973-898-5999

The Hand & Wrist Center

at Modern Orthopaedics of NJ

Our team specializes specifically in hand conditions and procedures. Learn more about treatments offered by our Board-Certified Orthopedic doctors.

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Top Orthopedic Care in NJ

De. Peter DeNoble - Orthopedic Surgeon New Jersey

Wayne Office

2025 Hamburg Turnpike, Suite C, Wayne, NJ, 07470

Paramus Office

70 Rt 17 North, Paramus, NJ, 07652

Parsippany Office

3799 Rt. 46, Suite 207, Parsippany, NJ, 07054 - Coming Soon

Hand Conditions

Phalanx (Finger) Fractures

Phalanx Fracture​ Treatment in Wayne, Paramus, and Parsippany NJ

Phalanx fractures are fractures of the small bones that make up the fingers.

Phalanges are the small bones that make up the fingers. Each finger has a distal, middle and proximal phalanx, and the thumb has a distal and proximal phalanx. Phalangeal fractures in adults most commonly involve the distal phalanx, while in children injuries to the growth plate of the small finger are most common. Regardless of the patient’s age or location of pain, this diagnosis is made by examination and x-rays. Treatment of theses fractures depends on the bone involved and the type of fracture. Attention must also be given to the rotation of the fingers that may be associated with a phalangeal fracture. There are a variety of fracture patterns, and each one calls for treatment tailored to that specific type of fracture. Some fractures can be immobilized in a cast or splint, other fractures may need to be manipulated into proper alignment and some may require surgical intervention for reduction and fixation of the fracture.

Metacarpal (Hand) Fracture

Metacarpal Fracture​ Treatment in Wayne, Paramus, and Parsippany NJ

Metacarpal fractures are common fractures in the hand that usually occur when a closed fist strikes an object.

The hand consists of many small bones, muscles, and tendons that articulate and work together to allow for fine motor movements, dexterity, and strength. The metacarpals are the long bones in the hand that connect to the fingers. The head of the metacarpal bones are what makes the prominence of your knuckles when you make a fist. Metacarpal fractures commonly occur during motor vehicle accidents, falls, or other trauma.

Metacarpal fractures can affect patients of all ages. Unfortunately, they affect use of the hand for grasping, lifting, catching, throwing, or balance. Generally, there will be swelling and pain over the top of the hand. There will also be a history of trauma and you may have difficulty making a fist. Sometimes your involved knuckle may appear less prominent than usual. If you are experiencing any of these symptoms you should be evaluated by one of our doctors.

At your initial evaluation, our doctors will carefully examine your hand and take x-rays to confirm your diagnosis. Your treatment will depend on the severity of your fracture and a variety of other factors. Fractures that are non-displaced or minimally displaced can be treated conservatively in a cast or a splint. These fractures will generally heal in about 4 weeks. Your doctor will follow up with you to ensure the fracture alignment doesn’t change and get worse during your healing process.

Fractures that are displaced may need to be treated with closed reduction and splinting. This involves manually moving the bones back into proper alignment and holding them in place with a splint. You will usually receive a local anesthetic prior to the reduction to decrease your pain. A splint will be used to ensure there is no motion at the fracture site. This splint will incorporate the wrist and the involved finger and neighboring finger out to the tips. These fractures are followed very closely and may need to be monitored weekly in the beginning to make sure things are staying well aligned. Your doctor will determine when you have sufficient healing and can discontinue wearing the splint. Healing depends on several factors including age, fracture type and severity, but most patients will be immobilized for about 4 weeks. Physical therapy will usually be a part of your recovery. Your hand may feel stiff and weak after the splint is removed and therapy will help you regain motion and strength.

Other displaced fractures that are unstable or in multiple pieces may need surgical intervention. Surgery may be done by putting a long screw into the canal of the metacarpal to realign the fracture or by using a plate and screw on the outside of the bone. The goal in both cases is to realign the bone and hold it in place with internal hardware. You will be placed in a splint after surgery. Often, you will remove the splint early on to begin range of motion exercises to avoid stiffness. Your fracture will not be healed at this point, but motion is safe because the hardware is keeping everything aligned. You will still be unable to do any strengthening or contact sports until the fracture is healed.

Basal Joint (Thumb) Arthritis

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Basil Joint Arthritis Treatment in Wayne, Paramus, and Parsippany NJ

Basal joint arthritis is a degenerative process that takes place at the base of the thumb.

Mallet Finger

Mallet Finger Treatment in Wayne, Paramus, and Parsippany NJ

Mallet finger injuries occur when the extensor tendon and often a fragment of bone detaches from the distal phalanx.

Each of our fingers consist of three separate bones called phalanges. These bones articulate allowing each finger to bend in three places. Tendons are long, thin, flexible bands of fibrous connective tissue that attach muscle to the bone, allowing our fingers to bend and straighten. When a tendon is cut or ruptured the muscle will no longer be able to control your finger because the connection is lost. Mallet finger injuries occur when the extensor tendon ruptures from the distal phalanx. Often times an associated avulsion fracture can occur, meaning that a small fragment of bone detaches from the distal phalanx with the tendon.

Mallet finger is a common injury that can occur on the sports field, at work, or in the kitchen. Usually the patient will report that something hit the tip of their finger while it was in a bent position and then they were unable to straighten it. The finger may be sore, but sometimes people feel little pain and only notice that they are unable to straighten the tip of the finger. Our doctors can usually tell right away when this injury has occurred through examination of the finger. X-rays are often taken to determine whether there is bony involvement of the distal phalanx.

Mallet Finger
The goal of treatment in mallet finger is to get the tendon to heal back to the distal phalanx. If there is an associated avulsion fracture the treatment is essentially the same, but healing can occur sooner in these cases because the piece of bone attached to the tendon may aid in the healing process. Although mallet finger seems like a small and sometimes insignificant injury the healing process can feel long. The good news is that the vast majority of mallet fingers will heal without surgery.

