Hand and Wrist Sports Surgery in Asturias

Wrist and hand sports surgery in Asturias: With 12 years of experience and advanced training, I specialize in innovative arthroscopic techniques to treat sports injuries, ensuring a fast and effective recovery. My personalized approach and commitment to excellence have established me as a leader in wrist and hand sports surgery in Asturias, offering optimal results and high-quality care to athletes.

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Triangular Fibrocartilage Repair and Reconstruction

Stener's Lesion Repair and Reconstruction

Scapholunate Instability

Metacarpal, Carpal and Distal Radius and Ulna Fractures

Nerve and Tendon Compression Release

Dupuytren's Disease Treatment

Flexor and Extensor Tendon Injuries

Rhizarthrosis Treatment

Ulnar Shortening

My Wrist and Hand Treatments in Detail

I have extensive experience and training in new techniques of complex wrist and hand surgery: arthroscopy, tendon and ligament repair, fracture fixation, and joint reconstruction. I am dedicated to excellence and provide individual care using the latest technology to get you back to function as soon as possible.

The triangular fibrocartilage complex (TFCC) of the wrist is a structure that stabilizes the distal radioulnar joint and transmits the load from the hand to the forearm, allowing smooth wrist motion and stability during activities.

TFCC injuries are common in athletes and people who perform repetitive wrist movements or acute trauma, such as a fall on the outstretched hand. Symptoms of a TFCC injury include pain on the ulnar side of the wrist that worsens with forearm rotation or gripping activities, swelling, snapping, and reduced range of motion. Patients may also experience weakness in the wrist, making daily activities difficult.

Treatment depends on the severity and type of TFCC lesion and may be conservative or surgical. Conservative treatment is reserved for cases with few symptoms that do not limit usual activities. Surgical treatment is performed by arthroscopic surgery.

Most of the lesions are repairable. Surgery consists of passing sutures through a tunnel made in the ulna to bring the TFCC to its insertion in the bone. Occasionally, the injury occurs in a non-repairable area. In these cases, debridement is performed, in which the injured area is removed to leave a stable rim. Chronic injuries with great instability and tissue loss require reconstruction. In this technique a tendon is removed from the forearm and passed through tunnels in the radius and ulna to give stability to the joint.

El cúbito plus, o varianza cubital positiva, se produce cuando el extremo del cúbito sobresale más que el radio en la muñeca. Esta variante anatómica ejerce más tensión y presión sobre las estructuras de la articulación ulnocarpiana y puede causar dolor y disfunción. 

Cubitus plus may be congenital or develop from previous fractures, growth disturbances, or repetitive stress.

Ulnar plus symptoms include pain on the ulnar side of the wrist, especially with gripping or twisting activities. Patients may also experience wrist swelling, decreased range of motion, and a feeling of instability. Chronic cases can lead to degenerative changes and conditions such as ulnar impaction syndrome, in which prolonged pressure damages the triangular fibrocartilage complex (TFCC) and other structures of the carpus.

There are two types of surgical treatment depending on how elongated the ulna is. When it is scarce, a "Wafer" procedure can be performed in which, under arthroscopic vision, a small lamina is removed from the most distal area of the ulna. If it is larger, an ulnar shortening osteotomy is performed, which consists of making cuts in the ulna to resect several millimeters and then fix the bone with a plate. In these cases, an arthroscopy is always performed to evaluate if there are lesions in the TFCC or other structures of the wrist.

The scapholunate joint connects the scaphoid and lunate bones. It keeps the wrist stable and allows smooth movement during hand activities. Proper function of this joint is necessary for complex wrist movements.
 
Scapholunate joint injuries usually result from trauma such as falls or direct blows and can cause ligament tears and instability. Symptoms of a scapholunate joint injury are localized pain in the wrist, swelling, decreased pressing strength, and an enlarged space between the scaphoid and lunate bones.
 
Treatment of scapholunate joint injuries depends on the severity. In general, surgery is recommended to avoid instability and severe osteoarthritis. 
 
If treated within the first few weeks of injury, arthroscopic surgery can repair the damaged ligaments and restore joint stability. When the injury is diagnosed later, it is necessary to take a tendon from the forearm to reconstruct the ligaments by arthroscopic or open surgery. In cases where the joint has degenerated, salvage options such as arthrodesis (fixing the joint), carpectomy (resecting all the bones of the first carpal row) or arthroplasty (replacing the injured bones and joints with a prosthesis) need to be considered, so it is important to treat these injuries early.

Fractures of the distal radius and ulna, carpal and metacarpal bones are frequent in the wrist and hand due to falls or direct trauma.

The distal radius and ulna are the two large bones of the forearm that attach to the small carpal bones of the wrist. Distal radius fractures are the most common, with symptoms of pain, swelling, bruising, and a visible deformity or angulation of the wrist. Distal ulnar fractures can occur with these injuries and will have similar symptoms.

Carpal bone fractures affect any of the 8 small bones of the wrist. The scaphoid is the most commonly fractured carpal bone and is usually caused by a fall on the outstretched hand. Symptoms of carpal bone fractures include localized pain, tenderness, swelling, and reduced range of motion of the wrist. Early diagnosis is important as some carpal fractures, especially scaphoid fractures, have a high risk of nonunion or avascular necrosis due to their poor blood supply.

Metacarpal bone fractures affect the long bones of the hand that join the carpal bones and phalanges. These fractures can be caused by direct blows or crushing injuries. Symptoms include pain, swelling, bruising, and sometimes visible deformity or shortening of the affected finger.

