Hand, Wrist & Upper Extremity Care

Expert Care from Fingertip to Elbow

Maryland Orthopedic Specialists provides comprehensive evaluation and treatment for the full spectrum of hand, wrist, forearm, and elbow conditions — both surgical and non-surgical — at our Bethesda and Germantown, Maryland locations. What sets our upper extremity program apart is the integration of board-certified orthopedic surgeons with on-site Certified Hand Therapists (CHTs), allowing patients to receive coordinated diagnostic, surgical, and rehabilitative care under a single roof without the delays and communication gaps of external referrals. Whether you are managing a new injury, a progressive condition like Dupuytren's contracture, or a chronic repetitive strain, our specialists are here to restore your hand and upper extremity function as efficiently as possible.

Conditions We Treat

Our upper extremity specialists evaluate and treat the following conditions with individualized, evidence-based care plans:

• Carpal Tunnel Syndrome — Compression of the median nerve within the carpal tunnel at the wrist, causing numbness, tingling, burning, and weakness in the thumb, index, middle, and ring fingers, often worsening at night or with sustained gripping.
• Trigger Finger (Stenosing Tenosynovitis) — Catching, popping, or locking of a finger caused by inflammation and narrowing of the tendon sheath around the flexor tendon, making it difficult for the tendon to glide smoothly.
• Dupuytren's Contracture — A progressive condition in which the palmar fascia thickens and tightens over time, forming nodules and cords beneath the skin that gradually pull the fingers — most often the ring and small fingers — into a flexed, contracted position; both non-surgical (Xiaflex collagenase injection) and surgical options are available at our practice.
• De Quervain's Tenosynovitis — Painful inflammation of the abductor pollicis longus and extensor pollicis brevis tendons as they pass through the first dorsal compartment at the base of the thumb, causing pain and swelling with pinching, gripping, or turning the wrist.
• Ganglion Cysts — Fluid-filled cysts that arise from the lining of a joint or tendon sheath, most commonly on the dorsal wrist, volar wrist, or finger; while often harmless, they can cause pain or pressure on adjacent structures.
• Hand & Wrist Fractures — Including distal radius fractures (Colles' and Smith's types), scaphoid fractures (which require careful management due to tenuous blood supply), metacarpal fractures, and phalangeal fractures — treated with casting, splinting, or surgical fixation depending on fracture pattern and displacement.
• Mallet Finger — A disruption of the terminal extensor tendon at the fingertip, typically caused by a sudden force to the tip of an extended finger, resulting in an inability to actively straighten the distal joint.
• Tennis Elbow (Lateral Epicondylitis) & Golfer's Elbow (Medial Epicondylitis) — Tendinopathy of the extensor (lateral) or flexor-pronator (medial) muscle origins at the elbow, causing aching pain that worsens with gripping or forearm rotation and is common in both athletes and non-athletes performing repetitive arm tasks.
• Cubital Tunnel Syndrome — Compression or traction of the ulnar nerve as it passes through the cubital tunnel at the inside of the elbow, producing numbness and tingling in the ring and small fingers, weakened grip, and — in advanced cases — atrophy of the intrinsic hand muscles.
• Thumb CMC Joint Arthritis (Basal Joint Arthritis) — Osteoarthritis at the carpometacarpal joint at the base of the thumb, causing a deep, aching pain with pinching and gripping activities; significantly more common in women over 50, and one of the most frequently treated hand conditions in our practice.
• TFCC Tears (Triangular Fibrocartilage Complex) — Tears of the fibrocartilaginous disc and surrounding ligament complex on the ulnar side of the wrist, producing ulnar-sided wrist pain that worsens with rotation, gripping, or weight-bearing through the wrist.
• Jersey Finger — An avulsion injury of the flexor digitorum profundus tendon from its insertion at the distal phalanx, occurring when a finger is forcibly extended during active flexion (such as grabbing a jersey in sports), resulting in inability to actively bend the fingertip.

Dupuytren's Contracture: Specialized Care

Dupuytren's contracture begins subtly — often as a painless nodule in the palm that is easy to dismiss. Over months to years, fibrous cords develop beneath the skin and progressively shorten, pulling the affected fingers — most commonly the ring and small fingers — into a fixed, flexed position that cannot be passively straightened. This process is not painful for everyone, but the functional loss can be significant: difficulty shaking hands, putting on gloves, or placing the palm flat on a table. At Maryland Orthopedic Specialists, we offer both non-surgical and surgical management pathways. For patients with contractures of at least 30 degrees at the MCP joint or any degree of PIP joint contracture, Xiaflex (collagenase clostridium histolyticum) — an FDA-approved enzyme injection — offers a non-surgical option in which the drug is injected directly into the Dupuytren's cord to enzymatically weaken it, followed by a manipulation the next day to rupture the cord and straighten the finger. For more advanced or recurrent contractures, surgical fasciectomy — partial or total removal of the diseased palmar fascia — is performed to restore finger extension. Our surgeons will discuss both options in detail, including expected outcomes, recurrence rates, and recovery timelines, so you can make an informed choice about which path is right for you.

Our Integrated Care Model

At Maryland Orthopedic Specialists, your orthopedic physician and your certified hand therapist are not separate teams working in silos — they are part of a unified care model that operates from the same practice locations in Bethesda and Germantown. When your physician determines a course of treatment, whether conservative or surgical, your hand therapist is immediately looped in to begin or plan the rehabilitation component. After surgery, therapists receive direct, real-time updates from your surgeon so that your rehab protocol reflects the specifics of what was done — not a generic post-op protocol. This integration eliminates the referral lag, communication breakdowns, and duplicated evaluation costs that occur when patients are sent to external therapy facilities. The result is a more coherent recovery experience, faster functional milestones, and better long-term outcomes.

Certified Hand Therapy

A Certified Hand Therapist (CHT) is an occupational therapist or physical therapist who has completed at least three years of clinical practice — with a minimum of 4,000 hours spent specifically in upper extremity rehabilitation — and has passed a rigorous specialty certification examination. This credential represents advanced expertise that goes well beyond standard OT or PT training. In practice, our CHTs provide a comprehensive range of therapeutic services tailored to the upper extremity: edema (swelling) management using compression techniques and elevation strategies, scar mobilization and management to prevent restrictive adhesions after surgery or injury, fabrication of custom thermoplastic splints and orthoses to position joints optimally during healing, nerve and tendon gliding exercises to restore excursion and prevent adhesions, desensitization programs for hypersensitive areas following nerve repair, and progressive strengthening protocols to rebuild grip strength and fine motor coordination. Certified hand therapy is available at both our Bethesda and Germantown locations, and therapy appointments are coordinated directly within your physician's care plan.

What to Expect at Your Appointment

1. Comprehensive Evaluation — Your visit begins with a thorough history and physical examination focused on the hand, wrist, forearm, and elbow. We assess strength, range of motion, sensation, and neurovascular status as appropriate to your complaint.
2. Imaging When Indicated — X-rays are available on-site for immediate review. When soft tissue detail is needed, we will order MRI, ultrasound, or CT imaging with a timely referral to a local imaging center, and we will review results with you at a follow-up or via our patient portal.
3. Discussion of Treatment Options — Your physician will explain all appropriate treatment pathways — conservative, minimally invasive, and surgical — with realistic expectations for each, and will give you time to ask questions before any plan is finalized.
4. Therapy Initiation or Surgical Planning — If conservative care is the chosen path, hand therapy can often begin within days of your physician visit. If surgery is planned, our team will coordinate pre-operative paperwork, scheduling, and pre-op education so that you feel informed and prepared.

Frequently Asked Questions