Many essential tasks call for use of your hands—signing a check, zipping your coat, managing a fork or spoon. An injury or condition that affects one or both of your hands can turn these routine tasks into big challenges. Fortunately, doctors have come a long way in their approaches to treating such conditions and in their ability to improve patients’ lives.

“For hand surgeons, it’s about function,” says Carrie Swigart, MD, a Yale Medicine hand surgeon. Yale Medicine surgeons have extensive expertise treating challenging conditions that impair peoples’ ability to use their hands. Specialized surgical procedures can often bring about a dramatic improvement.

A variety of conditions can prevent the hand from functioning properly, including degenerative conditions, such as arthritis, nerve compression syndromes and injuries. Some of these will require surgery, while others may improve with nonsurgical treatments.

Sometimes an event such as a fall, a sports accident or a workplace accident will result in injury to bone, muscle, tendon or ligament. The hand surgeons at Yale Medicine evaluate and treat such injuries with advanced and innovative techniques. Our team has access to advanced diagnostic tools including a dedicated musculoskeletal radiology service. 

Interestingly, however, Dr. Swigart says the majority of her patients do not remember being injured. 

“I commonly see people who have no history of an injury that they can remember,” Dr. Swigart says. “But their hand hurts when they do certain things, or it doesn’t move as well as it used to. Sometimes patients come in and say they’ve had a particular problem for years. Other patients say they noticed a problem three days ago.”

Possible diagnoses include:

• Arthritis of the hand, elbow or wrist
• Carpal tunnel syndrome
• Other nerve compression syndromes
• Dupuytren’s contracture
• Tendinitis
• Trigger finger
• Tumors of the hand
• Congenital and pediatric hand conditions

Your doctor will examine your hand, and may want you to have an X-ray, a CT scan, an MRI or other imaging test. If the doctor suspects nerve problems, clinicians may conduct electrodiagnostic studies of the nerves. These tests are done by a neurologist and involve stimulating nerves and sometime muscles with electricity to evaluate their ability to conduct and receive their signals properly.

But according to Dr. Swigart, most diagnoses can be made after simply “listening to people talk about their problem.”  Carpal tunnel syndrome, for instance, causes such symptoms as pain that wakes you up at night or numbness in the hands when you do certain activities, such as driving a car or fixing your hair.

Yale Medicine hand specialists provide nonsurgical treatment for hand conditions whenever possible.

Your doctor may prescribe over-the-counter pain medication, physical therapy, custom splinting or casting, or injection of a steroid preparation—or some combination of treatments. It all depends on the condition. It may be necessary to modify activities that may be contributing to the condition.

It’s important to talk to your doctor about the pros and cons of all the options.

Many of the most common surgeries for the hand are performed on an outpatient basis, many with local anesthesia similar to what the dentist uses when filling a cavity. Many surgeries are quick, taking 20 to 30 minutes.

Some hand surgeries are done endoscopically (through a scope), making small incisions and inserting a tiny camera to see inside the wrist. Others may be done using a traditional open approach, which allows the surgeon to see and work directly inside your hand or wrist.

 Here are some common hand conditions that can be effectively treated with surgery:

Carpal tunnel syndrome: The surgeon will cut the ligament that forms the roof of the carpal tunnel, a passageway that runs through the wrist and contains the tendons that bend the fingers, as well as the nerves to most of the fingers. This relieves the pressure it exerts on the median nerve in the wrist.

Dupuytren’s contracture: This is a slow and progressive thickening of tissue in the palm and fingers that can make it difficult or impossible to fully straighten them. Surgery removes or divides the bands to restore movement.

Trigger finger: This condition can cause your finger to become stuck in a bent position. Then, when you try to straighten your finger, it can pop or click abruptly into extension. Trigger finger can be painful. The problem is caused by a thickening of the tissues around the tendons that bend the finger. They grow tight around the tendons, restricting them from being able to smoothly glide. This can be due to injury but usually occurs with no trauma. 

Some joint problems such as severe arthritis may require more complex surgical techniques, such as joint fusion, joint replacement or a complex reconstruction of the joint. The choice of surgery will often depend not only on the type and location of the problem but on the goals of the individual patient as well.

Many hand surgeries are minor and not difficult to recover from, Dr. Swigart says. Typically, patients go home the same day, wearing only a light bandage. The bandage can be removed four or five days later. Two weeks later, the stitches will be removed.

Often surgery brings immediate relief from symptoms, such as the numbness from carpal tunnel syndrome. “But an incision, like having any kind of cut on your hand, has to heal and get tough again. For some people that takes a couple of weeks. For others, it takes a couple of months,” Dr. Swigart says. 

Beyond that, your recovery will depend on the type of surgery you have. It may include occupational therapy with a specialist hand therapist.

The Yale Medicine Hand Surgery Program is one of the region's most comprehensive for evaluation, diagnosis and treatment of both simple and complex conditions of the hand, wrist and forearm. Orthopedic surgeons and plastic surgeons who specialize in the hand and upper extremity work together to determine the best approaches to diagnosing and treating even the most complex injuries, abnormalities or diseases.  Many patients who come to Yale Medicine find that treatment improves their hand function dramatically.