Surgical options for these fractures vary depending on the bone involved and the severity of the break. For distal radius and ulna fractures, surgery consists of open reduction and internal fixation with plates and screws to realign and stabilize the bones, with arthroscopic assistance if the fracture involves the joint or joint injury is suspected because of the fracture pattern. Fractures of the carpal bones, especially scaphoid fractures, usually require screw fixation to promote healing. Metacarpal fractures are usually treated conservatively, although in cases of great displacement or joint involvement, screw fixation or plates and screws are used. Nowadays, needle treatment is reserved almost exclusively for small fractures with large joint displacement, fractures in children, or when the skin is severely affected.

Tendons and nerves in the wrist and hand are key to movement, sensation and dexterity. Tendons connect muscles to bones and allow precise and coordinated movements of the fingers, hand and wrist. The main tendons are the flexors and extensors, which bend and straighten the fingers respectively. The median, ulnar and radial nerves provide sensation and motor control.
 
Tendon and nerve injuries may be due to trauma, overuse, or degenerative diseases. Symptoms of tendon injuries (tendinitis or tears) are pain, swelling, weakness, and difficulty or inability to move the affected fingers or hand. Nerve injuries, such as carpal tunnel syndrome or ulnar nerve entrapment, cause numbness, tingling, burning sensation, and muscle weakness. In severe cases, it can lead to muscle atrophy and loss of function. 
 
In case of limiting tendon compressions that do not respond to conservative measures, the ideal option is decompression surgery. This consists of sectioning the tissue that compresses the tendon to allow its normal mobility. In case of tendon ruptures, surgery is necessary to repair or reconstruct the damaged tendons and achieve proper alignment and function.
 
When conservative measures do not work for nerve compressions, surgical options such as decompression (releasing the nerve) or nerve transposition (changing its pathway) are necessary to relieve pressure and achieve normal function. 
Dupuytren's disease is a progressive hand condition characterized by thickening and stiffening of the palmar fascia. This fibrous tissue beneath the skin of the palm and fingers gradually forms nodules and cords, which can lead to flexion contractures of the fingers, mainly affecting the ring and little fingers. The exact cause of Dupuytren's disease remains unclear, but is associated with genetic factors, age, and certain medical conditions.
 
Symptoms of Dupuytren's disease usually begin with the appearance of small firm nodules in the palm of the hand. As the disease progresses, these nodules develop into thick cords that can bend the fingers. Patients may experience difficulty straightening the fingers, impaired hand function, and difficulty performing everyday tasks such as grasping or holding objects.
 
Treatment options vary depending on the severity of the contractures and the impact on hand function. Collagenase injections, an enzymatic treatment that dissolves the cords, is a minimally invasive treatment that can provide temporary relief in single cord contractures.
 
In advanced cases, surgical intervention may be necessary. Fasciectomy, the removal of the affected fascia, is usually performed to release contractures and restore finger mobility. In cases of severe disease, dermofasciectomy, which involves removal of the diseased fascia and overlying skin, followed by skin grafting, may be necessary.

Rhizarthrosis (carpometacarpal joint osteoarthritis or CMC of the thumb) is a degenerative disease of the base of the thumb. This joint, where the metacarpal bone of the thumb meets the trapezium bone of the wrist, is crucial for thumb mobility and grip strength. Over time, the cartilage wears down and causes pain, stiffness, and functional disability.

Symptoms of rhizarthrosis include constant pain at the base of the thumb, especially with pinching or grasping. Patients may also have swelling, decreased range of motion, and grip weakness. As the disease progresses, the joint may develop visible deformities, such as a protrusion at the base of the thumb, and patients may find it more difficult to perform daily activities.

Treatment of rhizarthrosis ranges from conservative to surgical interventions, depending on the severity of symptoms and functional limitations. When conservative measures fail, surgical options may be considered.

Hemithrapeziectomy involves removing part of the trapezius bone to reduce pain and preserve function but is indicated only in relatively early cases. Ligament reconstruction and tendon interposition (LRTI) is another option, in which the trapezium is resected (trapezectomy) and part of a nearby tendon is used to reconstruct the damaged ligaments and stabilize the joint. Button suspension, or button suture arthroplasty, suspends the metacarpal after hemithrapeziectomy or trapeziectomy with a button and suture to maintain thumb alignment and stability.

Arthrodesis is a procedure in which the bones of the joint are fused to eliminate motion and pain. This involves a loss of joint mobility but maintains strength and stability. Arthroplasty, or joint replacement, involves replacing the damaged joint surfaces with a prosthesis that mimics natural motion to relieve pain and improve function. It is excellent in older patients or young people with low hand strength demands, although in athletes or manual workers, it is not usually the first indication.

Stener's lesion is a specific type of ulnar collateral ligament (UCL) injury of the thumb usually caused by acute trauma, such as a fall on an outstretched hand or forced abduction of the thumb. This condition is characterized by complete rupture of the UCL at its insertion on the proximal phalanx, with the adductor aponeurosis interposed between the torn ligament and its attachment site, preventing natural healing.

The main symptom of a Stener's lesion is pain and swelling at the base of the thumb, especially on the ulnar side. Patients present with significant thumb instability, especially during pincer or press activities. There may also be bruising and a palpable mass where the torn ligament has retracted and is trapped above the adductor aponeurosis, which is a unique clinical finding. If left untreated, it causes chronic instability and functional impairment of the thumb.

Surgical treatment is usually necessary for a Stener's injury, as the ligament cannot heal on its own. The method of choice in acute injuries is open surgical repair with sutures and anchors. This returns the ligament to its anatomic position under the adductor aponeurosis for optimal healing and stability of the thumb.

If the UCL cannot be repaired, either because of significant tissue loss or if the treatment is performed in the chronic phase, a graft with a tendon from the patient's forearm (autograft) can be used to reconstruct the ligament and provide additional support.