hand surgery allows him to treat the most complex orthopedic hand/wrist injuries and fractures.
Dr. Chen is also fellowship-trained in orthopedic hand and upper extremity surgery and has performed over thousands of complex fractures in the forearm, wrists, and hand. These include traumatic hand injuries ranging from severe industrial accidents to simple accidents at home and school. Dr. Chen is an expert in repairing bones, tendons, nerves, blood vessels, and open wounds in the hand, wrist and upper extremities. He is trained to re-attach severed hand and/or digits.
DeQuervain’s Tenosynovitis
This is a condition that affects the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons of the wrist, located on the thumb side (1st dorsal compartment). The tendons become inflamed and entrapped within the first extensor compartment, most commonly resulting from acute or repetitive trauma. The most common symptoms of De Quervain’s tenosynovitis are pain near base of thumb, swelling, or difficulty moving thumb and wrist.
Osteoarthritis of the base of the thumb
This is a very common condition that can affect many joints in the body including hands, wrist, neck, low back, and hips. Common symptoms are debilitating pain, swelling, and loss of range of motion. Osteoarthritis occurs when the cartilage between bones wears away and over time causes excessive friction of the two bones. This condition is commonly due to wear and tear as we age. Dr. Chen treats osteoarthritis in the hands and wrists, with the most common location being at the base of the thumb called the Carpometacarpal joint. All movement of the thumb revolves around this joint, and this wide variety of movement lends this joint to more instability than the joints of the other fingers.
Carpal Tunnel Release
This is a condition in the wrist where the “tunnel” overlying the median nerve and flexor tendons compresses on the median nerve causing pain, numbness, tingling, and over time weakness to the affected hand. Patient also commonly wake up in the middle of the night with their hand(s) ‘asleep’ and sometimes pain. The median nerve is responsible for sensation to the thumb, index finger, middle finger, and half of the ring finger. If CTS is left untreated it can result in atrophy (shrinking) of the muscles of the hand and permanent numbness and tingling to the digits involved.
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome is a condition that involves compression to the ulnar nerve, which is a large nerve that travels in the arm, past the elbow, and into the hand on the small finger side. It is responsible for some of the sensory information and motor function of the ring and small fingers, as well as the small finger side of the hand. The feeling resulting from hitting your “funny bone” is actually due to the ulnar nerve. Compression or irritation of this nerve most commonly occurs at the elbow but can also occur at the wrist. Injury can be a result of direct trauma to the elbow/wrist or chronic compression. When the ulnar nerve is compressed or irritated, you may experience some weakness of the ring and small fingers, numbness or tingling (similar to hitting your funny bone but can last longer).
Dupuytren's Contracture
This is a condition that causes a deformity of a finger, or multiple fingers, which usually progresses over many years. It’s an inherited condition that typically starts as a small lump in the palm of the hand and can eventually progress to a thick cordlike deformity that can result in pulling one or more fingers into the bent position.
Extensor Tendon Laceration
The extensor tendons are bands of connective tissue, in the back of the hand, that allows for extension of the fingers and thumb. A cut or injury to the back of the hand can result in a rupture of one or more extensor tendons making a patient unable to extend one or more fingers. If a tendon is ruptured it does require surgical repair to re-approximate the tendon.
Flexor Tendon Laceration
The extensor tendons are bands of connective tissue, on the palm side of the hand, which allows for flexion (bending) of the fingers and thumb. A cut or injury to the palm side of the hand can result in a rupture of one or more flexor tendons making a patient unable to bend one or more fingers. If a tendon is ruptured it does require surgical repair to re-approximate the tendon.
Osteoarthritis of the fingers
This is a very common condition that can affect many joints in the body including hands, wrist, neck, low back, and hips. Common symptoms are debilitating pain, swelling, and loss of range of motion. Osteoarthritis occurs when the cartilage between bones wears away and over time causes excessive friction of the two bones. This condition is commonly due to wear and tear as we age. Dr. Chen treats osteoarthritis in the hands and wrists; with a common location being at the metacarpophalangeal joint (MCP). The MCP joints are located at the base of the fingers.
