What We Treat

The upper extremity, from the hand to shoulder, is a complex system composed of bones, tendons, nerves and ligaments which requires a true specialist in the field of orthopedic surgery to know how to properly provide care.

Hand

Sport Injuries

Jersey Finger
Swan Neck Deformity
Mallet Finger
Finger Dislocation
Pulley Injury
Skier’s Thumb
Sagittal Band Injury
Bennett / Rolando Fracture
Bouttonière Deformity
Boxer’s Fracture

Condition

Carpal Tunnel Syndrome
Trigger Finger
Finger Cyst
Seed Ganglion
Hand Fractures
Thumb Basal Joint Arthritis
Tendon Injuries
Dupuytren’s Disease
Nerve Injuries
Hand and Finger Arthritis
Rheumatoid Arthritis

Wrist

Sport Injuries

Scaphoid Fracture
Intersection Syndrome
Scapholunate Ligament Injury
TFCC Injury
Hook of the Hamate Fracture
Extensor Carpi Ulnaris Injury

Condition

De Quervain Tenosynovitis
SLAC and SNAC
Wrist Ganglion Cyst
Kienbock’s Disease
Distal Radius Fracture
Ulnar Abutment
Wrist Arthritis - STT
Scaphoid Non-Union
Distal Radio Ulnar Joint Arthritis

Wrist

Elbow

Sport Injuries

Tennis Elbow
Triceps Tendon Injury
Golfer’s Elbow
Medial Collateral
Ligament Injury
Biceps Distal Tendon Injury
Capitellar OCD

Condition

Cubital Tunnel Syndrome
Radial Head Fracture
Lacertus Fibrosus Syndrome
Olecranon Fracture
Olecranon Bursitis
Elbow Dislocation and Instability
Elbow Arthritis

Shoulder

Sport Injuries

Labrum Injury - SLAP
Acromioclavicular Dislocation
Shoulder Dislocation -
Instability
Pectoralis Major Tear
Clavicle Fracture

Condition

Rotator Cuff Calcification
Shoulder Arthritis
Rotator Cuff Injury
Biceps Tendinopathy

Shoulder

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Frequently Asked Questions

Why is it important to consult a specialist in the upper limb rather than a general orthopedic surgeon for certain conditions?

A specialist in hand and upper extremity care has advanced training to provide focused, expert care for conditions affecting the hand, wrist, elbow, and shoulder. Their in-depth knowledge of these areas ensures more accurate diagnosis and treatment.

I feel numbness or tingling in my hand. Should I consult a doctor?

These symptoms may be related to a nerve problem such as carpal tunnel syndrome or ulnar nerve compression. Prompt evaluation can help prevent permanent nerve damage.

Is it normal to have persistent pain after a sprain in the wrist or hand?

Prolonged pain could indicate a ligament injury, an overlooked fracture, or joint instability. Consultation and imaging are recommended for a precise diagnosis.

I have elbow pain after intense training. Could it be “tennis elbow”?

It’s possible, but elbow pain can also be related to other issues such as tendinitis or joint instability. A consultation will help identify the exact cause.

What should I do if my shoulder frequently dislocates?

Recurrent shoulder instability requires a thorough evaluation. Specific exercises can help strengthen the stabilizing muscles, but surgical intervention may be considered to repair ligament damage and restore stability.

I was told there was nothing you could do for arthritis. Is that true?

Arthritis is a challenging condition, and while it may not have a cure, treatments like medication, therapy, joint injections, and surgery options can help alleviate symptoms and enhance mobility.

Is it possible to return to sports after upper limb surgery?

Most athletes return to their sport after surgery, but it depends on the type of injury, the procedure performed, and a dedicated rehabilitation program. The surgeon and physiotherapist will create a tailored recovery plan.

How long does recovery take after hand surgery?

Recovery after hand surgery varies depending on the procedure and the injury. Your recovery plan will be tailored to ensure optimal healing and a safe return to your routine or sport.

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Condition

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Definition

Mallet Finger is an injury to the extensor tendon at the tip of the finger, where the tendon is either torn or avulsed from the distal phalanx, sometimes with a small bone fragment. This results in a characteristic drooping of the fingertip and the inability to actively extend the distal joint. It typically occurs following a sudden forceful flexion of an extended finger, such as being struck by a ball, hence its common name, “baseball finger.”

