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The hand consists of dozens of bones and joints, as well as ligaments, tendons, muscles, nerves, and cartilage that work together to perform routine, everyday tasks. The frequency in which we use our hands makes them prone to injuries, dislocations, and fractures. Repetitive motions while at work or participating in activities can lead to tendinitis, arthritis, or carpal tunnel syndrome.

At OrthoNorcal Orthopedic Specialists, our specialty-trained orthopedic hand surgeon provides highly specialized care and treatment for hand injuries and conditions. This care includes, but is not limited to, tendon and nerve repair, carpal tunnel release (for carpal tunnel syndrome), De Quervain’s release, trigger finger release, ganglion excision, arthroplasty of the wrist, tendon and nerve reconstruction, compression and congenital reconstruction, and fracture repair.

arthritis-of-hand

Arthritis of the Hand and Wrist

Arthritis is an inflammatory condition of the joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis.

Fractures of the Hand and Fingers

Fractures of the Hand and Fingers

The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains.

hand-pain

Hand Pain

Injury or inflammation of any of these structures, due to a disorder or disease condition, may produce hand pain. Even compression of the nerves supplying these structures may cause hand pain.

scaphoid-fracture

Scaphoid Fracture

The scaphoid bone is a small, boat-shaped bone in the wrist, which, along with 7 other bones, forms the wrist joint. It is present on the thumb side of the wrist, and is at a high risk for fractures.

carpal-tunnel-syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

ganglion-cyst

Ganglion Cyst

Ganglion cysts are swellings that most commonly develop along the tendons or joints of wrists or hands.

Gamekeeper's Thumb

Gamekeeper's Thumb

Gamekeeper's thumb, also known as skier's thumb, is a tear of the ulnar collateral ligament, a band of tissue that supports the joint at the base of the thumb.

hand-infections

Hand Infections

Hand infections, if left untreated or treated improperly, can cause disabilities such as stiffness, contracture, weakness, and loss of tissues

Carpal Instability

Carpal Instability

Carpal instability is the loss of alignment of the carpal bones and/or radioulnar joint. The wrist is a complex joint that connects the forearm to the hand and allows it to move.

wrist-tumours

Hand Tumors

Any abnormal lump or bump on the hand is considered a hand tumor. Hand tumors can occur on the skin as a mole or a wart, underneath the skin soft tissue or on the bone.

boutonniere-deformity

Boutonniere Deformity

Tendons in your fingers connect the finger bones to finger muscles and help bend and straighten the finger at the joint when the muscles contract.

De Quervain's Tendinosis

De Quervain's Tendinosis

Inflammation and swelling of the tendon sheaths put pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist.

dupuytren-contracture

Dupuytren's Contracture

Dupuytren’s contracture is a hand condition where thickening of the underlying fibrous tissues of the palm causes the fingers to bend inward.

forearm-fractures-in-children

Pediatric Forearm Fracture

The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm.

Work Related Hand Injuries

The hand is one of the most flexible and useful parts of our body that assist us in most workplace activities. Hand injuries can range from minor cuts or burns to severe injuries.

Malunion of a Fracture

Malunion of a Fracture

Malunion of a fracture is a condition where the fractured ends of a bone heal in a misaligned position resulting in bone deformity. Malunions may occur in any bone fractures in the body often due to trauma.

flexor-tendon-injuries

Flexor Tendon Injuries

Deep cuts on the under surface of the wrist, hand or fingers can cut and injure the tendon, and make it unable to bend one or more joints in a finger.

hand-trauma

Industrial Hand Trauma

The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains

Distal Biceps Avulsion

The biceps muscle, located in the front of the upper arm, allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow.

kienbocks-disease

Kienbock's Disease

Kienbock's disease is a condition in which the lunate, one of the small bones of the wrist loses its blood supply leading to death of the bone.

Bennett's Fracture

Bennett's Fracture

Bennet’s fracture is a break at the base of the first metacarpal bone (thumb bone) that meets the wrist at the first carpometacarpal (CMC) joint.

finger-dislocation

Finger Joint Dislocation and Volar Plate Injury

Finger dislocation is a condition where the bones of your finger have moved away from its normal anatomical position.

Distal Radioulnar Joint

Distal Radioulnar Joint (DRUJ) Arthritis

Distal radioulnar joint (DRUJ) arthritis is an inflammatory condition characterized by gradual wearing away of the cartilaginous surface of the radioulnar joint resulting in significant pain, swelling, stiffness, and interference in the functioning of the wrist and/or arm.

Distal Intersection Syndrome

Distal Intersection Syndrome

Distal intersection syndrome also referred to as tenosynovitis of the radial wrist extensors is characterized by the radial wrist and forearm pain..

