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Tendon Transfers for Median, Radial, and Ulnar Nerve Palsy

Acknowledgment: This chapter is based on the chapters in previous editions of Green’s Operative Hand Surgery, which were written by George Anderson, William Burkhalter, David Green, John Ingari, and George Omer, as well as Nicholas Barton, who was my coauthor for the fourth edition. My tendon transfer experience cannot match that of these previous authors, and my thoughts and views on tendon transfer surgery have been…

Nerve Repair

Acknowledgment: Special thanks to Amy Moore, MD, who coauthored the seventh edition of Green’s online chapter on nerve transfers—much of which was incorporated into this updated chapter—and to Rolfe Birch for his extraordinary contributions to this chapter in the fifth, sixth, and seventh editions. The permanent sequelae of peripheral nerve injury can range from complete recovery to profound and debilitating functional loss. Regardless, many injury patterns…

Thoracic Outlet Compression Syndrome

Acknowledgment: The authors would like to thank and acknowledge the work of Dr. Karen Johnson Jones in previous versions of this chapter . Treatment of peripheral nerve compression in the upper extremity is one of the main components of a hand surgeon’s practice; however, most shy away from treatment of thoracic outlet syndrome (TOS). Objective electrodiagnostic studies of carpal tunnel, cubital tunnel, and other compressive neuropathies…

Compression Neuropathies

Acknowledgment: We would like to acknowledge Robert M. Szabo, MD, and William W. Eversmann, Jr., MD, for their contributions to the chapter on this subject in previous editions of this textbook. Compression neuropathies in the upper extremity are common. The rising prevalence of obesity in North America coupled with an aging population suggests that the problems of upper extremity compression neuropathy will likely increase in the…

Total Elbow Arthroplasty

Acknowledgments: We would like to acknowledge prior author Leonid Katolik, MD, for his contributions to earlier editions and his insights in developing the current text. Total elbow arthroplasty (TEA) is used for the treatment of debilitating elbow arthropathies. Although clinical outcomes following TEA were initially disappointing, modifications in surgical technique and implant design have improved reliability; however, durability with normal loading (>10 pounds) is still a…

Elbow Arthroscopy

Acknowledgments: The author would like to acknowledge Dr. Bogdan A. Matache for his assistance with the preparation of this manuscript. Arthroscopy of the elbow, similar to other joints, has undergone a transition from simple diagnostic procedures to the ability to conduct complex advanced procedures for the management of stiffness, fractures, and arthritis. The technical advances in elbow arthroscopy have come through an improved understanding of the…

Elbow Tendinopathies and Tendon Ruptures

Lateral Epicondylitis History In 1873, Runge described a condition associated with lateral humeral condylar tenderness and difficulty writing; Morris referred to it in 1882 as “lawn tennis arm.” Eventually, this entity became known as tennis elbow or lateral epicondylitis. Multiple treatments have been proposed for epicondylitis affecting the elbow, ranging from benign neglect to physiotherapy, bracing modalities, injection of various substances, and surgery; the optimal treatment…

Treatment of the Stiff Elbow

Although this text carries the title Operative Hand Surgery and was originally conceived as a compilation of techniques for surgery of the hand, attention to the problem of the stiff elbow is warranted for three reasons. First, loss of motion of the elbow directly restricts the ability to place the hand in space to and from the body, thereby disabling the function of the entire upper…

Chronic Elbow Instability: Ligament Reconstruction

The elbow is one of the most congruous joints in the body. Joint stability is provided by a combination of the bony architecture and the collateral ligaments and muscles. The lateral collateral ligament (LCL) complex plays a key role in elbow stability, preventing the proximal ulna and radius from subluxation as the supinated forearm is axially loaded. Trauma, usually dislocation, is the most frequent cause of…

Complex Traumatic Elbow Dislocation

Acknowledgment: We wish to thank Dr. Jawa and Dr. Hotchkiss for their excellent chapter in a previous edition of Green’s Operative Hand Surgery and their generosity in permitting much of their text and many of their illustrations to be reused. The elbow is one of the most constrained and inherently stable joints in the body, owing to numerous bony and soft tissue structures. , Therefore, even…

