Hand, Wrist and Elbow Treatment

Your hands and wrists are intricate structures containing over 2 dozen small bones; a network of ligaments, tendons and muscles; and a web of blood vessels and nerve endings, which give you your sense of touch. Because we use our hands and arms for so many common activities, they are vulnerable to injury.

Wrist injury, hand disorders, and elbow conditions are common and can cause pain, loss of sensation, loss of movement, and impaired function. Overuse injuries such as carpal tunnel syndrome and tendonitis are among the most common causes of pain. Your hands, wrists, and elbows can also be affected by normal wear and tear on the joints, resulting in arthritis.

Our physicians are trained to diagnose and treat all types of hand, wrist, and elbow problems, and Dr. Christian Bean is board certified in hand and microvascular surgery. He can expertly perform the most delicate procedures required to relieve hand pain and to preserve or restore normal function to the hands, wrists and elbows, including:

Hand and Wrist Procedures

Carpal Tunnel Release

Endoscopic Carpal Tunnel Release (ECTR) refers to a method of performing Carpal Tunnel Release Surgery using an endoscope or an arthroscopic device. ECTR releases the transverse carpal ligament (TCL) that overlies and compresses the median nerve within the carpal tunnel. It is this compression on the median nerve that leads to the characteristic 'pins and needles' paresthesia in the thumb, index, long and ring fingers. The primary benefit of endoscopic releases versus traditional open carpal tunnel release is the smaller incision size.

Open Carpal Tunnel Release surgery involves an incision on the palm about an inch or two in length. Through this incision, the skin and subcutaneous tissue is divided, followed by the palmar fascia, and ultimately the transverse carpal ligament.

Wrist Arthroscopy

Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopy of the wrist is used to investigate and treat symptoms of repetitive strain injury, fractures of the wrist and torn or damaged ligaments. It can also be used to ascertain joint damage caused by arthritis.

Finger Joint Replacement

Joint replacement is used to treat arthritis in the fingers. Surgical procedures include removal of arthritic bone and joint reconstruction.

• Basal Joint Arthroplasty is the replacement of the joint at the base of the thumb that allows for swiveling and pivoting.
• PIP Arthroplasty is the replacement of the second joint from the fingertip. This procedure is done when a patient has a finger that is painful, stiff or cannot move because or arthritis or injury. The implants will be press fit into the bones to create new joint surfaces to allow some motion and pain relief.
• MCP Arthroplasty is the replacement of the third joint (knuckle joint) from the fingertip

Wrist Joint Replacement or Wrist Fusion

Wrist Joint Replacement or Wrist Fusion can be used to treat severe arthritis.

Wrist Replacement involves an incision made on the back of the wrist. The damaged ends of the lower arm bones are removed and the first row of carpal bones may also be removed. The radial component of the prosthesis is inserted into the center of the radius bone on the outside of the lower arm. It is held in place with bone cement.

Aponeurotomy

Aponeurotomy is used to correct Dupuytren's contracture, an inherited condition of the hand that causes the tissue just under the skin on the palm side of the hand to thicken and contract. CVMC orthopedic surgeon Dr. Christian Bean is the only hand surgeon in Vermont to perform needle aponeurotomy, a minimally-invasive procedure. Learn more about in-office needle aponeurotomy.

Surgery to Treat De Quervain’s Tenosynovitis

De Quervain's syndrome is a painful inflammation of tendons in the thumb that extend to the wrist. During surgery for de Quervain's syndrome, the orthopedic surgeon opens the thumb compartment to release the pressure, make room for the irritated tendons, and relieve the pain caused by irritation and swelling.

Trigger Finger Release

Stenosing tenosynovitis, a condition commonly known as “trigger finger,” is common with certain medical conditions such as rheumatoid arthritis, gout and diabetes or can be caused by repetitive strong gripping. Trigger Finger Release surgery is used to open the sheath that surrounds the tendon to enlarge the space and release the swollen tendon.

Flexor and Extensor Tendon Repairs

Flexor muscles are muscles that bend (flex) the fingers. These flexor muscles move the fingers through cord-like extensions called tendons, which connect the muscles to bone. The flexor muscles start at the elbow and forearm regions, turn into tendons just past the middle of the forearm, and attach to the bones of the fingers.>/p>

Deep cuts can injure the tendons and nearby nerves and blood vessels and can only be repaired by surgery.

Elbow Procedures

Elbow arthroscopy is used to diagnose and treat elbow injuries.

Open Cubital Tunnel Release
ubital Tunnel Syndrome, a compression of the ulnar nerve at the elbow. To relieve the pressure on the nerve, surgery requires shifting the nerve to the front of the elbow.  This relieves pressure and tension on the nerve.  The nerve may be placed under a layer of fat under the muscle or within the muscle.

At UVM Health Network - CVMC Orthopedics & Sports Medicine, we are committed to delivering the best in comprehensive hand, wrist and elbow care. Call our office in Berlin, VT today at 802-225-3970.