Thomas J. Goetz
Jeff L. Nacht
Orthopaedic conditions of the hand and upper extremity can cause major disabilities by their effect on lack of function. In the past, mainstays of treatment were open surgery including that of shoulder instability, rotator cuff repairs and shoulder arthroplasty. Conditions about the wrist and hand have been subjected to intense scrutiny especially with respect to arthritis and post-traumatic conditions.
Treatment of the upper extremity has been aided by the rapid development of arthroscopic skills and minimal surgical access techniques over the past ten years. This has resulted in a movement from an in patient focused activity to day care surgery. Procedures such as arthroscopic rotator cuff repair and repair of instability through the arthroscope have been major areas of focus in shoulder meetings. The elbow has been dramatically helped both for diagnostic purposes and by minimal access surgery for capsular release and fracture management. The evolution of total elbow arthroplasty has been very valuable, particularly for those middle aged and older rheumatoid arthritic patients where a total elbow replacement has improved function.
Treatment of the wrist and hand has been revolutionized by arthroscopic minimal access techniques, used both in diagnosis and management. Newer techniques for small joint arthroplasty and hinged implants allow minimally invasive reconstructive surgery in the wrist and hand.
Growth in basic science and the application of engineering principles have enormously added to our knowledge of shoulder, elbow, wrist and hand problems and their treatment. The Division of Distal Extremities links strongly with the Division of Orthopaedic Engineering. The Division is dedicated to promoting new techniques and exploring new frontiers.