Foot, Ankle, & Hand

The primary focus at Advanced Healthcare Clinics is providing foot health in an informative and communicative way. The skilled providers proudly provide treatments for men and women of all ages, and every patient can feel comfortable discussing treatment options with their provider.

Advanced Healthcare Clinics Foot & Ankle Specialists treats several conditions, including arch and heel pain, arthritis, tendonitis, plantar fasciitis, ingrown toenails, bunions, flat feet, and ankle sprains.

In addition, the team uses several methods to diagnose any podiatry problem a patient may experience. These may include orthotic scanners, PVD testing for the ankle, digital x-rays, diagnostic ultrasounds, and in-office peripheral testing.

Advanced Healthcare Clinics Foot & Ankle Specialists has a qualified, extensive team and always makes the time for patients to be seen quickly. All providers will assess the best treatment options for your needs. The team prides themselves on explaining procedures clearly, have a conservative approach surgery, and provide personalized visits.

Advanced Healthcare Clinics Foot & Ankle Specialists is accepting new and existing patients. Reach out and book your appointment today, via phone or their online form.

Foot, Ankle, & Hand

Immediate Pain Relief  Quicker Recovery  Same-Day Appointments


Hand pain, numbness, tingling and weakness from CARPAL TUNNEL SYNDROME can affect all aspects of your life. Our Dallas hand surgery team at the Loredo Hand Care Institute in Dallas offers a revolutionary, minimally-invasive treatment, the STRATOS ENDOSCOPIC CARPAL TUNNEL RELEASE SYSTEM, to free you from hand pain so you can get back to doing what you love. Our HAND SURGEON specializes in CARPAL TUNNEL SYNDROME, TRIGGER FINGER, HAND AND ELBOW PAIN, WORKMAN'S COMP INJURIES, and HAND FRACTURES.

Dr. Pedro Loredo, Fellowship Trained Board Certified Hand & Microvascular Surgeon Can Help Treat Your Hand, Finger, Forearm, and Elbow Pain.

About our Doc

Pioneer • Innovator • Committed to Excellence

Pedro Loredo, MD III specializes in minimally invasive hand surgery, endoscopic carpal tunnel release, endoscopic cubital tunnel release, endoscopic pronator release, endoscopic trigger finger release and joint arthroscopic surgery. He is a pioneer in the treatment of wrist pain and carpal tunnel syndrome.

Dr. Loredo helped in the development of the Stratos Endoscopic Release System, the most advanced technology for carpal tunnel release and cubital tunnel release.

Dr. Loredo completed his hand and upper extremity surgery fellowship at the Christine Kleinert Institute. He is board-certified in General Surgery and Hand Surgery by the American Board of Surgery. Dr. Loredo is committed to improving the quality of care available to patients around the world and enjoys the opportunity to educate and train surgeons and surgical technicians.

Pedro Loredo, MD III
Pedro Loredo, MD III
Board Certified Hand & Microvascular Surgeon

About Foot & Ankle Orthopedic Care

Nothing slows down your lifestyle like an injury, arthritis, or other condition of the foot and ankle. When every step causes pain, you are less likely to want to exercise, leave the house, or even handle everyday chores.

Comprehensive Foot and Ankle Care

The Foot and Ankle team at Advanced Healthcare Clinics Orthopedic Surgery & Sports Medicine brings together foot and ankle specialists, and physical therapists who work together as a team, diagnosing the cause of your pain and determining the best solution.

Do You Need Specialized Orthopedic and Sports Medicine Care for the Foot or Ankle?

An ankle or foot condition or injury can disrupt your life as well as keep you from enjoying the activities you love. Below are some common signs and symptoms you may be experiencing if you have an injury or condition of the foot or ankle:

• A bump on the side of your big toe
• Bending or flexing your foot causes pain
• Pain that worsens when wearing shoes
• Stiffness
• Swelling
• Unable to bear weight on the affected joints
• Walking is painful or difficult

As one of our patients, you will experience our genuine and compassionate provider-patient relationships, as well as exceptional orthopedic and sports medicine care that is focused solely on you and your individual foot or ankle needs. Our devotion to you and your ankle or foot care starts the second you walk into any of our DFW clinic locations and lasts throughout your entire journey with us. Whether you need a custom treatment plan for a fracture, bunion, or sprained ankle or a surgical consultation to discuss if surgery is right for you, we are here to provide you with the exceptional patient-centered care you need to get back to your active, healthy life.

