Rochester Hand Center

Physicians & Surgeons, Plastic & Reconstructive, Physicians & Surgeons, Physicians & Surgeons, Dermatology

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47 Years

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Wheelchair accessible

(585) 368-4879Call Visit WebsiteVisit Website Map & DirectionsDirections1561 Long Pond RdRochester, NY 14626 Write a ReviewWrite Review

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Location

Park Ridge Professional Bldg

AKA

Rochester Hand Ctr

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http://rochesterhandcenter.com

Categories

Physicians & Surgeons, Plastic & Reconstructive, Physicians & Surgeons, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gynecology, Physicians & Surgeons, Hand Surgery, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Oncology, Physicians & Surgeons, Osteopathic Manipulative Treatment, Physicians & Surgeons, Surgery-General, Skin Care

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Parking: Lot, Free

Wheelchair Accessible: Yes

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Phone: (585) 368-4879

Address: 1561 Long Pond Rd, Rochester, NY 14626

Website: http://rochesterhandcenter.com

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Rochester Hand Center

General Practitioners

Osteoporosis
Arthritis
The MP joints are less often affected by arthritic conditions than the smaller joints in the hand or the joint where the thumb joins the wrist (CMC). The most common arthritic condition affecting the MP joints is rheumatoid arthritis. In this situation, the joint lining (synovium) produces chemical factors that inflame and destroy the cartilage and soft tissue, such as ligaments and tendons. The end result is that the joint surfaces are destroyed and the fingers drift into a characteristic ulnar-deviated position, in which they point towards the little finger (see Figure 2).
Family Practice
Emergency Care
If the bite results in swelling, redness, warmth, continued pain beyond 24 hours, pus draining from the bite wound, red streaks extending up the arm or forearm, swollen lymph nodes ("glands") around the elbow or in the armpit, loss of mobility, loss of sensation in the hand or fingertip, fever, malaise, night sweats, or rigors, emergency treatment should be sought either in your physician's office or the emergency room.

Pregnancy

Internal Medicine
Julie Sylvester received her Bachelors of Science Degree as a Physician Assistant from the Rochester Institute of Technology in 1999. She is board certified and a member of the American Academy of Physician Assistants. Julie completed a year of internal medicine at the Genesee Hospital in Rochester and a year of general surgery at Rochester General Hospital. She has been employed at The Plastic Surgery Group of Rochester/Rochester Hand Center since 2001. (Back To Top)

Carpal Tunnel Syndrome
Although carpal tunnel syndrome is common, it is not the only cause of numbness, tingling, and pain in the forearm and hand. Most of the lay public and some of the medical community are not aware of other causes, so numbness, tingling and pain may be mistakenly thought to be coming from carpal tunnel syndrome (go to the CTS section of this website). These symptoms can be caused by many other conditions.
Multiple Sclerosis
Numbness and tingling can be caused by diseases of the central nervous system. Multiple sclerosis, stroke, and other disorders of the brain and spinal cord may sometimes cause numbness in the forearm and hand.

Endocrinologist

Diabetes Care
Thyroid
Your physician will assess the pattern and distribution of your symptoms, and examine for muscle weakness, irritability of the nerve to tapping and/or bending of the elbow, and changes in sensation. Other medical conditions may need to be evaluated such as thyroid disease or diabetes. A test called electromyography (EMG) and/or nerve conduction study (NCS) may be done to confirm the diagnosis of cubital tunnel syndrome and stage its severity. This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.

Ultrasound
Segmental arterial pressure and pulse volume recordings, which assess the quality of blood flow in the vessels using small blood pressure cuffs and ultrasound transducers placed on the fingers and arm.
MRI
Scaphoid non-unions may also develop a problem called avascular necrosis. Avascular necrosis occurs when part of the scaphoid bone dies because of the loss of blood flow. This can eventually result in fragmentation and the collapse of the bone. Its presence also makes repair of the scaphoid much more difficult. An MRI scan can be helpful to check for avascular necrosis (see Figure 4).
X-Rays
Computed Tomography
Patients with a scaphoid non-union usually present with a history of previous wrist injury, especially a fall onto an outstretched wrist. They will typically have pain along the thumb side of the wrist and may also have diminished wrist mobility, particularly wrist extension. Scaphoid fractures and non-unions are usually confirmed by x-rays of the wrist (see Figure 2A and 2B). In many cases, special x-ray tests are also used to decide the best treatment approach. A CT scan is helpful to check for collapse of the scaphoid on itself, resulting in a bend in the bone, which is called a “humpback” deformity (see Figure 3).
Chemotherapy
Certain medications, such as cancer treatment drugs, are known to cause numbness and tingling in the hands. Some of these cause temporary numbness that resolves after completion of the chemotherapy treatment. Others may cause permanent numbness. Nutritional deficiencies, such as vitamin B1 deficiency, may result in numbness and tingling.