Initial treatment is a strict splinting regimen for 6-8 weeks. This involves a splint that keeps the most distal finger joint in complete extension. The splint must be kept on and not removed throughout the healing process so that the distal interphalangeal (DIP) joint does not bend. If the tip of the finger bends, it can disrupt any healing that has occurred and you often have to start the 8 week process again. If you need help changing your splint or need a new splint during this time you can call our office for a splint change. You should keep the splint covered while showering or getting your hands wet to avoid the splint slipping off or irritation of the skin on the top of the finger.

Once the tendon heals back to the bone, the patient will begin to wean the splint and begin gentle range of motion exercises. In most cases, the patient may have a slight extensor lag (meaning the finger may be unable to fully straighten at the tip), but the finger is fully functional. Generally, physical therapy is not a necessary part of your recovery. Most patients can return to their activities soon after they wean the splint.

In rare instances, some patients may be unable to tolerate 8 weeks of strict splinting for mallet finger treatment. If this is the case, there is a surgery that can be done. This involves having a pin inserted across the distal interphalangeal joint to place the tendon in a place where it will heal. The pin will stay in place for 8 weeks. Most patients will still feel more comfortable wearing a splint during this 8-week period, but it may be removed without the fear of having stress put on the tendon as it heals. After 8 weeks the pin will be removed and the patient will regain motion in their DIP joint. This is done as a same day procedure at the hospital or in a surgery center. Physical therapy is usually not necessary, but may be used if there are issues regaining motion.

Mallet fingers can be very bothersome and pesky injuries. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any finger issues and receive superior care from our doctors and staff.

Interphalangeal Arthritis

Interphalangeal Arthritis Treatment in Wayne, Paramus, and Parsippany NJ

Interphalangeal arthritis occurs in the fingers as a result of degenerative changes post traumatically, chronic wear or underlying inflammatory conditions.

Interphalangeal arthritis occurs in the fingers as a result of degenerative changes post traumatically, chronic wear or underlying inflammatory conditions. Over time, the cartilage wears down and the joint space narrows causing pain and swelling in the joint. Motion may be restricted and the patient may notice bony nodules surrounding the joint. Diagnosis may be made by x-ray that will show loss of joint space and may show osteophytes and joint degradation. If there is suspicion of an underlying systemic condition, it may be necessary to order blood tests. Treatment will begin conservatively with rest, anti-inflammatories and possibly an intraarticular cortisone injection. If a patient’s pain persists despite conservative management, they may be a candidate for surgery.

Extensor Tendon Rupture/Laceration

Extensor Tendon Rupture/Laceration Treatment in Wayne, Paramus, and Parsippany NJ

If an extensor tendon has ruptured or has been lacerated, you will be unable to actively straighten your finger.

Extensor tendons run along the back of your hand and allow you to straighten your fingers. These tendons may rupture due to trauma, bone spurs or from degeneration of the tendon over time. Extensor tendons are close to the skin surface and may also be cut as result of a hand laceration. You will be unable to actively straighten your finger if the tendon has ruptured or is lacerated. In this case, our surgeons may order an MRI to visualize the tendons and determine which tendons have been disrupted and the extent of the injury. In order to regain function of your fingers, you may need surgery, which can consist of either a tendon repair, reconstruction or transfer. Click here for more information on extensor tendon repair.

Flexor Tendon Rupture/Laceration

Flexor Tendon Rupture/Laceration​ Treatment in Wayne, Paramus, and Parsippany NJ

Injury to a flexor tendon of the hand results in the inability to bend the affected finger.

Flexor tendons of the hand are responsible for flexion (bending) of the fingers and are located on the palm side of the hand. Injury to one of these tendons creates an inability to bend the affected finger. Typically, these injuries occur due to deep cuts (lacerations) or if the tendons are place under high tension and rupture. Symptoms associated with this injury include the inability to bend one or more joints of the finger, pain when the finger is bent, tenderness to the tendon when pressure is applied and if the tendon was lacerated, an open wound with possible numbness to the fingertip. This is easily diagnosed in the clinical setting with a thorough clinical exam. Tendons cannot heal when completely torn and often require surgery to repair the affected tendon (See “Flexor Tendon Repair” found in the Treatments section). Once repaired, a period of rest is required to allow the repaired tendon to heal. Your surgeon will than start you on a gradually progressive physical therapy regimen to slowly regain motion and function of the finger.

Finger Mass/Cyst

Finger Mass/Cyst Treatment in Wayne, Paramus, and Parsippany NJ

Cysts or soft tissue masses can develop in the fingers and usually have no specific etiology. Most soft tissue masses are painless, but there are some that can cause pain. Glomus tumors, for example, are benign but painful and very sensitive to temperature change. Some masses may grow rapidly while others may be indolent and slow growing. Our hand specialists will examine and evaluate your issue and order the necessary testing to make a diagnosis. Some ganglion cysts can be aspirated in the office, but this does not guarantee that they will not recur. Ganglion cysts have a deeper stalk that will often cause the sac to reflate even after they have been drained. The most definitive treatment of any soft tissue mass or cyst is with a complete surgical excision and also gives you the best chance to avoid recurrence of the mass. Once the mass or cyst is excised, the specimen is sent to pathology to identify the exact origin for a definitive diagnosis.

Mucous Cyst

Mucous Cyst Treatment in Wayne, Paramus, and Parsippany NJ

Mucous cysts most commonly occur over the most distal joint of the finger.

Mucous cysts most commonly occur over the most distal joint of the finger. Distal interphalangeal (DIP) joint arthritis may cause bone spurs to develop in this area and mucous cysts may form. They usually appear as a bump on either side of the finger joint. They are often tender and fluid filled. The fluid inside the cyst is originating from the DIP joint. You should not attempt to drain the fluid on your own, because it is in direct communication with the joint and a serious joint infection could develop.

X-rays may be taken to determine the extent of the arthritis and identify any osteophytes (bone spurs) that have developed. If the mucous cyst is significantly bothersome or threatening to drain, surgical intervention is indicated.