To consult with one of our ankle experts or foot doctors, please call (888) 382-0161

Conditions We Treat 

Accessory Navicular Syndrome: When your teenage child complains of pain on the inside of the foot just above the arch, your child may have an extra bone or cartilage there. This additional bone is harmless, but if it irritates the bones around it, it requires treatment.

Achilles Tendinitis: The Achilles tendon connects the calf muscles to the heel bone. It can handle a great deal of stress and activity, but it can rupture or begin to break down if you do a lot of running and jumping, or if you are on your feet for long periods. You may develop pain and stiffness, especially in the morning.

Acquired Flatfoot: A number of different conditions can create a painful flatfoot, so the symptoms can vary from patient to patient. You may have pain along the inside of the foot that gets worse when you walk or exercise, or you may feel pressure on the outside ankle bone. If it's an old injury, painful bumps can form in the middle of the foot.

Anterior Impingement Syndrome of the Ankle: When bone spurs form on the front of the ankle joint. They can cause pinching of the nerves inside the ankle. Doctors see this in athletes who have many small injuries to the ankle—particularly in soccer players.

Arch Pain/Strain: Many factors can cause a painful arch: a direct injury to the foot, a sprained ligament or tendon, a strained muscle, overuse, arthritis, and a number of others. Our doctors can diagnose the cause of your pain, recommend the best course of treatment, and find the right way to lessen or end your pain.

Arthritis, Great Toe (Halix rigidus): Every time you take a step, you bend your big toe—so if arthritis causes the toe to lock in place, walking can be difficult or even impossible. Both non-surgical and surgical treatments can be effective in relieving pain and keeping you on your feet.

Arthritis, Midfoot: Midfoot arthritis often develops after an injury to the foot or ankle, but it's also common among athletes. In middle-aged people, the pain and stiffness in the middle of the foot can make it difficult to climb stairs or do similar activities. There are many non-surgical treatments for this condition.

Arthritis, Hindfoot: Pain, stiffness, and limited range of motion in the joint where the foot meets the ankle can signal arthritis. This often surfaces years after an injury to the ankle joint. Hindfoot arthritis may be corrected by arthroscopic surgery, or by a joint replacement in many cases.

Bunions: A sore, swollen bump where your big toe meets your foot is a bunion, a painful affliction of more than half the women in the United States. Bunions are most often caused by shoes that are too tight, or by pressure on the toes created by wearing high heels. A simple change to comfortable shoes can relieve many bunions, but surgical removal is also an option.

Cavus Foot (High-Arched Foot): An abnormally high arch is called a cavus, and it can cause discomfort when you wear shoes with little or no arch support. Custom-made orthotics, created for you using plaster casts of your feet, often can restore your comfort.

Charcot Arthropathy: If you have lost sensation in your foot or ankle because of diabetes or another disease that strikes the nerves, you may fracture or dislocate bones in your foot without even knowing it. When small injuries become larger, they can cause redness, swelling, and warmth in your foot joints—and you may not be able to walk.

Chronic Lateral Ankle Pain: After a sprained ankle, some people have chronic or recurring pain on the outer side of the ankle. Swelling, stiffness, and difficulty walking are all symptoms of this condition.

Crossover Toe: If your second toe drifts toward your big toe and eventually crosses it, you're sure to feel pain in the bottom of your foot—and it will be hard to find shoes that are comfortable. The pain will begin before the toe crosses over, however, and early diagnosis is an important part of treatment.

Diabetic Foot Ulcers: Foot sores are very common in people with diabetes, especially if you have lost some of the feeling in your foot. The Foot and Ankle team at TREND Healthcare Orthopedic Surgery & Sports Medicine can debride and treat foot ulcers, and help you find the bracewear and special shoes to help distribute your weight evenly, so you don't develop any new ulcers by putting too much weight on one part of your foot.

Equinus: Tightness in the Achilles tendon can cause you to lose the ability to bend your foot upward toward the front of your leg. When this happens, many patients try to compensate by changing the way they walk—which causes additional injuries. In many cases, the tightness is present at birth, but it can also come from spending months in a cast or from high-heeled shoes.

Extra Bones (Accessory Ossicles): Some people are born with more than the usual 26 bones in their feet. These may be painless and require no treatment, or they may give you some discomfort. Your doctor at TREND Healthcare Orthopedic Surgery & Sports Medicine can help you decide what to do about these bones.

Flexible Flatfoot: When you have arches while you're sitting down but they disappear when you stand up, you have flexible flatfoot. You may have pain in your heel, arch, or ankle, pain in your shins, and overpronation—your foot may splay outward at an abnormal angle.