General Surgery
Brian Kubiak earned his Bachelor of Science from St. John Fisher College and his medical degree from Ross University School of Medicine. He then completed a general surgery residency at SUNY Upstate Medical University in Syracuse, NY prior to completing a plastic and reconstructive surgery residency at the Medical University of South Carolina in Charleston. Dr. Kubiak is certified by the American Board of Surgery. (Back To Top)
Arthroscopy
Surgery is only considered when the pain is incapacitating and has not responded to conservative care, and symptoms have lasted more than six months. Surgery involves removing the diseased, degenerated tendon tissue. Two surgical approaches are available; traditional open surgery (incision), and arthroscopy — a procedure performed with instruments inserted into the joint through small incisions. Both options are performed in the outpatient setting.
Pinched Nerve
Carpal tunnel syndrome (CTS) is a condition brought on by increased pressure on the median nerve at the wrist. In effect, it is a pinched nerve at the wrist. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand (see Figure 1). Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hand and fingers (see Figure 2).
Joint Replacement
In a normal joint, bones have a smooth, glistening surface made of a substance called articular cartilage on their ends that allows one bone to glide easily against another. Joints are lubricated by a thin layer of fluid (synovial fluid) that acts like oil in an engine to keep moving parts gliding smoothly. When the articular cartilage wears out or is damaged or the joint fluid is abnormal, problems develop and joints often become stiff and painful – that’s arthritis. There are many types of arthritis, but the basic problem is the same in all types: the joint surfaces are worn out or not moving properly. In some cases, it may be possible to treat arthritic joints surgically, including “joint replacement” procedures.
Hand Surgery
At the Rochester Hand Center we believe that informed patients make the best choices about their treatment options. Please click on the hand surgery topics in the menu on the left to learn more about specific hand disorders.
Neurosurgery
David H. Refermat, M.D., F.A.C.S., is a Rochester native and a graduate of Pittsford Sutherland High School. He is a cum laude graduate of Williams College and earned his medical degree at the University of Rochester. After his surgical internship he served in the U.S. Navy throughout the Pacific Rim as a battalion surgeon with the Marine Corps 3rd Marine Division and at the Navyâ€™s S.E.R.E. school in Coronado, California. Dr. Refermat earned multiple commendations for his service and achieved the rank of Commander in the Navy Medical Corps. He then returned to the University of Rochester to complete his general and plastic surgery training. At Yale University, he subsequently completed a fellowship in hand surgery, peripheral nerve surgery, and microsurgery.
Gangrene
Aneurysms -An aneurysm is a localized weakness of the vessel wall that results in an isolated expansion of the vessel, like a balloon popping up (see Figure 4). Usually these present as a soft painless mass over the vessel. The vessel may become blocked through the formation of a blood clot or may even shower small clots to the fingertips. Aneurysms of the wrist may cause cold intolerance, pain or numbness as they enlarge, and can occasionally cause gangrene of the fingertips.
Arthroscopy
A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Other fractures may need surgery to properly set the bone and/or to stabilize it. Fractures may be stabilized with pins, screws, plates, rods, or external fixation (see Figure 2). External fixation is a method in which a frame outside the body is attached to pins which have been placed in the bone above and below the fracture site, in effect keeping it in traction until the bone heals. Sometimes arthroscopy is used in the evaluation and treatment of wrist fractures. Your hand surgeon will determine as to which treatment is the most appropriate in your individual case.
Reconstructive Surgery
Recovery time varies considerably, depending on the severity of the injury, associated injuries, and other factors as noted previously. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching. If the surface of the joint was badly injured, arthritis may develop. On occasion, additional treatment or reconstructive surgery may be needed.