UCL and RCL Rupture

UCL and RCL Rupture​ Treatment in Wayne, Paramus, and Parsippany NJ

Injury to the ligaments that help stabilize the fingers.

Ulnar collateral and radial collateral ligament injuries in the fingers generally occur at the metacarpophalangeal (MCP) joints. These ligaments help to stabilize the fingers and most importantly the thumb at this joint. This injury can occur in any of the fingers when an overwhelming stress is placed in either the radial or ulnar direction at the joint, but it most commonly occurs in the thumb. Gamekeeper’s thumb occurs when the ulnar collateral ligament of the thumb is ruptured, allowing the thumb to deviate beyond its endpoint when stressed in a radial direction. This may or may not involve an avulsion of the bone, meaning a small fleck of bone pulled off with the ligament. Sometimes, a “Stener” lesion will occur in which the ligament becomes displaced above the adductor aponeurosis and will not heal without surgery. Treatment depends on the severity and location of the tear. Often widening may be seen at the location of the tear with stress view x-rays. An MRI is the most definitive way to determine the extent and location of the tear. If the ligament is in good position for healing, the patient may start with conservative management which is strict immobilization for 4-6 weeks.

Trigger Finger

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Trigger Finger Treatment in Wayne, Paramus, and Parsippany NJ

Trigger finger is a bothersome clicking or locking of the finger.

Wrist Conditions

Distal Radius (Wrist) Fractures

Orthopedic Distal Radius Fracture Surgery in Wayne, Paramus, and Parsippany NJ

A fracture of the distal radius (wrist fracture) usually occurs from a fall onto an outstretched hand.

The wrist joint consists of eight small carpal bones in the hand that connect to the radius and ulna bones in the forearm. This joint allows for extensive movement and manipulation of the hand. The wrist is often injured if you fall onto an outstretched hand or put your hand behind you when falling backward. The radius, the larger of the two bones in the forearm, is most commonly fractured near the area where it meets the wrist. Many different types of radius fractures can occur.

A patient with a distal radius fracture will generally present with a history of trauma, pain in the wrist, swelling, and inability to move the wrist or bear weight on the hand. If a fracture is more severe they may have a visible deformity or the wrist may appear crooked. If you have any or all of these symptoms, you should be seen by an orthopedic doctor for evaluation.

Our doctors will examine your wrist and order an x-ray to determine the location and severity of your fracture. Sometimes a CT scan will be necessary to evaluate a complex fracture. Some nondisplaced fractures can be treated with a splint or a cast. Nondisplaced means that there is a visible fracture, but the alignment of the radius is unchanged. The fracture will be followed by serial x-rays to ensure there is no displacement or movement of the fracture site.These fractures will generally heal with 4 weeks of immobilization. At that point, if there is adequate healing and no tenderness over the fracture site, you can begin gentle wrist range of motion and return to activities gradually. Physical therapy is sometimes required as a part of you rehabilitation, although our doctors will determine if they think it is necessary.

A displaced distal radius fracture may need to be treated with closed reduction and splinting. This involves administering numbing medication into the wrist and manually moving the bones back into proper alignment. The fracture is then held in place with a splint. A sugar tong splint will often be used to ensure there is no motion at the fracture site. This splint starts at the hand and goes up and over the elbow.

If you have any or all of these symptoms, you should be seen by an orthopedic doctor for evaluation.

Our doctors will examine your wrist and order an x-ray to determine the location and severity of your fracture. Sometimes a CT scan will be necessary to evaluate a complex fracture.

These fractures are followed very closely and may need to be monitored weekly, in the beginning, to make sure things are staying well aligned. Your doctor will determine when you have sufficient healing and can discontinue wearing the cast. Healing depends on several factors including age, fracture type, and severity, but most patients will be immobilized for 4-6 weeks.

Surgery is often needed for distal radius fractures that involve the joint, are in multiple pieces, or are unstable. Your doctor will order necessary imaging prior to surgery to ensure they understand the fracture pattern and are prepared to fix your fracture. Your fracture will likely be fixed with a plate and screws that sit on the bone and hold the fracture in place.

This allows your bone to heal in the proper position so that you are less likely to have issues with motion and strength in the future. The hardware will generally stay in the wrist for the patient’s lifetime. On occasion, a patient may be bothered by the hardware in which case it can be removed with a subsequent surgery once the bone is completely healed. After surgery, you will be placed in a splint and follow up in our office in 1-2 weeks. At that point, new x-rays will be taken and the splint will likely be removed. Your doctor may place you in a removable brace and instruct you to start gentle range of motion, depending on your progress. Physical therapy is generally a part of your recovery. You will start with simple range of motion exercises and progress to strengthening when prescribed by your doctor.

Distal radius fractures can cause serious setbacks for patients of all ages. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any wrist issues and receive superior care from our doctors and staff.

Both Bone Forearm Fracture

Forearm Fracture Treatment in Wayne, Paramus, and Parsippany NJ

Both bone forearm fractures occur when both the ulnar and radius break, usually the result of direct trauma or a high-energy fall.

Both bone forearm fractures occur when both the ulnar and radius break, usually the result of direct trauma or a high-energy fall. A diagnosis is made by x-ray, and treatment is determined by the severity of the fracture, the patient’s age and their medical condition. If the fractures are not displaced and can be adequately immobilized, the fracture can be treated in a splint or cast. Other fractures that are displaced, unstable or open need to be treated with surgery. Please refer to our “Treatments” section for more information.

 

Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome​ Treatment in Wayne, Paramus, and Parsippany NJ

De Quervain’s Tenosynovitis

Wrist Tendonitis Surgery in Wayne, Paramus, and Parsippany NJ

De Quervain’s tenosynovitis produces pain over the thumb side of the wrist.

There are many different tendons that run over and under the wrist. These tendons allow for our fingers and wrist to bend and straighten. Each tendon has a unique location and function. DeQuervain’s tenosynovitis affects the abductor pollicus longus and extensor pollicus brevis tendons which help control thumb motion. DeQuervain’s tenosynovitis is a common tendon issue in the wrist and can affect patients both young and old. Patients may complain of pain when lifting their newborn, often referred to as “Mommy thumb”, others may notice the pain while doing repetitive lifting at their job or while doing house work, and some may notice the pain while texting or using their phone.