Forefoot Pain (Second MTP Synovitis, Metatarsalgia): A sharp pain in the ball of the foot can signal one of several conditions. It's caused by bones in the area starting to separate from the long bone of the foot (the metatarsal)—which can come from an abnormally high arch, a long second toe, some forms of arthritis, or wearing high heels.

Fractures: All broken bones are known as fractures. The Foot and Ankle Institute can diagnose and treat any kind of fracture in the foot or ankle, and is ready to work with you on recovery and rehabilitation.

Ganglion Cyst: These round or oval lumps may form on the tendons or joints of your ankles or feet. They are non-cancerous and filled with a jelly-like fluid, and they may be painful if they press on a nerve. These often go away on their own, but your doctor can treat your cyst as well.

Gangrene in Feet: When blood stops flowing to a part of your body, the tissue dies—and when this happens in a foot, it can mean a loss of function. People with diabetes, peripheral arterial disease, trauma to a foot or leg, or atherosclerosis may develop gangrene. If you suspect that you have gangrene in any part of your body, go to the nearest Emergency Department immediately.

Haglund's Deformity: If you notice a bony, inflamed bump on the back of your heel, you may have this condition—one that's also known as "pump bump." It can be caused by women's pumps, shoes that rub against the back of the heel—although men's dress shoes, ice skates, or other shoes with a rigid back can cause the same bump. The deformity can be treated non-surgically (but you'll have to switch to softer shoes).

Hammer Toes/Claw Toes/Mallet Toes: If your second, third or fourth toes are bent and held in a position for a long enough time—all day for months in the same ill-fitting shoes, for example—the muscles tighten, and the toes can no longer stretch out straight. The bent toes look like hammers or mallets, or they may bend under and look like claws. There are non-surgical treatments for this, but you can prevent hammertoes by wearing comfortable shoes with plenty of space for your toes to spread out.

Heel Spurs: When a calcium deposit forms on the underside of the heel bone, it can protrude from the heel by as much as half an inch. This is a heel spur, and it often rubs up against the plantar's fascia, a band of tissue that connects the heel bone to the ball of the foot. The result is a pain that feels like a nail in the bottom of the foot. Treatment can include orthotics, injections, or minimally invasive surgery.

Insensitive (Numb) Feet: Diabetes and some neurological disorders can cause you to lose sensation in your feet. This is a dangerous situation, because you can't tell if you have a sore that might develop into an ulcer. Your doctor may recommend special shoes to keep you from injuring your feet, as well as regular inspections of your feet to be sure there are no lesions.

Lisfranc Injuries: Usually the result of an impact accident, this injury involves the metatarsal bones, the ones that form the arches of the foot. When these are dislocated from their proper place, they leave a gap, usually between the joints in the first and second toes and the rest of the foot. Small dislocations can be managed without surgery.

Morton's Neuroma: A burning or sharp pain in the ball of your foot can be caused by this condition, in which a nerve thickens because it has been squeezed for prolonged periods. The neuroma is caused most commonly by tight, narrow, or high-heeled shoes.

Osteochondral Lesions of the Talus: The talus is the bottom bone of the ankle joint. After a traumatic injury to the ankle, a part of the talus surface may come loose and lodge somewhere in the ankle, causing the ankle to freeze in place. Surgery may be required to remove the fragment and reshape the talus to move smoothly again.

Peripheral Neuropathy and Nerve Compression Syndrome: Numbness, tingling, prickling sensations, and muscle weakness are all signs of damage to the part of the nervous system that transmits messages to your feet. This issue can be genetic, or it can show up later in life after a physical injury or a disease that affects the entire body (including diabetes).

Peroneal Tendinitis: On the outside of the ankle, the peroneal tendon connects the heel to the muscles that allow movement. Overuse can make the tendon thicken and enlarge, a painful situation that will heal with rest and a special boot to permit walking.

Plantar Fascitis (Heel pain): Possibly the most common cause of heel pain, this inflammation causes a stabbing pain that is at its worst first thing in the morning as you step out of bed. The more you sit during the day, the more this pain increases. It can continue indefinitely without treatment—and custom-made orthotics can eliminate the pain entirely. If these don't work, injection therapy and minimally invasive surgery may be indicated.

Posterior Tibial Tendonitis: This important leg tendon attaches the calf muscle to the bones on the inside of the foot. It provides support to the foot's arch, especially when you are walking. People who play high-impact sports often injure or tear this tendon. The result is pain and a loss of arch support, making it difficult to run.

Sports-related Sprains and Instability: Ankle sprains are the most common reason that people find themselves in the Emergency Department, and many of these are the result of instability—collapse of the ankle under stress. TREND Healthcare Orthopedic Surgery & Sports Medicine can treat any kind of sprain or instability, helping you maintain your mobility and avoid such accidents in the future.

