Hand and wrist surgery can
restore normal movement

when conservative treatment methods fail

Has arthritis or a disabling hand condition made it difficult to:

• Open a jar?
• Button your shirt?
• Tie your shoes?

Using your hands is essential to living a normal life

Have you tried:

• Pain relievers
• Anti-inflammatory medications
• Cortisone shots
• Physical therapy

... but you still find it painful or virtually impossible to do everyday tasks?

Hand surgery could be the answer to restoring your hands' normal function.

John Krebs, MD, specializes in hand surgery

Dr. John Krebs has advanced training in hand surgery, a sub-specialty of orthopedic surgery. In addition to his orthopedic surgery training, Dr. Krebs completed a Cleveland Combined Hand Fellowship at the University Hospitals of Cleveland and the Cleveland Clinic Foundation.

He is board-certified in orthopedic surgery, and certified with added qualifications (CAQ) in hand surgery by the American Board of Orthopaedic Surgery. Dr. Krebs is trained in state-of-the-art hand surgery procedures and can help restore your hands' normal function.

Dr. Krebs answers questions about
hand and wrist surgery

Basal joint arthritis

CMC arthroplasty replaces the joint at the base of the thumb

What is the most common type of arthritis affecting the hands?

“Carpal-metacarpal (CMC), or basal joint arthritis, affecting the joint at the base of the thumb, is probably the most common type of arthritis seen in the upper extremities.

“Arthritis destroys the cushioning cartilage at the ends of the bone. Without this cushioning, the bones at the base of your thumb rub against each other and the joint becomes inflamed and painful. Eventually, the small bone at the base of your thumb may even collapse, leaving you unable to straighten your thumb. When you have advanced arthritis in your thumb, you can't use your hand.”

Is basal joint arthritis commonly misdiagnosed?

“Yes. I see patients who have been diagnosed with carpal tunnel syndrome, but they actually have basal joint arthritis

Can an arthritic basal joint be replaced?

“Yes. When conservative treatments like cortisone injections, pain medication and physical therapy fail, many patients choose basal joint replacement surgery, a procedure known as CMC arthroplasty.”

How is CMC arthroplasty performed?

“To replace the joint at the base of the thumb, we take out a bone and use tendons to replace it. We do fancy things with tendons to reconstruct the base ligament. CMC arthroplasty is an outpatient procedure that works very well. Since 1994, I've stuck with this operation because it works.”

How long is the recovery after CMC arthroplasty?

“You will be in a cast for four weeks after surgery. After that, you will be fitted with a brace and begin physical therapy. You can expect to regain normal use of your thumb in about 12 weeks following your surgery.”

Finger joint replacement

How are arthritic finger joints replaced?

“When conservative treatments fail, we can resurface arthritic finger joints with pyocarbon implants that create a ceramic-like hard surface to replace the arthritic joint.

What can I expect after finger joint replacement?

“There are some restrictions early on after your surgery, but our goal is to give you full normal activity in your fingers in three to six months following joint replacement. It works very well.”

Which finger joints do you most often replace?

“Although most arthritis patients' hand deformities are at the distal interphalangeal joints—the ones closest to the fingernails—we don't recommend replacing them if they're not painful.

“But if your metacarpo-phalangeal joints—the ones at the base of your fingers—are painful and are dislocating or subluxing, joint replacement surgery can realign those joints and improve the function of your whole hand.”

Carpal tunnel syndrome surgery

What is carpal tunnel syndrome?

“Carpal tunnel syndrome is a condition where the tendons in the wrist swell and put pressure on the median nerve that helps supply feeling in the hand. You will experience pain and numbness in your hand, which may get worse when driving or performing repetitive motions.”

When is surgery necessary for carpal tunnel syndrome?

“When the hand pain and numbness of carpal tunnel syndrome are not relieved by wearing a wrist splint, taking anti-inflammatory medications or cortisone injections, surgery can release the pressure in the wrist's carpal tunnel.”

Dupuytren's contracture surgery

What is Dupuytren's contracture?

“Dupuytren's contracture is a disease of the hand that causes the fingers—especially the ring finger and the little finger—to bend toward the palm, making it difficult to use your hand normally.

“With Dupuytren's contracture, the palm's fascia—tough, fibrous tissue under the skin—thickens and pulls in. Often, small, hard knots called nodules also form under the skin near the base of the fingers.”

Can surgery correct Dupuytren's contracture?

“Yes. If the use of your hand is sharply limited, surgery is the only way to treat Dupuytren's contracture—but it's not considered a cure, as symptoms can recur a few years later. Surgically removing some of the fascia in the palm can help you regain a better range of motion in your fingers.

DeQuervain's tenosynovitis surgery

What is De Quervain's tenosynovitis?

“De Quervain's tenosynovitis is an inflammation of the tissue on the thumb side of the wrist. This common problem occurs when the tendons and the synovium, a slippery membrane that allows the tendons to move easily, become irritated, causing pain and inflammation.

Can surgery treat De Quervain's tenosynovitis?

“Yes. Surgery can relieve De Quervain's tenosynovitis when conservative treatment methods such as avoiding repetitive hand motions, taking anti-inflammatory NSAID medications, wearing a splint and having cortisone injections fail.

“Surgery to correct De Quervain's tenosynovitis is a simple, in-office procedure that takes only a few minutes under a local anesthetic to release the sheath that surrounds the tendons.”

What can I expect after De Quervain's tenosynovitis surgery?

“After surgery for De Quervain's tenosynovitis, you will need to wear a splint or dressing on your wrist for a few days to promote healing. Your inflammation should be reduced and you should be able to straighten your thumb without pain. You may need to do special exercises or have physical therapy to help regain strength and movement in your thumb.”