DeQuervain’s tenosynovitis / Wrist TendonitisPatients generally present with pain over the thumb side of the wrist. This area is called the first dorsal compartment of the wrist. This compartment contains the abductor pollicus longus and extensor pollicus brevis tendons. There may be visible swelling directly over this area and it may be tender to touch. Inflammation of the soft tissues surrounding the tendons in this compartment may cause narrowing and pain. Pain will commonly be elicited with any kind of lifting, pinching or grasping activity in ulnar deviation and with use of the thumb. Our doctors can usually make a diagnosis on physical examination alone. Once the diagnosis is established they will discuss the different treatment options.

Generally, initial treatment involves immobilization of the wrist and thumb with a soft brace. These thumb spica braces are available in our office or a custom brace may be made by a hand therapist. The brace allows the tendons to rest, helps alleviate pain and hopefully decreases inflammation in that area. It is also common that a cortisone injection will be offered at your initial apppintment. The cortisone is injected directly into the first dorsal compartment and surrounding the affected tendons. Cortisone is a steroid that works to decrease inflammation in that area. Patients will usually feel relief within a couple of days after the injection. If the pain does not respond to the cortisone injection or recurs, then surgical intervention may be indicated.

Surgical treatment for DeQuervain’s tenosynovitis is a straightforward and quick treatment although our doctors will continue to take the utmost care during this procedure. The procedure can be done under local anesthesia in a hospital or ambulatory surgery center. This means that a numbing injection will be given into the area of the wrist where the surgery is done, but otherwise you will be awake. You will not feel any pain and by avoiding general anesthesia you will not need to spend extra time in the recovery room time once the surgery is over. If you have any concerns about being awake during the procedure you can certainly discuss with you doctor other options.

During the surgery an incision is made over the thumb side of the wrist. The first dorsal compartment will be identified and released to open the tunnel and free the tendons. After surgery, a splint may be applied for about one week to rest the wrist. After one week, you will follow up in our office and the splint will be removed. At this point, you will begin to regain your motion and strength with a series of hand and wrist exercises. Generally these exercises can be done on your own at home, although formal physical therapy may also be recommended. Recovery generally takes two to three weeks, and you can return to most activities as tolerated within that time.

DeQuervain’s tenosynovitis can be extremely frustrating and cause serious setbacks and dysfunction for patients. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any wrist issues and receive superior care from our doctors and staff.

Dupuytren’s Contracture

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Dupuytren’s Contracture​ Treatment in Wayne, Paramus, and Parsippany NJ

DRUJ Instability/Arthritis

DRUJ Instability/Arthritis Treatment in Wayne, Paramus, and Parsippany NJ

Chronic repetitive use or direct trauma can cause distal radioulnar joint (DRUJ) instability and/or arthritis.

The distal radioulnar joint (DRUJ) is located between the ulnar head and the sigmoid notch of the radius. It is stabilized by various ligaments and the TFCC (triangular fibrocartilage complex). It can become unstable most commonly after distal radius fractures or TFCC tears (“See TFCC tear” for more information). Some symptoms associated with this condition are pain with forearm rotation, crepitus, snapping/clicking sensation and decreased grip strength. Radiographs can help diagnose your condition by showing widening at the DRUJ or ulnar head subluxation. Sometimes more advanced imaging is also used to evaluate the injury. This may be treated in a variety of ways depending on whether your injury is acute or chronic. Sometimes simple immobilization will be sufficient, while other times operative intervention may be necessary.

In other cases, arthritis may develop in the DRUJ over time. This can be diagnosed with careful examination and x-rays. On x-rays the DRUJ may be narrow and there may be degenerative changes within the joint. This may lead to pain, crepitus and weakness in the wrist. Treatment may involve immobilization, cortisone injections or ultimately surgical intervention. See our “Treatments” page for more information.

Ganglion Cysts

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Ganglion Cyst Treatment in Wayne, Paramus, and Parsippany NJ

Ganglion cysts are lumps that can commonly develop in the hand, wrist and fingers.

Scaphoid Fracture

Scaphoid Fracture Treatment in Wayne, Paramus, and Parsippany NJ

Scaphoid fracture is a fracture of one of the carpal bones in the hand located on the thumb side of the wrist.

The scaphoid is one of the eight carpal bones in the hand located on the thumb side of the wrist. It is commonly fractured but at times difficult to detect on initial x-rays and is often overlooked. Careful examination is important, and appropriate treatment is crucial to ensure healing. If the bone is not displaced, it can be treated with strict immobilization for 4-6 weeks, or in some cases longer, to heal. If the bone does not heal or if the fracture is displaced, surgery may be indicated to avoid future dysfunction and pain.

 

TFCC Tear Complex

TFCC Tear Complex Treatment in Wayne, Paramus, and Parsippany NJ

Injury to the TFCC (Triangular Fibrocartilage Complex) involves tears of the articular disc and surrounding ligaments of the wrist.

The wrist joint consists of eight small carpal bones in the hand that connect to the radius and ulna bones in the forearm. This joint allows for extensive movement and manipulation of the hand. The TFCC, triangular fibrocartilage complex, helps stabilize the distal radioulnar joint. It is made up of several ligaments and cartilage. There is a small articular disc in the center of the complex that cushions the wrist. Injury to the TFCC involves tears of the articular disc and surrounding ligaments. This injury can occur from an accident, falling onto an outstretched hand, repetitive wrist hyperextension and degenerative changes. Patients with positive ulnar variance, meaning the ulna is longer than the radius, are also more predisposed to TFCC injuries. This can be a result of a normal anatomic variant or from prior trauma. This relative difference causes the longer ulna to “abut” into the carpal bones, most commonly the lunate. This “impaction” can eventually cause TFCC tears along with other issues.