Stress Fractures: Tiny fractures may not seem like major injuries, but they can be a sign of osteoporosis or other more serious conditions. If you have pain and swelling on the top of your foot or in your ankle, call an orthopedic urgent care clinic closest to you—even if the injury hasn't slowed you down.

Tarsal Coalition: This abnormal connection in the back of the foot forms between cartilage, tissue and the tarsal bones. In most cases it forms before birth and presents itself later when the child has a limited range of motion in one or both feet. Many non-surgical methods help to reduce pain and increase motion, and surgery is a distant option.

Tarsal Tunnel Syndrome: On the inside of the ankle next to the ankle bone, there's a tunnel that contains—among other things—the posterior tibial nerve (see above). When the tunnel contracts because of an injury or abnormality, it compresses this nerve. You may feel something like an electric shock, a burning sensation, numbness, or shooting pain. Your doctors can recommend many non-surgical methods for reducing pain and relieving the symptoms. 

Foot & Ankle

Foot & Ankle Treatments

Conservative Treatments

Stretching Exercises: Your doctor can provide you with instructions and a demonstration of exercises that you can do at home. Following these directions, you can perform your own therapy and help your injury heal properly.

Rest: Some injuries heal in a matter of weeks, while others take more time—and returning to your normal activity too soon may cause more extensive damage. You may work with your doctor and a physical therapist to determine what level of rest you need, and for how long.

Anti-Inflammatory Medicine: In many cases, you can reduce swelling and pain at home with an anti-inflammatory medication. Your doctor will work with you to find the most effective medication with the fewest side effects for your specific case.

Orthotics and Bracewear: Many foot and ankle conditions can be corrected with custom-made orthotics that slip into your shoes and hold your foot in the perfect position for comfort. For some conditions or injuries, a brace on your foot, ankle or leg can keep your limb in the right position for complete healing.

Physical Therapy and Rehabilitation: At Advanced Healthcare Clinics Rehabilitation Clinics throughout the DFW area, you have the options of working with physical therapists who can help you regain your strength and mobility after an injury or surgery. Find out more about our Rehabilitation Clinics.

Injection Therapies

Cortisone (Corticosteroid) Injections: Corticosteroids are not pain relievers—they reduce inflammation, often working within minutes. Once the inflammation is gone, the pain usually disappears as well. You can receive an injection in the doctor's office, and one injection may be effective for months or even longer.

Hyaluronan Injections (Viscosupplementation): If you are diagnosed with mild to moderate osteoarthritis, this injection may be helpful to you. Hyaluronan is a natural substance that is in the joint fluid in a normal joint. Your doctor will inject hyaluronan several times over the course of weeks, and you will begin to feel the greatest relief from pain several weeks after the first injection.

Selective Nerve Root Blocks: When the pain in your foot or ankle follows the path of a single nerve, a nerve root block injection can provide relief. Nerve block injections are a temporary remedy, so you will see the doctor several times a year for these.

Minimally Invasive and Complex Surgical Procedures

Ankle Cartilage Repair: The surgeon makes three small incisions and uses one of several procedures to stimulate the growth of new cartilage. In some cases, when the tear or hole is very small, the surgeon will transfer healthy cartilage from one part of the joint to another to close the defect.

Ankle Fusion, Transfibular: In this complex surgical procedure, the surgeon first removes damaged bone and cartilage. He or she then uses pins, screws and plates to secure the bones in a specific position. Over time, these bones will fuse together, stabilizing the unstable ankle joint.

Ankle Instability Repair: Reconstruction of damaged ligaments can repair an unstable ankle. The extent of the damage will dictate the kind of surgery required to give you the stability you need for daily activity.

Arthroscopy: Using tiny incisions and a special camera, our surgeons can repair torn ligaments and tendons. They can find and remove loose cartilage or bone fragments after an injury—and they can see inside your ankle or foot to find the source of any other pain. You may be back on your feet in a few days.

Big Toe Joint Surgery: Your surgeon may perform a cheilectomy, a removal of the extra bump of bone on top of the big toe, to restore your range of motion. If your arthritis is severe, your surgeon may recommend a fusion of the bones in your big toe, removing any arthritic surfaces and connecting the bone at the base of the big toe (metatarsal) to the toe bone (phalanx). The doctor will use screws or a plate to hold these bones together. After the surgery, the bones will grow together naturally.