Ulnar Nerve Compression in Guyon's Canal

Ulnar Nerve Compression in Guyon's Canal

Ulnar nerve compression in Guyon’s canal is a condition characterized by pain, numbness, weakness, and tingling sensation in the hand.

congenital-disorder

Congenital Defects of the Hand and Wrist

The hand and wrist are formed during the 8th week of gestation. This process consists of various steps and failure in any one or more of these steps may cause congenital or birth defects.

Distal Radius Osteotomy to Correct Mal-Union

Distal Radius Osteotomy to Correct Mal-Union (Crooked Painful Wrist)

Malunion of a fracture is a condition whereby the fractured ends of a bone heal in a misaligned position resulting in bone deformity. Malunions can occur with any fracture and is often due to trauma.

Scapholunate Dissociation

Scapholunate Dissociation

Scapholunate dissociation is the abnormal orientation or movement of the small bones of your wrist: the scaphoid and lunate, in relation to one another.

Ulnar Carpal Impaction

Ulnar Carpal Impaction

The wrist is a complex joint made up of 8 carpal bones aligned in two rows, with four bones present in each row. The carpal bones are further connected to 5 metacarpal bones that form the palm of the hand.

triangular-fibrocartilage-complex-tfcc-injury

Triangular Fibrocartilage Complex Injury (TFCC)

The triangular fibrocartilage complex, or TFCC, is a complex of cartilage and ligaments located near the outer region of the wrist, below the little finger.

Guyon's Canal Syndrome

Guyon’s canal syndrome refers to compression of the ulnar nerve while it passes from the wrist into the hand through a space called the ulnar tunnel or Guyon’s canal.

Distal Radioulnar Joint

Distal Radioulnar Joint (DRUJ) Instability

Distal radioulnar joint instability is the abnormal orientation or movement of the radius and ulna bones at the wrist in relation to one another.

Extensor Tendon Injuries

Extensor Tendon Injuries

Tendons are bands of tissue connecting muscles to bones. The extensor tendon is a strong, smooth cord that connects finger bones to muscles in the hand.

Metacarpophalangeal Joint Arthritis

Metacarpophalangeal Joint Arthritis

The bones of the hand are called metacarpals and the bones of the fingers are called phalanges. The metacarpophalangeal joint or MP joint, also known as the first knuckle, is the large joint in the hand where the finger bones meet the hand bones.

repair-of-fractures

Hand Fracture Surgery

The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries

carpal-tunnel-release-surgery

Carpal Tunnel Release Surgery

Carpal tunnel syndrome is a common, painful, progressive condition that is caused by the compression of the median nerve at the wrist area.

carpal-tunnel-release-surgery-endoscopic-technique

Endoscopic Carpal Tunnel Surgery

The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form the bottom and sides of the carpal tunnel and a strong band of connecting tissue

Distal Radioulnar Joint Arthroscopy

Distal Radioulnar Joint Arthroscopy

The distal radioulnar joint (DRUJ) is a pivot type synovial joint located between the radius and the ulna just proximal to the wrist joint and assists in pronation and supination of the forearm.

hand-peripheral-nerve-surgery

Peripheral Nerve Repair

The peripheral nerves are the nerve fibers that compose the area from head to toe, connecting the brain and spinal cord with the rest of the body parts.

microvascular-surgery

Microvascular Surgery

Microvascular surgery or microsurgery is a surgical technique for joining or repairing the damaged blood vessels and nerves during reconstructive surgery of body parts.

Elective Emergency Hand Surgery

Elective Emergency Hand Surgery

Hand surgery is performed to restore the structure and functionality of the fingers, wrist and hand secondary to a traumatic injury, medical condition, severe infection, or birth defect causing pain and/or deformity of the hand.

Osteotomy for Distal Radius Malunion

Osteotomy is a surgical procedure to cut and reshape deformed bones. Your doctor recommends osteotomy to correct distal radius malunion when non-surgical options such as splinting or physical therapy are unsuccessful.

orif

ORIF of Distal Radius Fracture

The forearm consists of two bones, the radius and ulna. The radius is the larger of the two forearm bones, and the region towards the wrist is called the distal end.

LRTI

LRTI for Thumb CMC Arthritis

The joint located at the base of the thumb is known as the carpometacarpal (CMC) joint. The thumb CMC joint is where the metacarpal bone of the thumb connects to the trapezium (carpal) bone of the wrist.

orif

ORIF of the Forearm Fractures

The forearm is made up of two bones, the radius and ulna. A break in both or either of the bones is known as forearm fracture.

Arthroscopic Partial Wrist Fusion

Arthroscopic Partial Wrist Fusion

Arthroscopic partial wrist fusion is a minimally-invasive surgery that uses tiny incisions to immobilize selected bones of the wrist.

LRTI (Ligament Reconstruction and Tendon Interposition) for Thumb CMC Arthritis

LRTI is a surgical procedure that is most commonly conducted to treat thumb CMC (carpometacarpal) arthritis where the damaged joint surfaces are removed and replaced with a cushion of tissue that keeps the bones separated.