Disorders of the Forearm

Acknowledgments: I would like to acknowledge Kenneth R. Means, Jr., and Thomas J. Graham for their sixth edition version of this chapter. A special thank you goes to Sameer Shetty, MS, for his help in the preparation of the eighth edition of this chapter. Forearm Functional Anatomy The elbow, forearm, and wrist act as a unified structure to provide a stable, strong, and highly mobile unit…

Fractures of the Proximal Ulna

Fractures of the olecranon and coronoid processes occur in patterns that can help guide management. There are anterior and posterior olecranon-fracture dislocations and varus posteromedial pattern injuries. The eponym Monteggia is best reserved for forearm fracture dislocations, where fractures of the proximal ulnar diaphysis occur with dislocation of the proximal radioulnar joint. Preoperative Evaluation As with other traumatic injuries, the first step in management is to…

Fractures of the Radial Head

Fractures of the head of the radius are the most common fractures of the elbow. The majority occur between the ages of 20 and 60, with the incidence in females being twice that of males. Although fractures that are not displaced typically occur in isolation, displaced fractures are frequently associated with injuries of the medial and lateral collateral ligaments and/or of the interosseous membrane. In more…

Fractures of the Distal Humerus

Fracture of the distal humerus is one of the most challenging injuries that confront the orthopedic traumatologist. Given the relative rarity of these injuries, most surgeons have only limited experience in their management. Because of the complex regional anatomy, fracture comminution, and limited points for secure fixation, even experienced surgeons find it challenging to achieve stable fixation allowing early return of motion. Injuries of the distal…

Wrist and Hand Arthroscopy

Acknowledgments: The author wishes to acknowledge and thank the late Dr. Joe Slade, Dr. David Slutsky, and Dr. William Geissler. Their efforts in the previous editions of this text provided the foundation for this chapter. I would also like to express my sincere thanks and acknowledgment to the following colleagues who have been contributing to the building of experience, technique, concept, and knowledge over the past…

Fractures of the Carpal Bones

Acknowledgments: I would like to give full acknowledgment to the authors of previous versions of this chapter, Dr. William B. Geissler and the late Dr. Joseph F. Slade. Their chapter was the foundation of the current chapter; I have maintained many of their principles but have updated the chapter with my own thoughts, influenced by prime mentors of mine, Drs. Martin Posner, Scott Wolfe, and Michael…

Distal Radius Fractures

Acknowledgments: I would like to acknowledge with sincere gratitude those giants who have written past editions of “Distal Radius Fractures,” including Andy Palmer, Diego Fernandez, and Scott Wolfe. Their insightful perspectives, tricks, and techniques, as well as several of the original figures, tables, and parts of the text, have been an enormous asset to me in writing this chapter. The distal radius fracture (DRF) has for…

The Distal Radioulnar Joint

Acknowledgments: On the shoulders of giants, I gratefully acknowledge the tremendous contributions of Dr. Brian Adams and Dr. Bill Bowers, the authors of prior chapter editions, toward the evolution and development of this updated chapter on the distal radioulnar joint. The distal radioulnar joint (DRUJ) is a diarthrodial, synovial articulation that provides the distal link between the radius and the ulna and a pivot for pronation…

Carpal Instability

Acknowledgments: The authors gratefully acknowledge the very broad shoulders of the giants who have preceded us in writing this chapter, including Drs. David Green, Marc Garcia-Elias, William Geissler, and most recently Alberto Lluch. In particular, Marc Garcia-Elias, through his astute clinical observations, masterful theoretical reasoning, detailed drawings, and landmark research, has so eloquently unwound the mysteries of the carpus in these pages over the last 16…

Wrist Arthrodesis and Arthroplasty

Acknowledgment: The author and editors wish to acknowledge and thank John K. Stanley, MD, who contributed this chapter for the sixth edition. This work is built on his foundation as well as the seventh edition. A pain-free, stable wrist joint is essential for normal function of the hand. Pain arising from a traumatized, arthritic, or unstable wrist will, through the unconscious spinal reflex, inhibit the function…