Bunionectomy with Wedge Osteotomy: The surgeon removes a portion of the bone from the big toe. A wedge of bone is cut and removed from one of the big toe bones to straighten the joint. Tendons may need to be released to relieve the pull on the big toe. The surgeon then inserts a pin and other hardware to hold the toe in the right position. You may have a walking cast, splint, or a special shoe for several weeks after this surgery.

Cyst and Tumor Removal: When a ganglion cyst becomes painful or interferes with walking, a surgeon can remove the cyst. This procedure is usually done with a local anesthetic, and may be completed in the doctor's office.

Exostectomy: When bony bumps on the body's long bones press on nerves and tendons and cause pain, a surgeon can remove them. Depending on where the bumps are and how many need to be removed, the surgery can be minimally invasive or complex.

Fracture Fixation: Broken bones must be stabilized using surgical hardware until they are strong enough to support a person's weight again—especially if these fractures are in the ankles and feet. The surgeon will use plates, screws, rods, pins and/or wires to repair the bones and hold the pieces in place.

Hammer Toe Correction and Lesser Metatarsal Surgery: By removing part of one of the two small joints in the toe directly under the crooked part (a process called resection), our surgeons can straighten and shorten the affected toe. The surgeon may use a rod to keep the resected bones in place while they heel. Most patients return to their own shoes in a few weeks.

Joint Replacement: Replacing a damaged joint can restore your quality of life, especially if you have been in pain for some time. Our surgeons perform many joint replacements every year—and after the surgery, all of your physical therapy and rehabilitation may take place at one of our Physical Therapy locations nearest your home.

Ligament Reconstruction: Our doctors can repair a torn ligament, or use a ligament or tendon from another part of your body to strengthen a severely torn ligament.

Plantar Fasciotomy: The surgeon makes two tiny incisions in your foot and inserts a camera to see the Plantar fascia. He or she severs a portion of the fascia to eliminate the painful contact with the heel or heel spur. You will begin walking again within 24 hours.

Release Surgeries for Nerve Entrapment (Nerve Decompression): This minimally invasive procedure may be performed to relieve the pain of a pinched or trapped nerve in the foot or ankle.

Revision Surgery: If you have already had a joint replacement at a fairly young age, you may need a replacement joint after ten to twenty years. No matter what medical center did your joint replacement, TREND Healthcare Orthopedic Surgery & Sports Medicine can perform a second procedure, called a revision, to remove the worn joint and replace it with today's joint technology. We can also perform a revision if your joint replacement becomes loose, infected, or dislocated.

Tendon Repair for Achilles, Peroneal, or Posterior Tibial Injuries: Depending on the extent of your injury, our surgeons can either use a minimally invasive arthroscopic procedure to repair the damaged tendon in your foot or ankle, or make a larger incision to repair a broader area. After surgery, you will wear a cast or walking boot for six to twelve weeks.

Tendon Transplantation: When your foot suddenly becomes flat and painful after an injury, you have "foot drop"—and it's likely that you have damaged a nerve or muscle. Our surgeons can re-route a tendon in your foot to replace the damaged tissue. This will relieve your pain and restore some of your foot's function. 

Hand & Wrist

When a hand and wrist injury limits the use of our hands, we realize just how valuable our hands are—and how much we take them for granted.

The Hand & Wrist specialists at Advanced Healthcare Clinics diagnose and treat all conditions of the hand and wrist, from the simplest to the most complex in adults throughout the DFW area.

Advanced Healthcare Clinics Hand and Wrist specialists provide comprehensive care to adults in the DFW area. Our physicians are fellowship-trained specialists, and board-certified or eligible. We welcome all patients from injured workers, athletes, and the elderly.

Our facilities are conveniently located throughout the DFW area, bringing together all our renowned specialists and complementary services under one roof. 

Conditions We Treat

Arthritis: Chronic pain, swelling, and stiffness in your joints often means that you have arthritis. This disease can be particularly troublesome when it affects your hand, fingers, or wrist, as it can limit your ability to do the things you do on a daily basis.

Baseball (Mallet) Finger: This injury to the outermost joint of the finger is very common among baseball and basketball players. Pain, swelling, and trouble extending the finger are all symptoms of this injury to the tendon.

Boutonniere Deformity: An injury to the tendons that straighten the middle joint of your finger can make you finger bend—and make it impossible to straighten. This is usually the result of a blow to the hand or an accident.

Boxer's Knuckle: A direct blow to the knuckle—usually at the base of the middle finger—can cause a tear in the tendon that straightens the finger. The knuckle becomes weak and painful. The injury gets its name from its frequency among boxers and martial arts fighters.