Hand Rejuvenation

Cosmetic enhancement is generally focused only on the face, while the hands portray some of the most prominent signs of aging.

Hand Therapy

Hand Therapy

Hand therapy is a rehabilitation technique recommended to improve the strength and restore functional activity of hands in patients with upper extremity injuries.

Hand Anatomy

The human hand is made up of the wrist, palm, and fingers and consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, and many blood vessels and nerves.

The hands enable us to perform many of our daily activities such as driving, writing and cooking. It is important to understand the normal anatomy of the hand to learn more about diseases and conditions that can affect our hands.

Bones of the Hand

The wrist is comprised of 8 carpal bones. These wrist bones are attached to the radius and ulna of the forearm to form the wrist joint. They connect to 5 metacarpal bones that form the palm of the hand. Each metacarpal bone connects to one finger at a joint called the metacarpophalangeal joint (MCP joint). This joint is commonly referred to as the knuckle joint.

The bones in our fingers and thumb are called phalanges. Each finger has 3 phalanges separated by two interphalangeal joints, except for the thumb, which has only 2 phalanges and one interphalangeal joint.

The first joint close to the knuckle joint is called the proximal interphalangeal joint (PIP joint). The joint closest to the end of the finger is called the distal interphalangeal joint (DIP joint).

The MCP and PIP joint act like hinges when the fingers bend and straighten.

Soft Tissues of the Hand

Our hand bones are held in place and supported by various soft tissues. These include: articular cartilage, ligaments, muscles and tendons.

Articular cartilages are smooth material that act as shock absorbers and cushion the ends of bones at each of the 27 joints, allowing smooth movement of the hand.

Muscles and ligaments function to control the movement of the hand.

Ligaments are tough rope-like tissues that connect bones to other bones, holding them in place and providing stability to the joints. Each finger joint has two collateral ligaments on either side, which prevents the abnormal sideways bending of the joints. The volar plate is the strongest ligament in the hand. It joins the proximal and middle phalanx on the palm side of the joint and prevents backward bending of the PIP joint (hyperextension).

Muscles of the Hand

Muscles are fibrous tissues that help produce movement. They work by contracting.

There are two types of muscles in the hand:

  • Intrinsic muscles are small muscles that originate in the wrist and hand. They are responsible for fine motor movements of the fingers during activities such as writing or playing the piano.
  • Extrinsic muscles that originate in the forearm or elbow control the movement of the wrist and hand. These muscles are responsible for gross hand movements. They position the wrist and hand while the fingers perform fine motor movements.

Each finger has six muscles controlling its movement: three extrinsic and three intrinsic muscles. The index and little finger each have an extra extrinsic extensor.

Tendons of the Hand

Tendons are soft tissues that connect muscles to bones. When muscles contract, tendons pull the bones, causing the finger to move. The extrinsic muscles are attached to finger bones through long tendons that extend from the forearm through the wrist. Tendons located on the palm side help in bending the fingers and are called flexor tendons, while tendons on top of the hand called extensor tendons help in straightening the fingers.

Nerves of the Hand

Nerves of the hand carry electrical signals from the brain to the muscles in the forearm and hand, enabling movement. They also carry the senses of touch, pain and temperature back from the hands to the brain.

The three main nerves of the hand and wrist include:

  • Ulnar nerve: The ulnar nerve crosses the wrist through an area called Guyon’s canal and branches to provide sensation to the little finger and half of the ring finger.
  • Median nerve: The median nerve crosses the wrist through a tunnel called the carpal tunnel. The median nerve provides sensation to the palm, thumb, index finger, middle finger and part of the ring finger.
  • Radial nerve: The radial nerve runs down the thumb side of the forearm and provides sensation to the back of the hand from the thumb to the middle finger.

All three nerves originate at the shoulder and travel down the arm to the hand. Each of these nerves has sensory and motor components.

Blood Vessels of the Hand

Blood vessels travel beside the nerves to supply blood to the hand. The main arteries are the ulnar and radial arteries, which supply blood to the front of the hand, fingers, and thumb. The ulnar artery travels next to the ulnar nerve through the Guyon’s canal in the wrist. The radial artery is the largest artery of the hand, traveling across the front of the wrist, near the thumb. Pulse is measured at the radial artery.

Other blood vessels travel across the back of the wrist to supply blood to the back of the hand, fingers and thumb.

Bursae of the Hand

Bursae are small fluid-filled sacs that decrease friction between tendons and bone or skin. They contain special cells called synovial cells that secrete a lubricating fluid.

  • American Orthopaedic Society for Sports Medicine
  • American Association for Hand Surgery
  • American Academy Of Orthopaedic Surgeons
  • The American Board of Pediatrics
  • North American Spine Society