Hand and Upper Extremity

How well your hands, wrists and arms function affects nearly everything you do. So, when you have pain or other symptoms in the upper extremities, it can impact your quality of life.

At New Hampshire Orthopaedic Center (NHOC), our specialists have decades of experience diagnosing and treating hand and upper extremity conditions. They take time to discover the source of your symptoms and offer nonsurgical and surgical treatments that deliver excellent results.

Subspecialty Hand, Wrist and Arm Care in New Hampshire

At NHOC, we understand that living with pain or a lack of function can be difficult. That’s why we make it easy for you to get the care you need.

With our flexible scheduling, you don’t have to wait long to see one of our experts. And with office locations in Nashua, Bedford and Londonderry, you’re never far from subspecialty orthopedic care. You can also expect:

• Expertise: Our hand surgeons have completed the highest level of training (fellowship training) in upper extremity surgery and care. Their knowledge and skill are among many reasons why medical providers continually vote them among New Hampshire’s Top Doctors (according to New Hampshire Magazine).
• Subspecialty care: The structures within the hands, wrists and arms are delicate and complex. That’s why people experience better outcomes when orthopedic doctors specially trained in this area of the body care for them. At NHOC, you receive care from board-certified upper extremity specialists. Their expertise means you benefit from outstanding results for both routine and complex injuries and conditions.
• Easy to access urgent care: Every day, we save appointment openings for people who need follow-up hand or arm care after visiting an urgent care clinic. We also provide hand treatment in local emergency rooms. And if you have a fracture that requires surgery, our patient coordinators quickly arrange it and guide you through the process.
• Team-based care: When you come to one of our doctors, you also benefit from the experience of our other hand specialists. These experts regularly discuss treatment plans. Their collaboration helps personalize your care so that you can experience the best results possible.
• Compassion: Our goal is to help you feel better. Our doctors are both skilled surgeons and listeners. They take the time to understand what you’re going through and explain your options. Together, you’ll create a plan you feel comfortable with, and that fits your lifestyle and goals.

Hand and Upper Extremity Conditions We Treat

Our specialists provide nonsurgical and surgical treatment for hand, upper limb and elbow conditions and injuries, including:

• Arthritis: Arthritis is age-related wear and tear on the joints. We treat arthritis that affects the wrists and finger joints, including the carpometacarpal (CMC) joint at the base of the thumb.
• Carpal tunnel syndrome: The median nerve runs the length of your arm down to your wrist. At the wrist, it passes through a space called the carpal tunnel into your hands and fingers. Carpal tunnel syndrome happens when the carpal tunnel puts pressure on the median nerve, causing numbness and pain in the affected hand and forearm.
• Cubital tunnel syndrome (ulnar nerve entrapment): Like carpal tunnel, cubital tunnel syndrome is a type of nerve compression. It affects the ulnar nerve, which runs from the neck to the hand. The condition occurs when the cubital tunnel inside your elbow puts pressure on the ulnar nerve as it passes through.
• Dupuytren’s contracture (Dupuytren’s disease): Dupuytren’s contracture is a condition in which tissue (fascia) under the skin of your palm thickens. This thickening can cause lumps and bands of tissue that tighten (contract). Tightened tissue can cause one or more fingers to bend towards your palm, preventing you from fully opening your hand.
• Ganglion cyst: Ganglion cysts are lumps of fluid that can develop on your wrist or hand. They are not cancerous and usually painless unless they press on a nerve.
• Hand, wrist and arm injuries: We treat the full scope of hand and upper extremity injuries, including fractures, tendon and nerve lacerations (deep cuts or tears), and crush injuries.

Hand and Arm Tendonitis and Tenosynovitis

We treat all hand and arm conditions that affect the tendons. Tendons are the rope-like tissues that connect muscles to bones. Learn more about our tendonitis care, including how we treat:

• Biceps tendon ruptures: Biceps tendon ruptures usually occur suddenly when a heavy load is placed on your flexed arm, forcing it to straighten quickly. This tendon connects the biceps muscle to your forearm.
• De Quervain’s tenosynovitis (De Quervain’s tendinosis): De Quervain’s tenosynovitis affects the tendons that connect your thumb and wrist. While overuse of the thumb and wrist commonly causes the condition, it’s also associated with arthritis, pregnancy and breastfeeding.
• Golfer’s and baseball elbow (medial epicondylitis): Medial epicondylitis causes pain on the inside of the elbow. It happens when you overuse the tendons connecting the elbow to the wrist flexor muscles in the forearm. These muscles control your ability to bend your wrist and fingers. Movements like swinging a golf club and pitching a baseball can lead to this condition.
• Tennis elbow (lateral epicondylitis): This injury causes pain on the outside of the elbow. Overuse of the elbow tendons can lead them to swell and tear. Repetitive arm motions, like those performed while playing tennis, can cause lateral epicondylitis.
• Trigger thumb and trigger finger (stenosing tenosynovitis): Trigger finger and thumb occur when your finger or thumb permanently or temporarily gets stuck in a bent position. The flexor tendons are responsible for finger movement. They run from the forearms to your fingers. Cords of tissue called pulleys attach the flexor tendons to your finger bones. Trigger finger occurs when one of these pulleys—and eventually the flexor tendon—swells or thickens, affecting the tendon’s ability to move.

Diagnosing Hand and Upper Extremity Problems

Your doctor will listen as you describe your symptoms and how they affect your life. The doctor will also review your medical history and examine you. If you need an X-ray, we can take one while you are in our Nashua or Bedford office.

