A fall on an outstretched hand. A laceration. A crushing injury. The hand and wrist, with 27 bones, numerous ligaments and tendons, and a delicate web of nerves and blood vessels, is a complex limb. Even what seems like a simple problem has the potential to end a career or bring a lifetime of disability if not treated correctly.

Physicians across the globe refer patients to renowned orthopedic surgeon Elizabeth Ann Ouellette, M.D., MBA, to get to the root of the problem, reduce pain and restore function. Dr. Ouellette is chief of hand surgery at Baptist Health Orthopedic Care and vice chair of research and professor of orthopedics at Florida International University’s Herbert Wertheim College of Medicine.

With decades of experience and years of research in studying and developing the most innovative hand surgery techniques, Dr. Ouellette shared her expertise at the recent Baptist Health International World-Class Medical Care International Symposium. The meeting was attended by 115 physicians from 17 countries and was broadcast live to several medical schools in Latin America and the Caribbean.

Among the common hand injuries she discussed were triangular fibrocartilage complex (TFCC) tears and distal radius fractures. The TFCC consists of ligaments and cartilage in the wrist that contribute to hand function, wrist motion and stabilization. A distal radius fracture is a break in the radius close to the wrist. The injuries can result in pain, loss of grip strength and a reduction in pronation and supination.

While the problems can appear obvious at times, they can also be difficult to detect, Dr. Ouellette said.

“I treated a professional male tennis player late in his career who had fallen on an outstretched wrist. Nobody could find a fracture. Everybody told him there’s nothing wrong and to go back out and play. But he couldn’t,” Dr. Ouellette said. “When he finally came to see me, I told him it wasn’t his fault his career ended. He had a ring injury, or a tear in the peripheral part of the cartilage of the TFCC. These can be very subtle on imaging. You typically don’t see them on X-ray.”

Another injury that should be considered after a fall upon the hand is a fracture of the scaphoid, a small bone located between the base of the thumb and the end of the radius. “We went into the biomechanical lab and recreated falls with fresh, frozen cadaver specimens,” Dr. Ouellette said. “The most common break was the scaphoid.”

When it comes to the hands and wrists, her message to patients — and to physicians — is clear. “Have a broader mind about falling on an outstretched wrist. Take a look. And then take a closer look,” she said.

Many hand injuries, from trauma and gunshot wounds to lacerations and falls, involve damage to the nerve, which can lead to sensory and motor loss, pain, numbness and weakness. Dr. Ouellette and other physicians at Baptist Health Orthopedic Care are involved in several hand research studies to repair nerve damage, including:

• Using a connective tissue membrane to provide protection and a framework for nerve regeneration.
• Using an ultrasound-guided pulse generator to place an electrode near a damaged nerve and send small electrical pulses to the nerve to promote healing.
• Exploring structured water, or hydrogels, as a supportive environment for nerve cells to grow.

In addition to fractures, ligament, tendon and cartilage problems and nerve conditions, the hand and wrist team at Baptist Health Orthopedic Care cares for patients with arthritis, dislocations, sprains, tendinitis, Dupuytren’s contracture, ganglion cysts, trigger finger and other complex conditions.

“Our work is really about learning how to help people. That includes offering psychological support, listening to our patients, teaching coping strategies and reducing stress,” Dr. Ouellette said.

Dr. Ouellette and the hand team are also training the next generation of orthopedic surgeons. The Florida International University/Baptist Health Orthopedic Hand Surgery Fellowship begins this July. For more information on the program, click here.