Brachial Plexus Injury (Erb's Palsey): The nerves that send signals from your spine to your shoulder, arm, and hand are known as the brachial plexus. When these nerves are compressed or stretched to the breaking point, you may feel a burning sensation in your arm—or a sharp pain, like a lightning bolt, at the moment of impact. This may be followed by numbness or weakness in the injured arm.

Carpal Tunnel Syndrome: If you feel numbness or tingling in your hand and arm, you may have the pinched nerve in your wrist that doctors call carpal tunnel syndrome. Repetitive motion causes this injury—which is was assembly line workers, people who work at a computer all day, and people in many other professions develop this disorder. Early treatment with pain killers, a wrist splint, and cortisone injections can help you avoid surgery.

DeQuervain Syndrome (Washerwoman's Sprain, Gamer's Thumb): It's not clinically proven that too much gaming or thumb-typing causes this painful condition, but DeQuervain Syndrome still gets one of its nicknames from video game enthusiasts. The pain begins in the thumb and travels down through the wrist. You may have trouble gripping things with the affected hand, and your wrist may be swollen on the thumb side.

Dupuytren's Contracture: Over the course of several years, this hand deformity pulls the pinky and ring finger toward the palm in a permanently curled position. You may feel a tough lump in the palm of your hand, and cords of tissue extending up the afflicted fingers.

Flexor Tendon Injuries (Jersey Finger): When a deep cut on the palm side of your hand damages the tendons that control your hand's movement, you have a flexor tendon injury. This condition makes it impossible to bend your fingers toward your palm.

Fractures: All broken bones are known as fractures. At Advanced Healthcare Clinics, we can diagnose and treat any kind of fracture in the wrist or hand, and we are ready to work with you on recovery and rehabilitation.

Ganglion Cyst: These round or oval lumps may form on the tendons or joints of your wrist. They are non-cancerous and filled with a jelly-like fluid, and they may be painful if they press on a nerve. These often go away without treatment. Talk to your doctor about the treatment options and what will be best for you.

Kienböcks Disease (Avascular Necrosis of the Lunate or Lunatomalacia): An interruption of blood flow to a small bone in the wrist called the lunate can cause this bone to die. The symptom to watch for is pain and stiffness in the wrist.

Ligament Injuries: A sprain is an injury to a ligament, one of the strong bands of tissue that connect one bone to the next. It's very common to sprain a wrist, an injury that may stretch or partially tear a ligament. In a severe sprain, the ligament is torn clean through—and it may take a small bone chip (an avulsion) with it.

Nailbed Injuries: If you hit or jam your finger in an accident, the nail may separate from the nailbed. It can take six months for a new nail to grow back in its place. A doctor can help you detach the remaining nail and protect the nailbed from infection.

Radial Tunnel Syndrome: The radial nerve runs from the side of the neck to the hand, passing through a tunnel in the elbow. When the nerve gets squeezed at the elbow joint, it can be very painful. This squeezing can come from repetitive pushing and pulling, bending the wrist, pinching, and gripping—all motions that are common in everyday life.

Raynaud's Phenomenon: If your fingers turn pale, then blue, then red when they are exposed to cold temperatures, you may have this unusual condition. While the cause of Raynaud's Phenomenon is not known, some treatments (including medications and protection of the hands) have been found to protect the fingers and toes from this spasm of the blood vessels.

Reflex Sympathetic Dystrophy Syndrome: Also known as Complex Regional Pain Syndrome, this rare condition involves the sympathetic nervous system affects involuntary functions throughout the body. Patients have chronic, severe pain in an arm, fingers, palm, shoulder, or a leg or knee. The painful area may be swollen or inflamed, sensitive to hot and cold, and warm to the touch. The cause of this syndrome is not known, though it may come from a nerve injury, trauma, cardiovascular disease, or radiation therapy.

Repetitive Motion (Stress) Injury: People who perform the same motion over and over can injure muscles, tendons, ligaments, and nerves in the hand, wrist, foot, or ankle. This kind of injury can happen with athletes who play tennis, baseball or golf, but it's also common in long-distance runners.

Rheumatoid Arthritis: This form of arthritis is an autoimmune disorder—your immune system mistakenly attacks your body instead of fighting off infection. Rheumatoid arthritis affects the lining of the joints, causing pain and swelling and, eventually, bone erosion and deformity. It begins in the joints of your hands and feet, and it sometimes affects other organs like your eyes, skin, and lungs. Treatment can help slow the joint damage and help you manage the pain.

