The Yale Hand and Microsurgery Program has one of the most comprehensive and most respected diagnostic and treatment programs in the nation. Our faculty members specialize in hand and microsurgery, radiology, orthopedics, rehabilitation, and neurology to provide patients with complete care and current surgical techniques.
Our faculty members are internationally recognized for performing innovative procedures in the replantation of amputated digits or extremities, microvascular reconstruction, and free flap surgical techniques.
We understand that injury, trauma, or degenerative disease that affects the function of the hand, wrist, and the nervous system of the arm also affects the ability to work, participate in activities that patients enjoy, and, in some cases, it affects the ability to perform normal, daily routines. Our goal is to restore the hand and upper extremities to the highest level of function possible.
We also provide care for the most precious and delicate hands, those of a child. Our multidisciplinary faculty specializes in treating children born with congenital abnormalities that involve the hands, such as syndactyly, to allow for normal development and function.
Members of our faculty strive to apply the most current surgical and treatment technologies and they are at the forefront of research that creates these advancements. Clinical and translational research at the Yale Hand and Microsurgery Center covers a significant range of areas, including surgical techniques of the hand and wrist, brachial plexus reconstruction, peripheral nerve surgery, and free flap tissue transfers.
Arthritis in the hands can cause tremendous pain and discomfort and can interfere with normal daily activities. If non-surgical treatment hasn’t offered the patient relief, they may be a candidate for surgical treatment.
First and foremost, we will preserve or reconstruct the existing joint if possible. If the damage to the joint is past repair, we use a joint replacement to improve joint function. Most of the major joints of the hand and wrist can be replaced.
Dr. Thomson and Dr. Matthew specialize in hand surgery and arthritic hand reconstruction.
Some brachial plexus injuries are minor and will recover on their own completely in several weeks or months. However, if patients have sustained severe injury to the nerve bundle, they may have permanent disability in the arm, hand, and wrist. Some factors that can affect recovery after brachial plexus injury include age and the type, severity, and location of the injury.
Treating carpal tunnel does not necessarily mean surgery. Depending on the severity of the problem, carpal tunnel syndrome can be treated in two basic ways.
If patients have a very mild case, the carpal tunnel treatment may include work modification, wrist splints, or anti-inflammatory medications to manage carpal tunnel pain and to help induce healing. It is important to minimize the activity that caused carpal tunnel syndrome in the first place. An integral part of our program is considering the patient's lifestyle in order to help them discover which specific activities, whether at work or at home, have contributed to their condition.
If they do not gain relief from non-surgical treatment of carpal tunnel therapy, or if they have a much more severe case of carpal tunnel syndrome, patients may need surgery. Carpal tunnel surgery can be performed in one of two ways, depending on which surgery would be best for the specific case:
- An endoscope, which is a small television camera with a light, can be inserted into the hand through a very small incision in the wrist crease. The ligament that lies over the carpal tunnel can be cut using this technique.
- In some patients, it is necessary to make an incision in the palm in order to release this ligament.
Both surgeries are performed in an outpatient setting under local anesthesia. The patients can go home the same day.
If the cubital tunnel syndrome is mild, patients may be able to treat it by restricting elbow movement, by modifying their work, by protecting their elbow, and with anti-inflammatory medicine.
If patients have weakness of the hand, atrophy of the hand muscles, or permanent numbness, surgery is the recommended treatment of choice.
Treatment is an outpatient surgery in which we release the regions of nerve compression and relocate the ulnar nerve to an area that is better protected and causes less stretch on the nerve when the arm is straightened.
The primary treatment for tendonitis of the wrist is to restrict movement of the base of the thumb and part of the wrist with a splint. Work modification and anti-inflammatory medications can also help. Steroid injections can be used to reduce the inflammation.
If patients acquired De Quervain’s tenosynovitis from a repetitive task, our clinical specialists will help determine which activity, whether at work or at home, may have contributed to De Quervain’s tenosynovitis. The goal is to limit those activities or modify them so that patients do not have further or future issues with tendonitis in their wrists.
If they have a more severe case of De Quervain’s, or if their tendonitis does not respond to non-surgical therapy, patients may require outpatient surgery under local anesthesia.
Surgery is the only treatment for this disease. If the contractures or knuckle pads are very mild, patients may not require surgery right away. But if patients have a loss of function of their hands or worsening of the disease, surgery will be needed.
During surgery for Dupuytren’s contracture, the abnormal tissues and nodules are removed.
The most common form of treatment of a ganglion cyst is the “wait and see” approach, especially if it is not causing any pain. Wearing a brace may help by reducing mobility of the affected joint. Some ganglion cysts will resolve on their own; others may remain small without causing any issues.
If patients have a large ganglion cyst that is causing pain, they may require treatment. Often they can have the fluid drained at an office visit. In 60 percent of the cases, however, the ganglion cyst recurs. To prevent or minimize the chance of recurrence, patients can have the cyst removed surgically. The surgery is performed as an outpatient procedure under local anesthesia.
Treatment for lateral epicondylitis often includes resting the forearm muscles and activity modification. Most patients who minimize repetitive movement will get better over time. Some milder cases can resolve spontaneously in a few months.
If the tennis elbow is severe and does not respond to conservative treatment, our comprehensive hand and microsurgery team provides effective care and advanced surgical procedures. Often, tennis elbow can be repaired using arthroscopic surgery, which involves tiny instruments and small incisions for less pain and a faster recovery.
If a child has incomplete, simple syndactyly, they do not necessarily require treatment. However, most parents do have it surgically corrected early in life for cosmetic reasons. The child may also develop physical limitations to certain activities as they grow, such as playing the piano, etc.; therefore, it may become necessary to correct an incomplete, simple syndactyly.
Complex syndactyly should be treated in order to allow proper growth and development of the bones and skin of the fingers. The timing of surgery will be based upon the particular digits involved and the complexity of the webbing. A web may be corrected as early as six months or as late as -three to four years of age.
During the surgical process, the fingers are released using small skin flaps from each finger. If the child has more than two fingers fused, only one side of a finger is released in a single operation. In incomplete syndactyly, the creation of these skin flaps is usually sufficient to cover both sides of the previously fused fingers. If the fusion is complete and complex, the main problem stems from a deficiency of skin. Usually, full-thickness skin grafts will be required in order to cover both sides of the finger.
Even without a thumb, children adapt very well, learning how to use other fingers to function as the thumb normally would. If the child has a problem with developing fine motor skills, such as pinching and grasping, they may require surgery for correction.
Treatment for thumb aplasia can be very complex and varies from child to child.
Generally, surgery to correct thumb aplasia is done between 6 and 18 months old. When the thumb is absent, a technique called pollicization is performed, in which the index finger is transferred to the area of the thumb.
The only treatment for thumb duplication is surgery, which generally begins around age one.
Before the surgery, we discuss the child’s customized treatment plan with the parents so they understand the process and know what to expect.
One of the most common questions regarding trigger finger is if the condition will heal without surgery.
Generally, trigger finger treatment is a direct injection of steroids into the tendon sheath. This treatment is successful in a large number of patients.
However, if patients have multiple fingers affected, then they may require surgical release of the tendons.