Hand Surgery

Hand surgery is the field of medicine that deals with problems of the hand as well as the wrist and forearm.  Hand surgeons are orthopedic, plastic or general surgeons who have had at least a full year of additional training in surgery of the hand. They can treat patients with or without surgery. Many are also experts in diagnosing and care for problems of the shoulder or elbow.

woman on the bicycleThe hand is involved in almost every activity a person undertakes — from eating and drinking to dressing and personal hygiene to making a living and expressing oneself creatively. Though we tend to take healthy hands for granted, the ability for a person to perform these many activities depends on the hands having sensation and movement, including joint motion, tendon gliding and muscle contraction. When a problem occurs in the hand, attention and care must be given to all the different types of tissues that make functioning of the hand possible.  The hand surgery team at K and B Surgical Center are specifically trained to provide that kind of comprehensive care:

The K and B Surgical Team offers innovative surgical treatment options including:

Broken Bones and Injury

Fractures

Distal Radius Fracture (Colles’ Fracture) – The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist break. This is a common type of fracture — in fact, the radius is the most commonly broken bone in the arm. The break normally occurs when a fall causes someone to land on outstretched hands.

Finger Fracture – When a finger bone is fractured, it can cause a person’s entire hand to be out of alignment. Without proper treatment, it can cause major problems such as the entire hand being out of alignment.

Hand Fracture – A hand fracture can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). It is often the result of a twisting injury, a fall, a crush injury, or direct contact in sports.

Scaphoid Fracture of the Wrist – The scaphoid is one of the small bones in the wrist, located on the thumb side of the wrist, in the area where the wrist bends, which is easily be identified when the thumb is held in a “hitch-hiking” position. A scaphoid facture is usually the result of a fall on an outstretched hand, when the weight lands on the palm.

Thumb Fractures ­­– A broken thumb can be a serious problem when it affects the ability to grasp items — it can also increase the risk of developing arthritis later in life. Thumb fractures are usually caused by a form of direct stress, such as a fall, but can also be caused indirectly, from twisting or muscle contractions during contact sports such as wrestling, hockey and football.

Sprains, Strains and Other Injuries

Sprained Thumb – This is an injury to the main ligament in the thumb, the soft tissue structure that connects the two bones in the thumb. A sprained thumb can weaken one’s ability to grasp items between the thumb and the index finger.

Wrist Sprains – These are common injuries caused when the ligament (the strong band of connective tissue in the wrist that connects one bone to another) is stretched or torn. This can result when the wrist is bent forcefully, as well as when a person falls on an outstretched arm.

Other Injuries

Animal Bites – Although they may occur just about anywhere on the body, most animal bites tend to occur on the fingers of the dominant hand. Even if a bite does not break the skin, it may cause a crushing or tearing injury to underlying muscles, tendons, ligaments and nerves. If the skin is broken, there is the additional risk of infection.

Fingertip Injuries/Amputations – Injuries to the fingertips are common in accidents at home as well as at work — everything from slamming a finger in a car door to chopping fruits or vegetables.  Fingertip injuries can involve crushing, tearing or even amputating the tips of fingers and thumbs — and can include damage to the skin and soft tissue, bone (distal phalanx), or to the nail and nail bed. Fingertips contain lots of nerves, so they are extremely sensitive. Without prompt and proper care, a fingertip injury can disrupt the complex function of the hand, possibly resulting in permanent deformity and disability.

Flexor Tendon Injuries – The flexor tendons are the tissues very close to the surface of the skin that help control movement in the hand. A deep cut on the palm side of the fingers, hand, wrist or forearm can damage one or more tendons (cutting them into pieces or pulling apart the ends, for example), making it impossible for the tendon to heal on its own. A flexor tendon injury can result in numbness on one or both sides of the finger and can also make it difficult or impossible to bend the fingers or thumb, Certain health conditions, such as rheumatoid arthritis, tend to weaken the flexor tendons and make them more likely to tear.