Pain from a TFCC tear is usually localized to the small finger side of the wrist, although in some cases the pain can be more diffuse. It is usually aggravated by any type of forearm rotation. Sometimes, patients may feel instability or catching inside the joint. Tears are diagnosed by a combination of history, clinical testing and MRI. Contrast is sometimes used during the MRI to help visualize the tear better, but this is not always necessary.

At your initial evaluation, you doctor will examine your wrist and do specific tests to assess the location of your pain and any instability you may have. X-rays will be done in the office to determine any potential abnormalities. If a TFCC tear is suspected your doctor will likely order an MRI to evaluate the extent and location of the tear. An MRI allows your doctor to see cross sectional images of the wrist and the surrounding tissues. Our doctors will ask that you bring a copy of your MRI to your next appointment so they can personally review the images. They will be able to look through the images with you and show you the source of your pain and the extensiveness of your injury.

There are different grades of TFCC tears, but treatment usually begins conservatively with immobilization and possibly a cortisone injection. Sometimes with rest and the help of cortisone to decrease inflammation in the area the pain may resolve. If the patient’s symptoms have not improved with conservative management or the patient is experiencing instability, they may be indicated for an arthroscopic TFCC debridement or repair.

A wrist arthroscopy involves using small cameras to see inside the wrist joint, assess the problems firsthand and treat them accordingly. Sometimes the TFCC needs to simply be debrided, which means cleaning up frayed pieces of damaged tissue. Other times the TFCC is torn and needs to be repaired with sutures. In the case where a repair is performed, you will be immobilized for a total of six weeks after surgery to allow for the repaired tear to heal. For the first few weeks you will be in a sugar tong splint that incorporates the wrist and the elbow. This prevents you from moving the wrist and rotating the forearm, which could affect your repair. At 2-3 weeks post op you will be transitioned into a Muenster cast which will allow for more movement of the elbow, but will still immobilize the wrist. After 6 weeks, you will be transitioned to a removable brace and begin formal physical therapy. Physical therapy will play a huge role in your recovery. You will being with range of motion exercises and progress to strengthening when your doctor thinks you are ready. Patients can generally return to most of their activities within 3-4 months of surgery. Although, it may take longer to return to sports that require heavy lifting or full weightbearing on the wrist.

TFCC tears can cause serious pain and dysfunction for patients of all ages. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any wrist issues and receive superior care from our doctors and staff.

Finger Infections

Finger Infections Treatment in Wayne, Paramus, and Parsippany NJ

Infections of the finger often require medical attention to resolve.

There are several types of finger infections, and it is important to understand the differences. Fingertip infections, also known as felons, are located at the fingertip pad. A paronychia is an infection that involves the soft tissue that surrounds the fingernail. Septic tenosynovitis of the finger is an infection of the fluid-filled sheath that surrounds the tendons.  Finger infections can be very painful and persistent. Most finger infections are due to bacteria; however, fungal infections are also commonly seen. Initially these infections may be treated with oral antibiotics, antifungal medication if a fungal infection is suspected and warm soaks. If an abscess develops, it should be drained as a more definitive treatment. If the infection persists despite drainage and antibiotics, it may be necessary to surgically irrigate and debride the infected tissue. In the case of a paronychia, we remove the nail and cut the tissue just beneath the nail(eponychium) to allow complete resolution of the infection. Similarly, septic tenosynovitis often requires an incision, drainage and irrigation of the infected tendon sheath. Our hand specialists can address this issue in our office through clinical examination, imaging and drainage when needed. If the issue requires surgery, it may be done as a same-day procedure at a local hospital or surgery center.

Ulnocarpal Impaction

Ulnocarpal Impaction Treatment in Wayne, Paramus, and Parsippany NJ

Ulnocarpal impaction occurs when the distal ulna and carpal bones, primarily the lunate, bump into one another and cause pain.

Ulnocarpal impaction occurs when the distal ulna and carpal bones, primarily the lunate, bump into one another and cause pain. This may be caused by positive ulnar variance, radial shortening from a previous distal radius fracture or ligament tears. Pain is usually on the pinky side of the wrist and is worse with activities that cause ulnar deviation of the wrist. Radiographs may show positive ulnar variance, meaning the ulna bone is higher than the radius, and possibly sclerosis of the lunate bone or ulnar head from impaction. This also may predispose patients to TFCC tears. Conservative management consists of bracing and cortisone injections, although a surgical procedure may be the best option if pain and dysfunction persist.

 

Wrist Arthritis

Wrist Arthritis Treatment in Wayne, Paramus, and Parsippany NJ

Wrist arthritis commonly occurs post traumatically or from chronic and repetitive wear.

Wrist arthritis commonly occurs post traumatically or from chronic and repetitive wear. Symptoms generally occur as pain and swelling in the wrist, along with decreased range of motion, ultimately effecting the patient’s overall function. The exact type and degree of wrist arthritis is best diagnosed with radiographs which can help pinpoint the joint surfaces and bones that are most involved. Management begins conservatively with bracing, NSAIDs and cortisone injections. If the pain persists despite conservative management, the patient may be a candidate for surgery. Surgical intervention consists of fusing specific joints in the wrist or hand. Removing certain carpal bones may be indicated as part of the procedure to eliminate the associated pain. A total wrist fusion, a partial wrist fusion, a four corner fusion or a proximal row carpectomy are some of the options available depending on the exact location and severity of the arthritis. Our orthopaedic hand specialists will determine which, if any, procedure would be best to treat your wrist for your lifestyle and needs.

SNAC Wrist
Scaphoid nonunion advanced collapse (“SNAC wrist”) occurs after sustaining a scaphoid fracture that goes undiagnosed or does not heal. Patients may present with a history of an old injury with complaints of wrist pain, stiffness and weakness. Diagnosis is often made with radiographs that show a scaphoid nonunion and the progression of the collapse. Treatment of this condition begins conservatively with bracing and cortisone injections, but definitive treatment requires surgery.

