"The name 'Hand Center' really does not tell the whole story," says Steven I. Grindel, MD, Medical College of Wisconsin Assistant Professor of Orthopaedic Surgery. Dr. Grindel is one of seven physician specialists who use state-of-the-art medical and surgical techniques to treat patients who come to the Hand Center.

The Hand Center is equipped to meet the needs of a wide variety of patients, notes Dr. Grindel. "There are three orthopaedic surgeons and four plastic surgeons. Among us, we cover every possibility.

"Some patients come to us through the Emergency Department because of major trauma caused by an accident. Others come to us because of congenital conditions, for instance, we see newborns with supernumerary (extra) fingers and toes, shortened limbs and other problems," Dr. Grindel says.

Arthroscopic Surgery Minimizes Down-Time
There is no single most common injury to the upper extremities, but there are some that are more frequently seen than others, Dr. Grindel says. "Much of what we do is post-traumatic, such as repairing fractures, burns, cuts, and crushing injuries. But the most common conditions we see are probably carpal tunnel syndrome, tennis elbow, and rotator cuff tears," he says. Another frequently treated injury is the tendon problem commonly referred to as "trigger finger."

Most of the surgeries performed in the Hand Center are done on an outpatient basis. This is possible in large part because surgeons are now able to use arthroscopic surgery for many repairs. In arthroscopy, surgeons make small incisions and insert miniature instruments to view and repair injuries.

This process is much less invasive than open surgery, and offers greater benefits to the patient. "We do arthroscopic surgery with smaller incisions, less scarring, less recovery time, and a more favorable outcome for our patients," Dr. Grindel states.

Treatment of Chronic Conditions
Many patients come to the Hand Center for treatment of painful chronic conditions such as arthritis and tendonitis.

"We have a very active hand therapy program, with some of the best physical and occupational therapists as well as a psychologist, physician assistants, and nurses," Dr. Grindel says. "Patients need therapy for a wide variety of reasons. They do much better overall because of the work our therapists do."

Fifteen therapists are on staff to help provide services to Hand Center patients, most of them board-certified hand therapists. Dr. Grindel and other surgeons work very closely with the therapy staff in getting patients back to their everyday activities after surgery.

In fact, patients who are gearing up to return to work are often able to receive therapy in an environment quite similar to their workplace, says Don Kroll, manager of the Hand Center. "We try to simulate different work environments for patients prior to returning to the workplace so if they have a problem, they can experience it here, not on the job.

"After a trauma, a patient may need multiple services, including protective splinting and range-of-motion therapy, scar management, strengthening and retraining of the muscles, or perhaps adaptive therapy," he explains. "We also have home treatment programs and counseling services available. All of these services help people quickly return to their daily lives."

Specialties
Several specialized areas exist within the Hand Center with services that address specific injuries or conditions. These include:

Acute Care Clinic: As noted by Dr. Grindel, this clinic focuses on repairing hand damage after serious injury. That may include high-level traumas such as reattachment and reconstructive surgery. "We treat some very serious cases," says Dr. Grindel.

Cumulative Trauma Disorders Clinic: CTDs are caused by repetitive motion of the hands over a long period of time. These injuries, which are often work-related, affect the muscles, nerves, tendons and arteries of the wrist and arm. Treatment typically includes a combination of surgery, occupational medicine, and counseling.

Congenital Conditions: Hand Center specialists work closely with the staff of Children's Hospital of Wisconsin to treat or repair conditions that are present at birth. These conditions "can be challenging, but often can be managed with expert treatment, says Mr. Kroll.

Brachial Plexus Program: A brachial plexus injury "involves nerves in the neck that control the shoulder, arm or hand," Dr. Grindel explains. "When those nerves are injured it can mean loss of the use of an arm." Dr. Grindel says. Hand Center specialists evaluate and treat these injuries in newborns, children, and adults.

Rehabilitation Psychology: Getting back into daily life after a traumatic injury is not always easy. "Our clinical psychologists can help post-traumatic patients deal with the psychological aspects of their injuries," Dr. Grindel says. Consulting with experts sensitive to psychological recovery helps patients cope with the aftermath of an injury.

Prosthetic Training: If patients require prosthetics for full recovery from a hand trauma, the team at the Hand Center will provide careful instruction and training to help them prepare for the challenges involved in using a prosthesis.

Lymphedema Therapy: Lymph node removal - sometimes needed in cancer treatment - can result in the swelling and inflammation of lymphedema. Therapists at the Hand Center use manual therapy, massage, compression garments and exercise techniques to relieve symptoms.

"We are seeing more patients every year," says Mr. Kroll, noting that in 2005 alone, the Center saw 5,262 new patients. "They're coming from throughout the state of Wisconsin, the Midwest and beyond. We really are a regional facility."

"Our combined years of expertise help to ensure optimal recovery and a return to independence," Dr. Grindel concludes.

JoAnn Petaschnick
HealthLink Contributing Writer