Mallet Finger (Baseball Finger) – This deformity can result when the exterior tendon of the finger is damaged from a ball or other object striking the tip of the finger or thumb with force. The force of the blow may even pull away a piece of bone along with the tendon and, as a result, the finger or thumb cannot be straightened.

Nerve injuries – The nerves in the hands, fingers, and wrists are fragile and can be damaged by pressure, stretching or cutting. Injury to a nerve can also stop signals going to and from the brain, resulting in muscles not working properly and a loss of feeling in the injured area.

Diseases and Syndromes

Carpal Tunnel Syndrome – This condition, more common in women than men, causes numbness in the hand or fingers, pain, a tingling sensation, weakness, and/orlady hula hoop aching. It’s associated with a variety of factors, including repetitive motion or overuse, fluid retention during pregnancy, injury to the nerve in the carpal tunnel, rheumatoid arthritis and even heredity. The carpal tunnel is a narrow, tunnel-like structure in the wrist that protects the median nerve and flexor tendons that bend the fingers and thumb. Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist (known as the synovium) swell and put pressure on the median nerve.

Compartment Syndrome – Compartments are grouping of muscles, nerves and blood vessels found in the arms and legs. They are covered by a tough membrane known as a fascia, which keeps the tissues in place and does not stretch or expand easily. Compartment syndrome develops when there is swelling or bleeding within a compartment. Because the fascia does not stretch, there is increased pressure on the capillaries, nerves and muscles within the compartment and as a result, blood flow to the muscle and nerve cells is disrupted. Without a steady supply of oxygen and nutrients, the nerve and muscle cells can be damaged unless the patient receives proper treatment. Considered a medical emergency, compartment syndrome is usually caused by a severe injury such as a car accident or a broken bone.

Arthritis of the Hand – Arthritis is the leading cause of disability in the U.S. An estimated one out of every five people in this country has at least one joint with arthritic symptoms — about half of them are under the age of 50. Simply defined, arthritis involves inflammation of one or more of the joints — the areas of the body where the ends of bones meet. This inflammation causes swelling, pain, and stiffness in the joint.

Arthritis can affect any joint in the body, but it is most visible when it occurs in the hand and fingers. Each hand has 27 bones plus the two bones of the forearm that help define the wrist. Joints are created whenever two or more bones come together, so there is plenty of potential for arthritic problems in the hand.

Dupuytren’s Contracture – This condition, more common in men than women, results from a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Though painless, the thickening and tightening of the fibrous tissue can cause the fingers to curl. The symptoms usually occur very gradually. The cause of Dupuytren’s contracture is unknown, but it most common in people of Northern European descent, often is hereditary, may be associated with alcohol consumption, and increases in frequency as people age.

Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome) – This is a condition that involves intense burning pain, stiffness, swelling and discoloration and most often affects the hands. There are two types of Reflex Sympathetic Dystrophy. One type occurs after an illness or injury that did not directly damage a nerve in the affected area. The other type follows a distinct nerve injury. The exact causes of the condition are unknown, however. Early diagnosis and treatment are important in order to prevent the atrophic stages of the condition in which there is less hope of getting motion in the hands back — and the symptoms may spread to other areas of the body.

Wrist

Ulnar Tunnel Syndrome of the Wrist – This is a condition that causes numbness and tingling in the little finger and along the outside of the ring finger.  It results from pressure on the ulnar nerve, one of the three major nerves that provide feeling and function in the hand. The ulnar nerve runs down the inside of the forearm to the heel of the hand where it branches out across the palm and into the little and ring fingers. Excessive pressure on this nerve can cause a loss of feeling and/or muscle weakness in the hand.  Symptoms of the condition develop gradually, and as the syndrome progresses, it may become difficult to open jars, hold objects, or to type on a keyboard or play a musical instrument.

Arthritis of the Wrist – Although there are many different types of arthritis, most wrist pain is caused by the two major types:  osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA) is a progressive condition that destroys the smooth articular cartilage that covers the ends of bones. As the cartilage wears away, the bare bones rub against each other, resulting in pain, stiffness and weakness.