SLAC Wrist
Scaphoid lunate advanced collapse (“SLAC wrist”) usually occurs as the result of a chronic scapholunate ligament injury. Loss of stability between these carpal bones causes the scaphoid to go into a flexed position and the lunate to be extended. Over time, these abnormal forces and instability lead to arthritic changes between the radiocarpal and midcarpal joints. Patients may present with a history of an old injury and complaints of wrist pain, stiffness, and weakness. Diagnosis is often made with radiographs that will show scapholunate widening, radiocarpal and/or midcarpal arthritis, and a DISI (dorsal intercalated segment instability) deformity.

Hand Treatments

Phalanx (Finger) CRPP and Phalanx ORIF

Phalanx CRPP and Phalanx ORIF Treatment in Wayne, Paramus, and Parsippany NJ

Procedure allows a finger fracture to be realigned and stabilized with metal wires (aka “pins”) or internal hardware.

Phalanx CRPP
Closed reduction and percutaneous pinning of a finger (phalanx) fracture allows the fracture to be realigned and stabilized with metal wires (aka “pins”). This usually does not require any kind of incision, but there will be small poke holes where the wires were inserted. This is done in an operating room under sterile conditions and with live x-ray which will show your surgeon when the bones have been reduced to anatomic alignment in real time. The patient is generally immobilized for about four weeks (depending on the fracture). Once the fracture has healed, the pins are pulled out in the office. Hand therapy is usually a very important part of recovery to regain motion and normal hand function. In some cases, it takes several months for full motion to return.
Phalanx ORIF
Open reduction and internal fixation (ORIF) of a phalanx fracture allows the fracture to be stabilized with internal hardware. This surgery is usually reserved for fractures that may be in many pieces, unstable and/or very displaced. This involves making an incision over the fracture and putting hardware over the bone to realign the fragments. This hardware is designed to be kept inside and does not need to be removed. The bone will still take four to six weeks to heal, but the hardware keeps everything aligned so that the bones heal in anatomic alignment. Although the patient may begin gentle motion earlier after an ORIF (vs. percutaneous pinning), formal hand therapy is still an important part of recovery.

 

Metacarpal (Hand) CRPP or PRIF

Metacarpal CRPP or PRIF Treatment in Wayne, Paramus, and Parsippany NJ

Metacarpal fractures may need stabilization with wires placed through the fracture site in the operating room or with internal hardware as plates and screws.

Metacarpal CRPP (Closed Reduction and Percutaneous Pinning)

Metacarpal fractures may need stabilization with wires placed through the fracture site in the operating room. Percutaneous pinning generally does not require an incision of any kind, and the pins are removed once the bone is healed. The bone will need to be immobilized while the pins are in place and the area needs to be kept clean and dry to avoid infection. Once the bone is healed and the pins are removed, the patient will need to regain their motion either on their own or with the help of formal physical therapy.

Metacarpal (ORIF) Open Reduction Internal Fixation

Some metacarpal fractures are best treated with open reduction and internal fixation (ORIF). This requires an incision and application of internal hardware in the form of plate and screws or an intramedullary screw to stabilize the bones. This hardware generally stays in place and is not removed. It still takes four to six weeks for the fracture to heal, but often range of motion can be started sooner because the fracture is stabilized from the inside. X-rays will be taken during your follow up appointments to ensure maintained alignment and healing of the fracture.

Basal Joint (Thumb) Arthroplasty

Basal Joint Arthroplasty in Wayne, Paramus, and Parsippany NJ

A procedure designed to alleviate thumb pain while preserving mobility and function of the thumb.

Surgery usually involves removing a small carpal bone called the trapezium that sits at the base of your thumb and is the source of pain in basal joint arthritis. Removal of this bone does not alter the mobility or function of the thumb but does alleviate your pain. Once that bone is removed, the thumb metacarpal will be suspended in a variety of ways that may involve a tendon transfer, pinning or a tight rope suspension. All of these are appropriate options, although some may allow for earlier motion than others. Physical therapy will be a large part of your rehabilitation process regardless of the specific type of surgery done.

 

DIP Pinning for Mallet Finger

DIP Pinning for Mallet Finger in Wayne, Paramus, and Parsippany NJ

Have a pin inserted across the distal interphalangeal joint to help correct mallet finger injuries.

Some patients may be unable to tolerate eight weeks of strict splinting for mallet finger treatment. If this is the case, then they can have a pin inserted across the distal interphalangeal joint, essentially replacing the tendon back to the its proper placement on the bone. The pin will be removed after eight weeks and the patient will regain motion in their DIP joint. This is done as a same-day procedure at a hospital or ambulatory surgery center. Most patients will still feel more comfortable wearing a splint during this eight-week period while the pin is in place.

Interphalangeal Joint Fusion

Interphalangeal Joint Fusion in Wayne, Paramus, and Parsippany NJ

This is for severe painful arthritis with little to no preserved motion in the joint.\

Interphalangeal fusion is usually reserved for patients with severe painful arthritis with little to no preserved motion in the joint. The goal of a fusion is to eliminate pain caused by arthritis by fusing the two bones together, which will also subsequently eliminate any motion through the joint. This may be done in a variety of methods, but usually involves implanting hardware. The fusion may take six to eight weeks to fully heal, and your activities will be restricted until full healing has occurred.

Extensor Tendon Repair

Extensor Tendon Repair in Wayne, Paramus, and Parsippany NJ

The extensor tendon will likely need to be repaired to regain function and mobility.

After an extensor tendon rupture or laceration, the tendon will likely need to be repaired to regain function. The procedure should be done as close to the incident as possible to have the greatest chance of a solid repair, otherwise a tendon transfer or reconstruction may be needed. If a laceration was involved, the wound may need to be washed out and explored to avoid infection and to assess whether any nerve or vessel injuries occurred concurrently. After the tendon repair is complete, the hand will be immobilized. Further instruction will be given with regards to post-operative follow up in our office for removal of your dressing and protocol involving further immobilization, recovery and therapy. Closely following the instructions of your surgeon and therapist is critical because the tendon needs to be rehabilitated properly in order for you to regain motion and not compromise the repair. Each individual patient will have a rehab that is tailored specifically to their needs.