Mallet Finger
A Mallet finger is an injury to the extensor tendon of affected finger that works to straighten the end of the finger. This condition is also known as Baseball Finger. This type of injury most commonly results when a ball or other object strikes affected fingertip causing it to forcefully bend resulting in a tear of the extensor tendon. This will prevent finger from straightening. Other symptoms can include pain, swelling, and bruising to affected finger; however, inability to straighten tip of the finger may be the only symptom.
Fracture of the Wrist (Distal Radius)
The radius is one of the paired bones comprising the forearm. It is located on the thumb side (the other paired bone is the ulna, located on the small finger side). The distal radius fracture is one of the most common fractures of the arm and usually follows a fall on an outstretched hand. Symptoms of a distal radius fracture include wrist pain after an injury or fall, loss of wrist motion, and swelling. You should also be cautious about decreased circulation to the hand or numbness/tingling, as that could indicate possible injury to the blood vessels or nerves supplying the hand.
Fracture of the Fingers/Thumb
Fractures of fingers/thumb that are displaced, or out of position, most often times require surgical repair. An Open Reduction and Internal Fixation (ORIF) involves fixing severely broken bones and placing them back together using pins, plates, or screws. Depending on the type of hardware used for the ORIF, it may be temporary or permanent.
Fracture of the Wrist (Scaphoid)
The scaphoid is a small bone in the wrist, which is most commonly fractured. A scaphoid fracture is often the result of falling on an outstretched hand. Symptoms of a scaphoid fracture include wrist pain after an injury or fall, loss of wrist motion, and swelling. The most common way to treat a displaced (or out of position) scaphoid fracture is with a screw. This screw is usually permanent.
Trigger Finger
This condition affects the tendons in your finger or thumb, due to irritation and thickening of the tendon sheath tunnel, in which the flexor tendons of the finger and thumb slide through. Normally a snug tendon sheath covers the flexor tendons and allows you to bend and straighten your fingers/thumb, keeping them in place. As the tendon sheath becomes irritated and thickened, it may become difficult for the flexor tendons to slide through the sheath tunnel and results in the tendon becoming momentarily stuck, resulting in locking or catching of the affected finger/thumb. The most common symptoms of trigger finger include pain when bending/straightening finger, catching or locking sensation in affected finger/thumb, swelling, and tenderness in the palm.
Ulnar Collateral Ligament Rupture of Finger
The ulnar collateral ligaments are strong band that is attached to the joints of the finger. Injury to this ligament is commonly due to any hard force put on the finger that causes the finger to be bent too far sideways, usually a result of a sports related injury. This force can result in a partial tear of the UCL (ulnar collateral ligament) or a complete tear of the UCL, known as a rupture. A tear to the UCL results in instability of the affected joint of the finger becoming very unstable and painful. The most common symptoms associated with UCL injuries are swollen, painful joint, and possible deformity of the finger, as well as bruising.
Gamekeeper’s/Skier’s Thumb (Ulnar Collateral Ligament Rupture of Thumb)
The ulnar collateral ligament is a strong band that is attached to the middle joint of the thumb (metacarpophalangeal joint). Injury to this ligament is commonly due to any hard force put on that thumb that causes the thumb to be pulled away from the palm of the hand, usually a result of a sports related injury. This force can result in a partial tear of the UCL (ulnar collateral ligament) or a complete tear of the UCL, known as a rupture. A tear to the UCL results in the MCP (metacarpophalangeal) joint of the thumb becoming very unstable and painful. The most common symptoms include swollen and painful joint, and weakness to thumb especially with gripping or pinching.
Ligament tear of the Wrist
The triangular fibrocartilage complex (TFCC) is a structure made of cartilage and ligaments in the wrist, located on the side of the small finger. This complex is a very commonly injured, and treated, structure of the wrist. The TFCC supports and stabilizes the forearm and wrist, especially during rotation or load bearing. Injury to the TFCC can be a result of trauma, such as falling onto an outstretched hand, or excessive rotation of the wrist, but can also be caused by chronic degeneration. Injury to the TFCC most commonly results in pain to the small finger side of the wrist. Moving your wrist from side to side, rotating your forearm, or gripping objects can exacerbate pain.