Ganglion (Cyst) of the Wrist – A ganglion cyst contains a thick, clear, mucus-like fluid similar to the fluid found in the joint. It can develop indifferent areas of the wrist. What triggers the formation of a ganglion is not known, but it is a more common occurrence among gymnasts, who repeatedly apply stress to the wrist.  Women are more likely to develop a ganglion cyst than men.

Kienböck’s Disease – This is a condition in which the blood supply to one of the small bones in the wrist (the lunate) is interrupted.  Loss of blood supply can lead to damage to the lunate, which causes a painful, stiff wrist and, over time, can lead to arthritis. The cause of Kienböck’s disease is unknown, but many people who have the condition have experienced some form of trauma to the wrist, such as a fall, which can disrupt blood flow to the lunate. The conditions progresses slowly, and eventually leads to symptoms such as pain, swelling, and/or limited range of motion in the wrist, decreased grip strength in the hand, and/or difficulty in turning the hand upward.

Finger/Thumb

Arthritis of the Thumb – Arthritis is a condition that irritates or destroys a joint. The type of arthritis that most commonly affects the joint at the base of the thumb (the basal joint) is osteoarthritis, which is as also known as degenerative or “wear-and-tear” arthritis. Arthritis of the base of the thumb is more common in women than in men, and usually occurs after age 40. Previous fractures or other injuries to the joint may increase the likelihood of developing this condition. Various symptoms of arthritis of the thumb include pain in activities that involve gripping or pinching, swelling and tenderness at the base of the thumb, and development of a bony prominence or bump over the joint.

Boutonnière Deformity – This is an injury to the tendons in the fingers that usually prevents the finger from straightening fully. As a result, the middle joint of the injured finger bends down, while the fingertip bends back. Boutonnière deformity is generally the result of a forceful blow to a bent finger or a cut on the top of the finger. Unless treated promptly, the deformity may progress, leading to permanent deformity and impaired functioning.

Trigger Finger – This condition affects the tendons in the fingers or thumb, limiting finger movement. When an individual tries to straighten a finger, it will lock or catch before popping out straight. The cause is unknown, though certain factors increase the risk of developing the condition. For example, it is more common in women than men, occurs most frequently in people between the ages of 40 and 50, especially those with certain medical problems such as diabetes and rheumatoid arthritis.

Treatment and Rehabilitation

Injury to the upper part of the spinal cord can leave a person with little or no sensation or movement in the arms and legs, a condition known as tetraplegia. A tendon transfer is a surgical technique that is designed to help restore function to paralyzed arms and hands. The procedure essentially repositions the tendons of a working muscle so that they can take over the functions of a paralyzed muscle. Tendon transfer surgery can help restore the patient’s ability to grip with the fingers and hand, and to bend and straighten the wrist.

Wrist Arthroscopy – Arthroscopic surgery is a minimally invasive procedure designed to diagnosis and treat problems inside a joint. Since the wrist is essentially a complex joint with eight small bones and many connecting ligaments, arthroscopic surgery is an excellent tool for assessing conditions affecting it. The surgeon makes small incisions through the skin in specific locations around the wrist. A pencil-sized instrument, known as an arthroscope, is inserted through these incisions. The arthroscope contains a small lens, a miniature camera, and a lighting system that allow 3-D images of the joint to be projected onto a television monitor. The surgeon then has a larger canvas with which to assess or correct the problem affecting the wrist.

Wrist Joint Replacement (Wrist Arthroplasty) – Joint replacement surgery can be an option for patients suffering from painful arthritis in the wrist that does not respond to other treatments. The procedure can be effective in helping to relieve pain and to restore function in the wrist and hand. The typical candidate for wrist replacement surgery has severe arthritis but does not need to use the wrist heavily during the day.

Meet our Hand Surgery Team

Matthew J. Enna, M.D.