Flexor Tendon Repair

Flexor Tendon Repair in Wayne, Paramus, and Parsippany NJ

Surgical repair of a ruptured flexor tendon is commonly required to allow for regained flexion of the finger.

Complete flexor tendon ruptures or lacerations will require surgical repair to regain function of the affected finger. It is important that the repair is done in a timely manner and as close to the incident as possible to prevent the need for a more complex surgery. This surgery can be done as a same-day procedure in an ambulatory surgical center. After the tendon is repaired, the hand is splinted in a bent position to immobilize the fingers and keep tension off of the newly repaired tendon. Closely following the instructions of your surgeon and therapist is crucial during this post-operative phase, because the tendon must be rehabilitated properly in order to regain motion and not compromise the repair. Once adequate time is spent resting and healing the repair, your surgeon will progress you to formal physical therapy which is done in a gradual manner. Each individual patient will have a rehab protocol that is tailored specifically to their ability and needs.

Finger Mass/Cyst Excision

Finger Mass/Cyst Excision in Wayne, Paramus, and Parsippany NJ

Surgically excise a mass or cyst that has become bothersome or cannot be treated conservatively.

When a mass or cyst has become bothersome or cannot be treated conservatively, it may need to be excised surgically. Depending on the size and depth of the mass, this may be done under local anesthesia. The procedure involves making an incision directly over the mass and dissecting through the surrounding tissues to remove it. Sometimes an MRI may be required for preoperative planning to assess the exact location and depth of the mass. The specimen will be sent to pathology for a definitive diagnosis. Generally, the dressing may be removed two to three days after surgery. The sutures will be removed in the office about two weeks after surgery, and your surgeon will review your pathology results at that time.

Mucous Cyst Excision

Mucous Cyst Excision in Wayne, Paramus, and Parsippany NJ

Excision of small cysts that grow over finger joints.

The surgery requires a small incision directly over the cyst. Dissection is taken down to the level of the joint, and the stalk of the cyst is excised. Additionally, any osteophytes are identified if present and then removed. The finger is usually placed in a soft dressing for the first few days after surgery. After this time, the dressing may be removed and the patient is encouraged to begin gentle range of motion. The stitches are removed after two weeks and the patient is cleared to return to all activities.

Formal therapy is generally not necessary; instead simple range of motion exercises can be performed at home. To keep your fingers moving, alternate between straightening and flexing each finger making sure to attempt to complete a full fist. This a simple yet important part of your recovery. It is also important to gently massage your surgical scar (after the first week) which will help soften and desensitize the healing tissue.

UCL and RCL Repair

UCL and RCL Repair in Wayne, Paramus, and Parsippany NJ

This involves making an incision over the disrupted ligament and repairing the native tissue.

If a collateral ligament fails to heal with conservative management or is significantly displaced (i.e. Stener lesion), surgical intervention may be necessary. This involves making an incision over the disrupted ligament and repairing the native tissue when able or reconstructing the ligament with a tendon autograft if a primary repair is not possible. A primary repair will often involve the use of a small suture anchor in the bone to ensure a solid repair. The patient will need to be immobilized over the next four to six weeks to ensure that the ligament heals properly. After that point, the patient will begin therapy to regain motion and strength. A therapist may make you a custom removable brace that you can wear at times for rest and comfort.

Trigger Finger Release

Trigger Finger Release in Wayne, Paramus, and Parsippany NJ

The pulley is released to allow the finger tendon to glide smoothly.

If a corticosteroid injection does not successfully treat your trigger finger after two attempts, then you may be a candidate for either percutaneous trigger finger release or open trigger finger release.

Percutaneous trigger finger releases can be done in the office. The finger of interest must be reproducibly triggering so that we are able to determine whether or not the pulley is successfully released. Local anesthesia is given, and a small poke hole is made in the skin. A needle is used to cut and release the pulley that the tendon is getting caught on. The finger is then tested to ensure that it is no longer getting caught. A compressive dressing is placed for the patient to wear over the next few hours. The area may be sore for a few weeks while everything heals. Hand and finger range of motion is encouraged immediately after the procedure. This is only an option for certain patients depending on the finger involved and the severity of the triggering.

The open trigger finger release may also be done under straight local anesthesia, but this procedure is done at a hospital or ambulatory surgery center. It involves making a small incision at the base of your finger over the involved pulley. The pulley is cut so that your tendon will glide smoothly without getting caught. A soft dressing is placed after surgery that may be removed after two to three days. Stitches will be removed in the office two weeks after surgery. Hand and finger range of motion is encouraged immediately after surgery, and full recovery usually takes a few weeks.

Wrist Treatments

Wrist, PRC, and Four Corner Fusion

Wrist, PRC, and Four Corner Fusion in Wayne, Paramus, and Parsippany NJ

A partial wrist fusion involves fusing the radoiocarpal joints that have been most affected by arthritis, while a total wrist fusion involves fusing the whole radoiocarpal joint.

Total or Partial Wrist Fusion
A partial wrist fusion involves fusing the radiocarpal joints that have been most affected by arthritis, while a total wrist fusion involves fusing the whole radiocarpal joint. This may be done with screws, plates or staples. In this case, the patient will be sacrificing wrist motion for pain relief. Recovery will involve immobilization for about six weeks while the fusion heals.

Four Corner Fusion
A four corner fusion is one technique in which midcarpal arthritis can be addressed surgically. This procedure involves removing the scaphoid bone and fusing together four of the remaining carpal bones. This is usually reserved for patients with a well preserved radiolunate joint and isolated midcarpal arthritis. The capitate, lunate, hamate and triquetrum are fused together with screws or large metal staples. This eliminates motion between these bones but preserves some motion at the wrist. These bones will fuse together into one bone with no joint space over time. The goal of this surgery is to eliminate pain caused by midcarpal arthritis and allow the patient to return to having a functional pain free hand and wrist.