Skier's Thumb: This injury accounts for as many as 10 percent of all skiing accidents, because skiers fall on an outstretched hand holding a ski pole. The result is a painful tear of the ligament that connects the bones of the thumb. Ice and immobilization can help, but a full rupture requires a surgical repair.

Tendinitis: Any one of a wide range of activities can affect your tendons, either through repetitive motion or a sudden injury. Anyone can be affected, but tendinitis is more common in people over 40 because tendons become less elastic and tolerant of stress as we get older. Localized pain and restricted motion are the most common symptoms.

Trigger Finger: If one of your fingers or your thumb gets stuck in a bent position and you feel a popping or clicking when you try to straighten it, you may have trigger finger. This most often develops in the hand you use most. Your finger may be stiffer in the morning, and you may get a bump at the base of the finger. 

Hand & Wrist Treatments

Arthroscopy: Using small incisions and a tiny camera, our wrist surgeons can stabilize a wrist fracture, repair torn ligaments, remove bits of cartilage that may be preventing your wrist from moving freely, or repair torn cartilage. This minimally invasive procedure can shorten your recovery time, putting you back on the field faster than major surgery.

Cyst or Tumor Excision: In this outpatient procedure, the doctor makes an incision and removes the ganglion cyst and its root—a part of the joint capsule or tendon. Your doctor may recommend this surgery if the cyst does not shrink after use of a wrist brace or drainage (aspiration) of the fluid inside of it. In the case of a tumor, the entire mass is removed to guard against any risk of the growth becoming cancerous.

Dupytren's Contracture Release Surgery: A surgeon can divide or remove the bands of thickened tissue to restore some motion in the affected finger. Physical therapy after surgery can help you regain strength in your hand.

Endoscopic Carpal Tunnel Surgery: If you have had nonsurgical treatment and you still have a lot of pain in your hand, your doctor may recommend this surgery. The surgeon makes one or two small incisions and inserts a flexible tube with a camera on the end. He or she uses this camera to see inside the wrist, and inserts tiny tools through the tube to cut the transverse carpal ligament, releasing pressure on the median nerve. This relieves the pain caused by carpal tunnel syndrome. Most patients go home on the same day, and you can begin physical therapy in a day or so. If the surgery is on your dominant hand—the one you use for most tasks—your recovery may take 4 weeks or more.

Fracture Fixation: Using plates, nails, rods, wires, and screws to hold broken bones together and keep them in place, surgeons can help patients return to their normal activities more quickly than they could with a cast or splint. The surgical procedure reduces the risk of infection, allows patients to go home sooner, and reduces the possibility of a break healing improperly.

Joint Alignment: When a break in the bone pushes the wrist out of line with the arm, it may take more than a cast to keep it in the right position for proper healing. A surgeon can insert a plate, screws, wires, nails, or rods to hold the bone in place while it heals. In some cases, a device called an external fixator may be used on the outside of your arm to hold the bone in the correct place.

Microsurgery: Performing surgery under a microscope allows our surgeons to reconnect tiny blood vessels and nerves—skills that are very important when we need to reattach a severed finger or thumb. This special surgery also comes into play in traumatic injuries, when repairing a nerve or blood vessel can help to restore function in a badly injured hand.

Peripheral Nerve Surgery: When trauma damages the nerves in your wrists and hands and nonsurgical treatments have not helped, our surgeons can repair the nerves and give you back the use of your hands. Your surgeon will discuss the specific surgery with you and the chances for success, to help you decide if this procedure is right for you.

Radial Nerve Release Surgeries: When the nerve that allows you to extend your fingers becomes entrapped or injured, surgery may be needed if other kinds of therapy don't correct the problem. Surgery relieves the pressure on the nerve, allowing it to function normally again. You may wear a splint or a brace after the surgery while the nerve heals, and you will see a physical therapist to help you regain the strength and motion in the affected arm.

Tendon Repairs: Depending on the extent of your injury, our surgeons can either use a minimally invasive arthroscopic procedure to repair the damaged tendon in your wrist, or make a larger incision to repair a broader area. After surgery, you will wear a brace or cast for six to twelve weeks.

Tendon Transfer: When any of the three nerves in the hand—radial, median, and ulnar—are damaged or destroyed, you can lose feeling and function in your hand. This can make activities of daily living impossible for you. In some cases, our surgeons can transfer a healthy tendon to the paralyzed area, restoring your hand's ability to perform basic functions—and vastly improving your quality of life.

Tenosynovectomy: Overuse of a joint in the hand or wrist, infection, or injury may case the lining of the tendon sheath—the covering that protects the tendon—to become inflamed and painful. An experienced surgeon can release this tightened sheath and remove this inflamed material, reducing the risk that the tendon could rupture and cause more serious damage.