Some people also need more advanced testing, such as an MRI or nerve testing (nerve conduction studies). Nerve testing helps diagnose carpal tunnel and cubital tunnel syndrome.

MRI uses magnetic fields and radiofrequencies to create detailed pictures of the inside of your arm or hand. MRI services are also available in Nashua and Bedford.

Once we understand the cause of your symptoms, your doctor explains your diagnosis and treatment options. To help you make an informed decision, the doctor:

• Reviews the pros and cons of each treatment option
• Discusses the benefits and risks of surgery (if applicable)
• Explains what to expect during surgery or after treatment

Nonsurgical Hand, Wrist and Arm Treatments

Most hand and upper limb conditions respond well to nonsurgical treatment. We offer a wide variety of nonsurgical treatments, including:

• Activity modification: Adjusting how you perform certain activities can help you heal and prevent the condition from worsening. We teach you how to make these changes to optimize your recovery.
• Bracing and splinting: Wearing a brace or splint can help you heal and reduce your symptoms.
• Cold laser therapy (low-level laser therapy): Cold laser therapy uses light energy to stimulate healing and reduce swelling. Learn more about cold laser therapy, available through our partnership with OrthoLazer in Nashua.
• Injections: We offer different types of injections to reduce swelling and pain. These treatments include cortisone (steroid) injections and platelet-rich plasma (PRP) therapy Medicine: We may prescribe anti-inflammatory medications like ibuprofen to manage pain and inflammation.

Hand therapy

Hand therapy can help relieve pain and improve function. For your convenience, we offer comprehensive therapy services in our Nashua and Bedford offices.

Our services include:

• Hand therapy
• Therapeutic exercises
• Dry needling (inserting thin needles into muscle knots to relieve pain)
• Ultrasound
• Iontophoresis (a device that uses mild electrical stimulation to deliver medication into your muscles)

Your hand specialist works closely with your physical therapist to ensure you receive coordinated, effective care. Learn more about our physical and occupational therapy services.

Dupuytren’s Contracture Treatment

Because Dupuytren’s often develops slowly, many people don’t need treatment. But if the condition worsens, you may benefit from:

• Dupuytren’s contracture surgery
• Nonsurgical collagenase enzyme injection with manipulation

Dupuytren’s contracture surgery

During Dupuytren’s contracture surgery, your hand surgeon divides or removes the cords of thickened tissue in your palm. Altering or removing this tissue helps restore hand function.

Our hand doctors offer extensive experience and successful outcomes for both collagenase enzyme injection with manipulation and Dupuytren’s contracture surgery. They will discuss your options and help you make the decision that’s best for you.

Collagenase enzyme injection

Collagenase clostridium histolyticum is an enzyme injection for Dupuytren’s contracture that treats the cords of tissue under the skin. Collagenase enzyme injection for Dupuytren’s contracture is a two-stage treatment that we perform in our office:

1. First, your hand specialist injects the enzyme directly into the thickened tissue.
2. You go home for two days while the enzyme dissolves and softens the affected tissue.
3. Then, you return to our office for the second part of the procedure. During this visit, your hand doctor numbs and manipulates (moves) your hand to further break up the tissue. This manipulation makes it possible for you to straighten your hand.
4. We then provide you with a splint to wear at night for three to four months. We also teach you finger exercises to optimize your recovery.

The collagenase enzyme injection provides a nonsurgical option for people who can’t or don’t want to have surgery. It also offers a faster, easier recovery. However, Dupuytren’s contracture is less likely to return after surgery.

Hand Surgery

When conservative treatments stop helping or don’t work, surgery can be an effective option. Our hand surgeons perform a range of hand and upper extremity surgeries, including:

• Fracture repairs
• Joint replacement and reconstruction
• Nerve decompressions
• Nerve releases
• Reconstruction of injuries, rheumatoid deformities and congenital hand defects
• Tendon repairs
• Trigger finder releases

Mini-open carpal tunnel release surgery

Mini-open carpal tunnel release involves a smaller palm incision and lower complication risk than traditional open carpal tunnel release surgery. The procedure only takes about 15 minutes, and you can go home the same day as your procedure.

During mini-open surgery, your carpal tunnel surgeon numbs the affected area with local anesthetic. You do not need sedation or general anesthesia.

Your carpal tunnel surgeon then makes an incision in the top of the carpal tunnel to widen it. This action relieves the pressure that the carpal tunnel puts on the median nerve. Our patients experience excellent outcomes with this approach.

CMC joint arthroplasty

The thumb joint (CMC joint) is located where the thumb meets the wrist’s trapezium bone. You may need thumb joint reconstruction when the CMC joint has moderate to severe arthritis damage.

Our hand surgeons are skilled in CMC joint replacement procedures. During these procedures, doctors remove all or part of the joint and reconstruct it. They may replace it with a rolled-up piece of your own tendon or other implant. They may also reconstruct the ligament that holds the thumb in place.

Locations

Nashua
17 Riverside Street, Suite 101
Nashua, NH 03062
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Bedford
9 Washington Place, Suite 101
Bedford, NH 03110
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Londonderry
41 Buttrick Road
Londonderry, NH 03053
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Contact Us About Hand and Upper Extremity Care

For questions about our hand and upper extremity program or to make an appointment with one of our specialists, call or text 603.883.0091.