Proximal Row Carpectomy
A proximal row carpectomy involves removing the scaphoid, lunate and triquetrum bones. This may be used in patients with Kienbock’s disease (avascular necrosis of the lunate), scaphoid nonuion, SLAC (scaphoid lunate advanced collapse) or SNAC (scaphoid nonunion advanced collapse) wrist. It is usually not a good option for patients with advanced arthritic changes. The goal of the surgery is to remove the bones causing pain while allowing the patient to retain some motion. The recovery time is generally quicker following this procedure, because you do not need to wait for any bones to fuse or heal before returning to activities.

 

Both bone forearm Open Reduction Internal Fixation (ORIF)

Scaphoid Fracture Treatment in Wayne, Paramus, and Parsippany NJ

Surgical repair of the radius and ulna of the forearm with intramedullary rods or plates and screws.

Both bone forearm fractures may need to be treated with open reduction and internal fixation. This may be done with intramedullary rods, more commonly in children, or plates and screws. The goal of surgery is to reduce the fractures to their proper anatomic alignment and keep them aligned with internal hardware. It will still take four to six weeks for the bones to heal, but the hardware ensures that they maintain anatomic alignment while the healing process takes place and therefore avoid improper healing which can cause future pain and dysfunction.

 

De Quervain’s Release

De Quervain’s Release in Wayne, Paramus, and Parsippany NJ

A procedure in which the first dorsal compartment on the thumb side of the wrist is released.

If a patient has attempted conservative management and failed to achieve pain relief, they may be a candidate for a first dorsal compartment release. This procedure can be done under local anesthesia in a hospital or ambulatory surgery center. It involves an incision over the thumb side of the wrist. The first dorsal compartment will be identified and released to open the tunnel and free the tendons. After surgery, a splint may be applied for about one week to rest the wrist. After one week, the splint is removed and you will begin to regain your motion and strength with a series of hand and wrist exercises often able to be performed at home. Recovery generally only takes two to three weeks, and you can return to most activities as tolerated after your first follow up appointment.

 

Darrach and Sauve-Kapandji Procedures

Darrach and Sauve-Kapandji Procedures in Wayne, Paramus, and Parsippany NJ

This procedure is for patients with chronic DRUJ (distal radioulna joint) instability or DRUJ arthritis.

Darrach Procedure
A Darrach procedure is reserved for patients with chronic DRUJ (distal radioulna joint) instability or DRUJ arthritis. This surgical procedure involves resection of the ulnar head which eliminates the rubbing of the distal portion of the ulna on the sigmoid notch of the radius.

Sauve-Kapandji Procedure
Sauve -Kapandji procedure involves fusion of the ulnar head to the radius and resection of a portion of the distal ulnar shaft. This allows the structures of the TFCC to remain intact while eliminating pain at the DRUJ. Resecting a portion of the distal ulnar shaft preserves the ability of the arm to supinate and pronate (turning your palm up and down).

 

Ulnar Shortening Osteotomy or Wafer Procedure

Ulnar Shortening Osteotomy or Wafer Procedure in Wayne, Paramus, and Parsippany NJ

This procedure is for patients with chronic DRUJ (distal radioulna joint) instability or DRUJ arthritis.

If a patient has positive ulnar variance and persistent pain despite conservative management, they may be a candidate for an ulnar shortening procedure. This can be done through a wrist arthroscopy often performed at the same time as a TFCC debridement or repair. The procedure involves using an instrument to shave down the most distal portion of the ulnar head so that it no longer impacts the carpal bones. An ulnar shortening osteotomy involves cutting out a piece of the ulnar shaft to shorten the whole bones and fixing it with a plate and screws. In this case, the bone needs to heal at the site it was cut before the patient can return to activities.

 

 

Ganglion Cyst Excision

Ganglion Cyst Excision in Wayne, Paramus, and Parsippany NJ

Instruments are used to excise the cyst sac all the way down to the stalk.

Ganglion cyst excisions are usually done with a small open procedure directly over the cyst. On some occasions, they are removed arthroscopically depending on the cyst’s location and size. Once the cyst is visualized, instruments are used to excise the cyst sac all the way down to the stalk. Removing the cyst stalk helps to ensure that they cyst will not recur. Generally, you will wear a small splint for the first week after surgery. Once the splint is removed, you will begin to regain your motion and strength frequently with a home exercise program. Full recovery generally takes a few weeks, although you may return to most activities as tolerated after your first follow up visit.

 

Scaphoid Fracture Open Reduction Internal Fixation (ORIF)

Scaphoid Fracture Open Reduction Internal Fixation (ORIF) in Wayne, Paramus, and Parsippany NJ

Surgical fixation of scaphoid fracture that has either displaced or has not healed properly.

Sometimes surgery is indicated to treat a scaphoid fracture whether it is an acute problem or a long-term problem. A scaphoid nonunion occurs when a scaphoid fracture is chronic and has not healed properly. This may cause pain and can lead to an issue called scaphoid nonunion advanced collapse or SNAC wrist. In either an acute or chronic case, the fracture is reduced and internal hardware is inserted to keep the fracture in proper anatomic alignment. Bone graft may or may not be used to augment healing. Strict immobilization is very important after surgery to ensure proper healing of the bone. Once the bone is healed, the patient will begin exercises to regain motion and strength.

 

 

Arthroscopic TFCC Repair

Arthroscopic TFCC Repair in Wayne, Paramus, and Parsippany NJ

Arthroscopic repair of the TFCC in the wrist.

If your symptoms have not improved with conservative management then you may be a candidate for an arthroscopic TFCC (triangular fibrocartilage complex) debridement or repair. This involves using small cameras to see inside the wrist joint, assess the problem firsthand and treat it accordingly. Sometimes the TFCC needs to simply be debrided, which means cleaning up frayed pieces of damaged tissue. Other times the TFCC is torn and needs to be repaired with sutures. In the case where a repair is performed, you will be immobilized for a total of six weeks after surgery to allow for the repaired tear to heal. Thereafter, you will begin therapy to regain motion and strength.

 

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