Trigger Finger Release Surgery: Many cases of trigger finger respond to steroid injections, but some require surgery to release the tendon. This outpatient procedure is performed using a local anesthetic, and the surgeon will wrap the finger in a bandage to allow it to heal before you begin to use it again.

Ulnar Nerve Release Surgery: The nerve that controls the forearm and hand muscles is critical to the sense of touch from our fingertips to just before the elbow. Damage to this sensitive nerve can be very painful, and it can restrict the movement of the thumb and cause weakness in the hand. When all other corrective measures have been tried, surgery can repair damage to the ulnar nerve; if a tumor is pressing on the nerve, removing it can relieve pain and restore feeling.

Wrist Fusion: When treatments for arthritis in your wrist no longer control the pain, your doctor may recommend this procedure. The wrist has as many as 12 joints that allow it to bend and flex, and each of these can become arthritic—so the pain may come from several different bones rubbing against each other. Fusing the bones together—making them grow together into one bone—makes them stop rubbing, so the pain is gone. There are some trade-offs, but you may feel these are worthwhile: Your wrist will no longer bend after the surgery, but you will get your grip back and regain strength in your hand. 

Hand Rehabilitation

A Program for Every Injury

Whether you are recovering from surgery or you have a work injury that limits the use of your hands, our Hand and Upper Extremity Rehabilitation Program can help you regain your range of motion.

Working directly with you, our physicians at Advanced Healthcare Clinics Orthopedic & Sports Medicine and with doctors throughout the community, our Hand and Upper Extremity Rehabilitation Team can address the issues created by repetitive motion, work injuries, auto related injuries, and chronic pain disorders.

Our services go well beyond physical therapy and pain relief. Our team collaborates with your family, your insurance company, and even your employer to change your environment and your lifestyle to free you from pain in your hands and arms.

Find out more about our Specialty Programs for people in professions that generate hand and arm injuries.

We provide you with feedback you can use, in progress notes, written evaluations, and discharge summaries that help you maintain good habits to protect your hands.

We begin with a full patient evaluation to understand your injury or condition, and the factors in your environment that may contribute to your pain. With this information, we develop a therapy and care plan that may include any of the following:

• Dexterity Training
• Edema (Swelling) Management
• Functional Capacity Evaluation
• Individualized Therapeutic Exercises
• Injury Management and Prevention
• Joint Protection Education
• Onsite Ergonomic Evaluation
• Orthotic Fabrication and Training
• Pain Control
• Prosthetic Training
• Scar Management
• Sensibility Re-education
• Strengthening
• Training in Activities of Daily Living
• Work Conditioning/Job Simulation 

Hand and Upper Extremity Rehabilitation Specialty Programs

We have developed a number of specialty programs for the kinds of hand and arm injuries we see most often in our region. To learn more about one of these programs and how it may help you return to work, call (888) 382-0161.

Injured Worker Program

Following a work or auto related injury, Hand and Upper Extremity Rehabilitation therapists can help you return to the same or a similar job, even if you need some changes in your workplace to do so. Following the initial injury management program, we guide you through a Work Hardening/Work Conditioning Program to maximize your ability to return to work. Before you return to work, we perform Functional Capacity Evaluations (FCE) to measure your ability to tolerate an 8-hour workday. If you need more time, we continue to work with you to strengthen and condition the injured area.

Program for Office Workers

Whether as a result of an on-the-job or out-of-the office injury, hand and arm problems can affect your livelihood as well as your life. In Hand and Upper Extremity Rehabilitation, we perform ergonomic evaluations of workstations and provide advice on workplace changes and tools to help you on the job. We often evaluate your job site, where we also educate managers and employees about proper body mechanics to prevent further injury.

Program for Myofascial Pain

Myofascial pain is a chronic pain disorder in which a pressure point in one muscle can cause pain in a seemingly unrelated spot somewhere else in your body. It can affect any muscle, but it often occurs in hands when you contract a muscle repeatedly for a long period of time—in your job, or in a sport or a hobby, for example. You may feel pain in the contracted spot, or pain in a "referred" spot elsewhere when you press on a specific point. Tightness, tenderness, popping and clicking, stiffness, limitation of movement, twitching, and muscle weakness are all symptoms of this condition.

Our Hand and Upper Extremity Rehabilitation therapists can be helpful in decreasing myofascial pain. They can use a number of different treatments, including therapeutic ultrasound (phonophoresis), pain suppression through electrical nerve stimulation (TENS), a hands-on technique called myofascial release, and stretch and spray techniques. 

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