Plastic Surgeons

Plastic Surgery
Welcome to the Rochester Hand Center, part of The Plastic Surgery Group of Rochester. The physicians at our Western New York offices in Rochester, also serving Buffalo and Syracuse, treat the wide spectrum of hand and wrist pathology and soft tissue problems of the arm.

Skin Cancer
Whenever patients discover a lump or bump in their hand, one of their first concerns is whether or not they have cancer. Fortunately, cancer in the hand is very rare. The most common primary hand malignancies are skin cancers like squamous cell carcinoma, basal cell carcinoma, or melanoma. Other cancers are very rare but include sarcomas of the soft tissue or bone. It is also possible for cancer to spread to the hand from somewhere else in the body, like lung or breast cancer. This would represent metastatic cancer. With any cancer in the extremity, some type of tissue biopsy is usually required to make a definitive diagnosis.
Acne Treatment
Cyst
Ulcer
Raynaud‘s -Raynaud‘s phenomenon/disease describes a condition in which the arteries in the fingers go into spasm, depriving the finger of blood flow. The fingers typically change color, going from white to blue, then red as the spasm resolves and blood flow returns. It often occurs when the hand is exposed to cold or tobacco. Treatment entails cessation of smoking, avoiding cold weather, use of protective garments (e.g. mittens, gloves), and occasionally medicines that can help dilate the vessels and improve blood flow to the fingertips. When unresponsive to these measures or a non-healing ulcer is present, surgery to separate the nerves from around the vessels may be considered, to relieve the effect of the sympathetic nerves that contributes to spasm of the arteries.
Fungus
A paronychia is an infection of the cuticle area around the fingernail (see Figure 1). Acute paronychia is caused by bacteria, and presents with redness, swelling, pain, and later with pus. Early cases may be treated with soaks and antibiotics, but if pus is seen or suspected, drainage by lifting the cuticle and/or nail, or lancing the area, is required also. Chronic paronychia is caused by fungus, and the cuticle area becomes just mildly red and swollen, with scant or no drainage and mild tenderness. It occurs in people whose hands are frequently wet, such as bartenders. It may be treated with special medication and reduction or elimination of the constant exposure to moisture, which promotes this fungal infection. On occasion, surgery is needed to remove infected tissue. It is commonly mistaken for a bacterial infection. Prolonged treatment is common with chronic paronychia.
Lesions
The hand is known to frequently present signs or symptoms of generalized or systemic diseases. Because the hand contains structures from the skin, muscular, skeletal, circulatory, and nervous systems, it often provides clues to diseases which are yet to be diagnosed in other parts of the body. Presentation of complaints, lesions, symptoms or signs in the hand may alert the hand surgeon to these systemic diseases. Although the hand surgeon may not treat all of these diseases, he is in a position to help make the diagnosis and refer the patient to a different specialist.
Psoriasis
Less commonly, other conditions can produce pain, deformity, and motion loss. Previous injuries can result in a gradual loss of joint cartilage (post-traumatic arthritis) with progressive pain and stiffness. Similar findings are seen with osteoarthritis. Post-traumatic and osteo-arthritis most commonly affect the thumb, index, and middle fingers, and the degree of deformity is often much less severe than in rheumatoid arthrosis. Gout, psoriasis, and infection are other less common causes of MP joint arthritis.

Physical Therapists

Sports Medicine
Physical Therapy
These injuries are extremely severe and often lead to multiple finger amputations. Infections are common; antibiotic medicines are usually necessary. Frequently, multiple surgeries are needed to adequately clean wounds. As stated above, multiple soft tissues and bone may be injured. Surgery is usually required to repair or reconstruct multiple structures. Unfortunately, most patients with these severe injuries never recover full, normal use of the hand. Oftentimes, fingers have been partially or completely amputated, and remaining parts may not have full motion or feeling. Multiple surgeries and many months of hand, occupational, and physical therapy are usually necessary to maximize movement and function.
Tennis Elbow
Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. Tendons anchor the muscle to bone. The muscle involved in this condition, the extensor carpi radialis brevis, helps to extend and stabilize the wrist (see Figure 1). With lateral epicondylitis, there is degeneration of the tendon's attachment, weakening the anchor site and placing greater stress on the area. This can then lead to pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis are commonly associated with this, but the problem can occur with many different types of activities, athletic and otherwise.

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