Causes

Mallet Finger typically results from a sudden forceful flexion of an extended fingertip, usually during sports. This often happens when a ball hits the tip of a straight finger, causing the tendon that straightens the fingertip to tear or pull off a small piece of bone. This mechanism leads to disruption of tendon continuity and loss of active extension at the distal joint.

Signs and Symptoms

The hallmark sign is a drooping fingertip due to the inability to actively extend the distal interphalangeal joint (DIP). Additional symptoms include pain, swelling and tenderness over the dorsal aspect of the fingertip. If an avulsion fracture is present, there may also be bruising, a visible deformity and sometimes a palpable bony fragment.

Diagnosis

Diagnosis is primarily clinical, based on the characteristic drooping of the fingertip and the inability to actively extend the distal phalanx.  
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X-rays are mandatory to identify any bony avulsion or joint subluxation.

Treatment

Mallet Finger is most often managed non-surgically with a custom splint that keeps the distal joint in extension for 6 to 8 weeks, allowing the bone or tendon to heal properly. It is crucial that the fingertip remains fully extended during the entire period to avoid reinjury.
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Surgical treatment may be required in more complex cases, such as when there is a large bony avulsion, volar subluxation of the distal phalanx, or open tendon injury.  

Recovery can take several months. Physiotherapy is often recommended after splinting or surgery to help restore range of motion and strength. Most patients regain good function, though residual stiffness or mild deformity can persist in more severe cases.
Dr. Bernard Lallemand will guide you through the best treatment options tailored to your specific case.

Condition

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Definition

Carpal Tunnel Syndrome (CTS) occurs when the median nerve is compressed within a narrow passage in the wrist called the carpal tunnel. This tunnel, bordered by wrist bones and a tight ligament known as the transverse carpal ligament, contains flexor tendons and the median nerve, which controls sensation in the thumb, index, and middle fingers.  

CTS is the most common nerve entrapment of the upper limb.

Causes

CTS can arise from various factors that make the carpal tunnel tighter. Common causes include injuries or swelling around the wrist, arthritis, diabetes, and pregnancy-related changes.  
It is more frequently seen in women, likely due to a naturally smaller carpal tunnel.

Signs and Symptoms

Typical symptoms of Carpal Tunnel Syndrome include numbness or tingling affecting the thumb, index and middle fingers, often becoming worse at night or during repetitive tasks like driving. Wrist discomfort or pain can also radiate upward along the forearm. Gradually, grip strength may decrease, causing difficulty holding objects or performing precise movements such as buttoning clothes. Without treatment, severe cases may result in persistent and irreversible numbness.

Diagnosis

Diagnosis of CTS generally involves a thorough physical examination combined with a detailed evaluation of symptoms. Specific clinical tests can identify signs of nerve compression. In certain cases, additional assessments such as nerve conduction studies, electromyography (EMG) or ultrasound might be required to confirm the diagnosis and rule out other conditions.

Treatment

Treatment for Carpal Tunnel Syndrome (CTS) typically begins with conservative methods, including resting the wrist and wearing a removable splint, especially at night, to relieve pressure on the median nerve. Physiotherapy can also play a beneficial role by teaching patients nerve-gliding exercises, improving wrist strength, and reducing symptoms. Corticosteroid injections may temporarily reduce inflammation and alleviate discomfort.

If conservative treatments are insufficient, carpal tunnel release surgery, performed under local anesthesia, effectively relieves nerve compression by cutting the transverse carpal ligament. Although some residual numbness may remain, tingling and nighttime symptoms usually improve considerably following surgery.
Dr. Bernard Lallemand will guide you through the best treatment options tailored to your specific case.

Condition

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Definition

Seed ganglia are small, gel-like cystic nodules that typically develop on the fingers, often near the base of the flexor tendons. They are connected to the tendon sheath through a narrow stalk and are usually anchored at the level of the A1 or A2 pulley, fibrous bands that help keep the flexor tendons close to the bone during finger movement. These ganglia result from degenerative changes within the tendon sheath and may fluctuate in size over time.

Causes

Seed ganglia are caused by repetitive microtrauma or degenerative changes in the tendon sheath. They result from the buildup of gel-like fluid near the tendon. These cysts commonly affect individuals who perform frequent hand or finger movements.

Signs and Symptoms

Seed ganglia present as small, firm, round lumps on the palmar side of the fingers, typically at the level of the tendon sheath near the A1 or A2 pulley. They are usually non-mobile and may range from a few millimeters to over a centimeter in diameter. Patients often report discomfort or tenderness when pressing on the lump or during gripping activities.