Dr. Enna has unique experience in advanced techniques in arthroscopic, hand, and trauma surgery. He is one of only a select few physicians in California to achieveDR._ENNA subspecialty certification in both hand surgery and sports medicine.

An interest in both the humanities and pre-medical education led him to Washington University in Saint Louis, where he earned a bachelor’s degree in English Literature in 1997. He spent his senior undergraduate year at Oxford University, where he studied Shakespeare, Dickens and Leonardo da Vinci. He then entered Tulane University School of Medicine, where he graduated in 2001.  Dr. Enna did his general surgery internship, orthopedic surgery residency, and a fellowship in orthopedic trauma at Brown University in Providence, Rhode Island. During his training at Brown, he was an assistant team physician for the Brown University varsity football, hockey and lacrosse teams, and for the Providence Bruins hockey team.

After his trauma fellowship at Brown, Dr. Enna completed an additional fellowship — in hand and microsurgery — at UCLA. In 2008, he joined the Sansum Clinic in Santa Barbara where he gained valuable experience in advanced techniques in arthroscopic, hand, and trauma surgery.

Amir Tahernia, MD

Amir Tahernia, MD enjoys challenges, be they academic, athletic, as head of a family, or as a plastic surgeon. As he says “excellence matters… a lot”. A native of New York, Dr. Tahernia spent his early years there before moving to the west coast and attending college at UCLA. He knew from early on in his medical training that he wanted to become a plastic and reconstructive surgeon. To him there was no other specialty in medicine that so nicely married science with art. It is this balance of science and artistry that drew him to the field and continues to excite him each day as he practices his craft.

Dr. Tahernia has had an impeccable academic pedigree, having attended some of the finest institutions in the country. His education has taken him from UCLA to NYU School of Medicine and most recently Duke University. At UCLA he was elected to the elite Phi Beta Kappa society, which recognizes only a small fraction of undergraduates as the brightest students in the country. While at the NYU School of Medicine he won honors in Surgery. He completed a total of 7 years of General Surgery training, which included dedicated research in plastic and reconstructive surgery. This lead to several fine works resulting in publications and presentations at national meetings. Dr. Tahernia is a diplomat of both the American Board of Plastic Surgery and the American Board of Surgery, putting him in an elite group of double board-certified surgeons. Dr. Tahernia is also an attending teaching faculty member in the division of Plastic Surgery at Cedars-Sinai Medical Center in Los Angeles. Dr. Tahernia was recently bestowed the honor of being named a Fellow of the American College of Surgeons.tahernia

He comes to Los Angeles after completing a rigorous three-year plastic surgery fellowship at the prestigious Duke University Medical Center. Duke has consistently been ranked as one of the top 10 medical centers in the nation. During his time there he performed the entire spectrum of plastic surgery from the most sophisticated reconstructive procedures to high-end aesthetic surgery. Dr. Tahernia was fortunate to be trained by some of the masters of plastic surgery while at Duke.

Commensurate with his clinical acumen he was also heavily involved in resident education while at Duke. While there, his contributions lead to all-time high scores on plastic surgery board preparatory examinations. In addition his academic efforts there lead to fine publications in the specialties’ main scientific journals. He also has had extensive training in hand surgery, having completed a 4-month fellowship at the world-renowned Kleinert Hand and Microsurgery Institute in Louisville, Kentucky. All in all he has had over 10 years of surgical training with a particular focus on aesthetic and reconstructive surgery.

In his spare time, Dr. Tahernia really enjoys spending time with his wife, Azzy and two children, Pasha and Sienna. He is also an avid tennis player and plays whenever he has the opportunity.

We hope you enjoy the contents of our website, which gives insight into our practice and the procedures which Dr. Tahernia performs. Dr. Tahernia individualizes his care for each patient, based on their wishes and needs. His philosophy is that it’s important to treat each patient like family and to provide the safest and most up-to-date surgical options. This ultimately translates into optimal results, which pleases him and more importantly leads to happy patients.

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Dr. Tahernia is author to book chapters in Seminal Plastic Surgery textbooks.