Hand and Wrist Surgery Program

About the Program

Located within a renowned academic medical center, the Massachusetts General Hospital Division of Plastic and Reconstructive Surgery’s Hand and Wrist Surgery Program specializes in medical, therapeutic and surgical treatment of hand and wrist disorders.

Our physicians are leaders in using innovative surgical techniques, including minimally invasive procedures, to treat conditions of the upper extremities, including bones and joints, tendons, nerves and blood vessels. We are also very experienced in performing microsurgery for soft tissue reconstruction.

Mass General is one of New England's top referral centers for complex reconstructions of the hand and wrist, including microsurgical re-attachment. Microsurgical procedures, used in transplanting, reattaching or repairing body parts damaged or lost due to injury, disease or surgery, involve repairing small arteries, veins and nerves under a microscope using a very fine suture. Surgeons at the Massachusetts General Hospital pioneered limb replantation even before the advent of microsurgery, starting with Dr. Ronald A. Malt, who performed the world's first successful re-attachment of a human limb in 1962.

Patient Care 

During your consultation, the surgeon will review your medical history and treatment goals. Treatment options, including risks and benefits, will be discussed in detail. Photos may also be necessary. We also ask that you bring a list of medications, vitamins and herbal supplements that you take, along with information on dosages.

Our goal is to give you a realistic picture of what to expect so that you can make an informed decision. We also review what's involved in any surgery, including:

• Anesthesia
• Anticipated results
• Hospital care
• Postoperative recuperation

As part of our multidisciplinary approach, we work closely with Mass General specialists in the Department of Neurosurgery, the Department of Neurology, the Division of Rheumatology, the Vascular Center and other Mass General departments to evaluate, diagnose and treat patients.

Occupational and physical therapists are also available post-surgery to provide care during your recovery process and to assist in the rehabilitation of the hand and wrist to regain function and counteract scarring, stiffness and swelling.

Common Conditions

Arthritis

We address this condition by noninvasive means when possible, including splinting and joint injections, as well as removing tissue from inflamed joints, repositioning tendons and rebalancing damaged joints or implanting artificial joints. We also use joint fusion to stabilize and relieve pain from degenerative changes.

Bone/Ligament Injuries

Our team treats fractures using a variety of tools and techniques, including implanted wires, plates and screws. We also perform ligament reconstructions, often with tendon grafting, in the small joints of the hand and wrist for weakened or divided ligaments.

Brachial Plexus Injuries

We surgically repair the network of nerves running from the spine into the neck and upper arm using state-of-the-art techniques of microsurgical nerve repair, nerve grafting and nerve transfers.

Burns

We use advanced techniques for reconstructing burn-injured hands including dermal substitutes, scar contracture releases, skin grafting and microsurgical flap reconstructions.

Carpal Tunnel Syndrome/Peripheral Nerve Compression

We treat nerve decompression syndromes such as carpal tunnel syndrome with both traditional (open) and minimally invasive endoscopic techniques. In addition, we offer treatment for other nerve compression syndromes such as cubital tunnel syndrome.

Congenital Hand Deformities

We correct multiple congenital defects such as syndactyly, in which two or more fingers are fused together, duplicated digits, absent or deformed digits and thumb reconstructions.

Dupuytren's Contracture

We surgically treat abnormal thickening of the fascia (the tissue just beneath the skin of the palm) with removal of abnormal tissues and soft tissue reconstructions with grafts and tissue transfers.

Nerve Injuries

We reconstruct damaged or severed nerves using microsurgical techniques. We also perform tendon transfers to restore function.

Tendon Injuries and Disorders

We repair and reconstruct divided tendons acutely with direct repair techniques or after a significant delay with grafting techniques. We also use noninvasive and surgical treatments to remedy inflammation of tendons that cause trigger fingers, lateral epicondylitis, and painful conditions of other tendons with both.

Trauma

We surgically reconstruct hands damaged by injury, including complex combined injuries to bones, tendons, blood vessels, and nerves, including re-attachment of severed fingers, hands, forearms and upper arms.

Research

Our team conducts leading research into hand and wrist disorders. A promising study currently underway explores using lasers and light-activated dye to bond nerves, arteries and tendons together. We believe this approach may create less scar tissue and improve recovery in comparison with current surgical methods. We are currently in the final stages of preparation of a clinical trial for the nerve repair technique. Other areas of study include:

• Stem cell transplantation for enhancement of peripheral nerve regeneration: The possibility of transplanting stem cells directly into injured muscle to improve recovery following nerve repair and prevent muscle atrophy and irreversible muscle damage
• The brain-body interface project: Examining ways to record and send cortical signals from the brain directly to the hand to restore arm movement in patients with spinal cord injuries (a collaboration with the Massachusetts Institute of Technology). The project is supported by a grant from the Center for the Integration of Medicine and Innovative Technology