Diagnosis

Diagnosis of seed ganglia is mainly clinical, based on the presence of a firm, non-mobile lump along the flexor tendon, often with tenderness. Ultrasound can confirm the cystic nature and its connection to the tendon sheath, helping rule out other soft tissue lesions.

Treatment

Seed ganglia are often benign and may resolve on their own over time as the body gradually reabsorbs the gelatinous fluid. When the cyst is painful or interferes with hand function, a non-surgical option is aspiration, where the fluid is drained using a sterile needle in the clinic. Aspiration is relatively simple but has a recurrence rate of up to 50%.

If the cyst persists or recurs, surgical excision is recommended.
Dr. Bernard Lallemand will guide you through the best treatment options tailored to your specific case.

Condition

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Definition

Thumb basal joint arthritis, also known as carpometacarpal joint osteoarthritis (CMC1 arthritis), is a common degenerative condition affecting the joint between the base of the first metacarpal and the trapezium bone in the wrist. This joint enables the thumb’s wide range of motion and is essential for gripping and pinching.

Causes

Thumb basal joint arthritis is significantly more common in women, occurring about ten times more frequently than in men. Symptoms usually begin in the mid-forties but can present earlier, especially in individuals with a history of joint laxity, repetitive hand use, or familial predisposition.

Signs and Symptoms

The earliest signs often include intermittent pain following gripping or pinching tasks. Over time, this discomfort may become persistent, accompanied by reduced range of motion and decreased hand strength. Simple daily activities—such as turning a key, opening a jar, or twisting a tap—gradually become more challenging. In more advanced stages, a prominent bump may appear at the base of the thumb, with stiffness and difficulty grasping larger objects.

Diagnosis

The diagnosis of thumb basal joint arthritis is primarily clinical, based on a characteristic history of pain at the base of the thumb, often exacerbated by gripping or pinching activities. Physical examination usually reveals tenderness over the carpometacarpal joint, reduced thumb mobility, and a positive grind test, which reproduces pain with axial loading and rotation of the thumb metacarpal.
Standard X-rays are used to confirm the diagnosis. Typical radiographic findings include joint space narrowing, subchondral sclerosis, osteophyte formation, and sometimes subluxation of the joint.

Treatment

Most cases of thumb base arthritis can be treated non-surgically through a combination of pain medications, the use of a thumb splint, modification of daily activities to reduce joint strain, and sometimes injections. These conservative measures often help control symptoms and maintain function.
If the pain becomes persistent and disabling despite these efforts, surgery may be considered. Two main surgical options are commonly performed:
- Trapeziectomy with ligament reconstruction and tendon interposition (LRTI), where the diseased trapezium bone is removed and the base of the thumb is stabilized with a tendon graft to prevent collapse and preserve movement.
- CMC1 joint arthroplasty, or joint replacement, which uses an implant to maintain thumb alignment and mobility, offering faster recovery in selected cases.
Dr. Bernard Lallemand will guide you through the best treatment options tailored to your specific case.

Condition

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Definition

Trigger finger is a condition in which a finger or thumb catches, clicks, or locks when bent toward the palm. It is caused by a thickened pulley – a band that normally holds the tendon close to the bone – interfering with smooth tendon movement. In more severe cases, the affected finger may become stuck in a bent position and require manual straightening.

Causes

The exact cause of trigger finger is not fully understood, but it is more commonly observed in individuals with diabetes. It can also be associated with conditions such as rheumatoid arthritis, gout, or may develop following repetitive or excessive strain on the flexor tendons.

Signs and Symptoms

Pain typically occurs at the base of the affected finger or thumb, often in the palm. A clicking or catching sensation may be felt during movement, and in more advanced cases, the finger or thumb can become locked in a bent position, requiring manual straightening. If left untreated, stiffness may develop in the joints further along the finger or thumb.

Diagnosis

A good description of the symptoms and a careful examination is often sufficient to make the diagnosis.

Treatment

Mild symptoms may improve with rest, pain medication and physiotherapy. Injections of local anesthetic and corticosteroids between the tendon and the pulley can relieve symptoms in up to 70% of cases, though they are less effective in patients with diabetes.  

If symptoms persist, a surgical procedure may be required to release the tight pulley and restore smooth tendon movement.
Dr. Bernard Lallemand will guide you through the best treatment options tailored to your specific case.