Treatment & Services

A healthcare professional assists a man in a green striped shirt and glasses with his blue cast on his arm at the renowned Shepherd Center. The man sits in a wheelchair, receiving upper extremity treatment, with a white towel covering part of his lap and arm. Shelves and medical equipment are in the background.

Explore this Clinic

Highly specialized reconstruction and rehabilitation services to restore function in the hands, wrists, and elbows

At the Upper Extremity Clinic, our primary goal is to support you on your journey toward regaining the use of your hands, wrists, and elbows. As part of continued trauma care, our clinic operates within a multidisciplinary setting, tailoring surgical and non-surgical procedures, as well as subsequent rehabilitation, to meet your unique needs.

Our hand and upper extremity rehabilitation team comprises highly skilled specialists with extensive experience addressing neurological disorders, ensuring we achieve the best outcomes for your upper extremity function.

What to expect at the Upper Extremity Clinic

When you first arrive at the Upper Extremity Clinic, your recovery journey begins with a comprehensive patient evaluation. Our specialists work closely with you to understand your specific needs and goals, forming the foundation of your personalized care plan.

The care plan may include functional restoration therapies and tailored rehabilitation to address your complex injury or condition. Surgical reconstruction may be recommended in cases where hand and upper extremity conditions are severe.

Hand and upper extremity injuries and conditions we rehabilitate and restore

One of the most common conditions we treat is upper extremity dysfunction after a spinal cord injury or disease. Our focus is to restore tendon or nerve functions through reconstructive surgeries, directed therapy, and other therapeutic modalities. Tendon transfer surgeries allow us to effectively address issues such as wrist extension, grip, and pinch. During this surgery, a tendon with sufficient strength or a functioning nerve is carefully selected and transferred from its original attachment to another muscle site, restoring functional abilities. We take pride in being among a select few facilities in the country offering this advanced surgical option to individuals with spinal cord injuries.

Contractures result in the loss of joint mobility due to structural changes in non-bony tissues such as muscles, ligaments, and tendons. These changes occur when the elastic tissues are replaced by inelastic tissues, leading to the shortening and hardening of these tissues and causing loss of movement around the joint. We address contractures and offer treatment options to restore mobility around the affected joint.

Heterotopic ossification (HO) involves the formation of bone tissue in soft tissues. It often occurs following an injury or major surgery, resulting in the development of a bony lump beneath the skin. When the lump is near a joint, it can restrict the range of motion. Our team specializes in managing HO and provides interventions to alleviate pain and restore joint function.

Arthritis can cause pain in the hands, wrists, and elbows. The most common site of arthritis in the hand is the thumb basal joint (CMC joint), although other finger joints and the wrist can also be affected. Our expertise lies in treating osteoarthritis, arthritis resulting from injuries, and rheumatoid arthritis. Treatment approaches may involve therapy, injections, and surgeries such as joint reconstruction, replacement, or fusion.

A brachial plexus injury occurs when any part of the nerve network connecting the spinal cord to the upper extremity is stretched, compressed, or torn. These injuries can affect individuals of any age group and present symptoms such as weakness or numbness in the hand or arm, shocking or burning sensations, and severe pain. Depending on the type and location of the brachial plexus injury, surgery may be recommended to repair the brachial plexus. Surgery may involve the removal of damaged nerves, nerve grafts, or transferring a nerve from its original attachment to another nerve site, restoring functional ability.

We also address general orthopedic conditions affecting the upper extremities, such as carpal tunnel syndrome, cubital tunnel syndrome, and other repetitive motion injuries. Our treatment options range from close observation and therapy to decompression surgery or microsurgical repair/reconstruction for others. Additionally, we expertly manage fractures involving the upper limb and other joint issues.

I have easily done more in the past six years than the 15 years before. I can write with no aid. I can get dressed without the dressing stick, and I can get stuff out of kitchen cabinets now with my grip. I can grab the steering wheel and turn it, and pushing a manual chair is a million times easier now. I can’t say enough about it. For someone injured as long as I had been and to have gotten used to my condition, it is almost like being able to walk.

Shannon Tharpe, Georgia Patient, Upper Extremity Clinic

Shepherd Center refines tendon transfer surgery for people with quadriplegia

A doctor in a white coat attentively listens to a seated patient with a beard in a green shirt and adaptive gloves, who is in a wheelchair. They discuss upper extremity treatment and services at the Shepherd Center, surrounded by medical supplies and a computer in the office.
Tendon transfer surgery can improve hand and arm function in people with quadriplegia. Shepherd Center consulting orthopedic surgeon Allan Peljovich, M.D., MPH, explains.