Services & Procedures
Dr. Jennifer Tucker is a fellowship-trained and board-certified orthopedic hand and upper extremity surgeon. Her practice focuses on conditions that affect the hands and upper extremities. Dr. Tucker believes that hand surgery is the ultimate combination of art and medicine. She trained with the forefathers of hand surgery and quickly learned to respect the complexity and beauty of our hands. Dr. Tucker also spent time learning microvascular techniques and complex shoulder reconstruction, as well as performing biomechanical research. Her exceptional training has provided her with innovative technical skill to provide high-quality care for our members. Some of the services and procedures Dr. Tucker provides include:
- Hand & Finger Conditions
- Dupuytren's Contracture, Ganglion Cyst, Hand Fracture, Joint Replacement, Nail Bed Injury, Osteoarthritis, Raynaud's Disease, Rheumatoid Arthritis, Tendon Injury, Thumb Arthritis, Trigger Finger
- Lateral Epicondylitis
- Wrist and Forearm Surgery
- DeQuervain Syndrome, Distal radius Fracture, Wrist Fracture, Scaphoid Fracture
- Nerve Conditions
- Carpal Tunnel, Cubital Tunnel, Nerve Injury & Repair, Radial Tunnel
- Total Shoulder Replacement
- Reverse Shoulder Replacement
- Dr Tucker Elbow Arthroscopy
- Dr Tucker Cortisone Injection Procedure
- Dr Tucker Replantation Procedure
- Dr Tucker Joint Replacement
- Dr Tucker Nerve Repair
- Dr Tucker Wrist Arthroscopy
- Dr Tucker Lateral Epicondylitis Exercises
- Dr Tucker Carpal Tunnel Exercises
Working with patients who have physical limitations has provided Dr. Tucker with a foundation of gratitude, and she firmly believes that staying strong physically is integral to staying strong mentally. Physical or occupational therapy is often critical in restoring or maintaining strength during recovery. Dr. Tucker looks forward to becoming a part of your healthcare team.
Hand and Finger Conditions & Treatment Options
(click on links for more detailed information)
Dupuytren's (du-pwe-TRANZ) contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position. The affected fingers can't be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves, or shaking hands.
For more severe cases, various treatment options are available to straighten the finger(s). These options may include needles, injectable medicine, or surgery. Splinting and hand therapy are often needed after treatment in order to maintain the improved finger function.
Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. Ganglion cysts are typically round or oval and are filled with a jelly-like fluid. Small ganglion cysts can be pea-sized, while larger ones can be around an inch (2.5 centimeters) in diameter. Ganglion cysts can be painful if they press on a nearby nerve. Their location can sometimes interfere with joint movement.
If your ganglion cyst is causing you problems, we may try and drain the cyst with a needle. Removing the cyst surgically is also an option.
The bones of the hand serve as a framework supporting the muscles that make the wrist and fingers move. When one of these hand bones is broken (fractured), it can prevent you from using the hand, wrist, and fingers. There can be different variations of a fracture, including:
- Stable fracture, when the bone pieces are aligned
- Unstable fracture, when there are bone fragments that have shifted
- Comminuted fracture, when the bone is shattered into many pieces
- Open (compound) fracture, when a bone fragment breaks through the skin; this causes a risk of infection
In a joint replacement, the abnormal bone and structures of the joint are removed surgically, and new parts are inserted in their places. These new parts may be made of special metal or plastic or specific kinds of carbon-coated implants. The new parts allow the joints to move again with little or no pain. Finger joints (called PIP), knuckle joints (called MP) and wrist joints can all be replaced.
Nail Bed Injuries
Nail bed injuries can be very painful and prevent you from using your fingers. However, these injuries are treatable and typically the result of incidents such as catching the fingertip in a door. Any type of pinching, crushing, or sharp cut to the fingertip may result in a nail bed injury. Simple crushes of the fingertip may result in a very painful collection of blood under the nail. More severe injuries can result in the nail cracking into pieces, part of the nail or fingertip being torn off, and/or other injuries to the finger.
Collections of blood are drained by making a small hole in the nail in order to relieve the pressure and provide pain relief. More serious injuries may be treated with surgery and/or splinting.
Osteoarthritis of the Hand
Arthritis – literally, “inflamed joint” – an affect any joint in the body, including the joints between the 29 bones of the wrist, hand, and fingers. Arthritis of the hand can hurt and keep you from being able to do what you want or need to do. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the smooth cartilage that covers bone surfaces at the joints is damaged or wears away over time.
The goals in treating osteoarthritis are to relieve pain and restore function. A brief rest – either by changing activities or wearing a splint – can help. Anti-inflammatory medication or a steroid injection into the joint can decrease pain, but neither cures osteoarthritis. Surgery is considered when the nonsurgical options above have not helped. One type of surgery is joint fusion. The worn cartilage is removed and the bones on each side of the joint are fused together, which means that the joint will not move but it will not hurt. Another choice is joint reconstruction, where the rough joint surface is removed and either replaced with your own soft tissue or with an implant. The type of surgery depends on the joint involved as well as your specific anatomy and activities.
A common vascular disease that causes constriction of the blood vessels in the hands when exposed to cold temperatures. Having cold hands at all times usually occurs due to decreased blood flow to the hands. Our bodies keep our hands warm primarily by regulating the blood flow that travels from the heart, down the arm, all the way to our fingertips. More blood to the hands means pink, warmer hands; less blood flow means colder and sometimes painful hands.
Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues.
Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
The muscles that bend (flex) the fingers are called flexor muscles. These flexor muscles move the fingers through cord-like extensions called tendons, which connect the muscles to bone. The flexor muscles start at the elbow and forearm regions, turn into tendons just past the middle of the forearm, and attach to the bones of the fingers. In the finger, the tendons pass through tunnels that keep them close to the bones, which helps them work better.
A cut tendon cannot heal without surgery. Nearby nerves and blood vessels may need to be repaired as well. After surgery, the injured area will need to be moved to limit stiffness, but the repair must be protected.
Patients with thumb arthritis report pain and weakness with pinching and grasping. For instance, opening jars, turning doorknobs or keys, and writing are often painful. The diagnosis is made by talking with you and examining you. The appearance of the thumb can change with the development of bone spurs and stretching of soft tissues (ligaments). A grinding sensation may also be present at the joint. X-rays can help you understand the disease and why surgery is being considered.
Options for treatment include nonsurgical methods and surgery. Treatments without surgery range from ice/heat, pain medicines, splinting, and injections. Surgery consists of removing the joint either by removing a bone or connecting the bones together. There are options for moving one of your tendons to secure or cushion the bone.
Trigger finger, also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis), is a condition in which one of your fingers gets stuck in a bent position. Your finger may straighten with a snap — like a trigger being pulled and released. Trigger finger occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position.
The goal of treatment in trigger finger is to eliminate the swelling and catching/locking, allowing full, painless movement of the finger or thumb. Common nonsurgical treatments include night splints, anti-inflammatory medication, and steroid injections. If nonsurgical treatments do not relieve your symptoms, surgery may be recommended. The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. The clicking or popping goes away first. Finger motion can return quickly, although there can be some stiffness after surgery.
Wrist Conditions & Treatment Options
De Quervain Syndrome
Patients with de Quervain's tenosynovitis have painful tendons on the thumb side of the wrist. Tendons are the ropes that the muscle uses to pull the bone. You can see them on the back of your hand when you straighten your fingers. In de Quervain's Tenosynovitis, the tunnel where the tendons run narrows due to the thickening of the soft tissues that make up the tunnel. Hand and thumb motion can cause pain, especially with forceful grasping or twisting.
Treatments that can relieve symptoms include a splint that stops you from moving your thumb and wrist, and Tylenol or aspirin-type medications (e.g., ibuprofen). Treatments that attempt to change the course of the disease include a cortisone-type of steroid injection into the tendon compartment. Surgical intervention is also an option to open the tunnel and make more room for the tendons.
Distal Radius Fracture
A common fracture that involves the radius. Treatment of these fractures is crucial to protect range of motion and promote proper healing. Symptoms include pain, swelling, and decreased range of motion. A wrist fracture is a medical term for a broken wrist. The wrist is made up of eight small bones that connect with the two long forearm bones called the radius and ulna. Although a broken wrist can happen in any of these 10 bones, by far the most common bone to break is the radius. This is called a distal radius fracture.
A padded splint might be worn at first in order to align the bones and support the wrist to provide some relief from the initial pain. If the fracture is not too unstable, a cast may be used to hold a fracture that has been set. Other fractures may benefit from surgery to put the broken bones back together and hold them in place.
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. 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.
Treatments include a variety of conservative options, including activity modification, medication, bracing, physical therapy, and steroid injections. Surgery is considered when the pain is incapacitating and the patient has not responded to conservative care. Surgery involves removing the diseased, degenerated tendon tissue.
A wrist fracture is a medical term for a broken wrist. The wrist is made up of eight small bones that connect with the two long forearm bones called the radius and ulna. A broken wrist can happen in any of these 10 bones.
Some fractures are more severe than others. Fractures that break apart the smooth joint surface or fractures that shatter into many pieces (comminuted fractures) may make the bone unstable. These severe types of fractures often require surgery to restore and hold their alignment. An open fracture occurs when a fragment of bone breaks and is forced out through the skin. This can cause an increased risk of infection in the bone.
Scaphoid Fracture and Scaphoid Nonunion
The scaphoid is one of eight small bones that make up the “carpal bones” of the wrist. The scaphoid connects two rows of these bones - the proximal row (closer to the forearm) and the distal row (closer to the hand). This connection puts it at extra risk for injury.
If the fracture is nondisplaced (the bone has not moved out of place at the fracture), it usually can be successfully treated with a cast. Although the fracture may heal in as little as six weeks, it may take longer for some patients. If the fracture is in a certain part of the bone or if the fracture is at all displaced (bone ends have shifted), surgery might be the best option. Surgery may include the insertion of surgical-grade screws or pins.
Nerve Conditions & Treatment Options
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition that causes numbness, tingling, and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed median nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist. The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis. The anatomy of your wrist, health problems, and possibly repetitive hand motions can contribute to carpal tunnel syndrome. Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. The ulnar nerve runs in a groove on the inner side of the elbow. Cubital tunnel syndrome can cause pain, loss of sensation, tingling, and/or weakness. “Pins and needles” usually are felt in the ring and small fingers. These symptoms are often felt when the elbow is bent for a long period of time, such as while holding a phone or while sleeping. Some people feel weak or clumsy.
Sometimes, nerve testing (EMG/NCS) may be needed to see how much the nerve and muscle are being affected. This test also checks for other problems such as a pinched nerve in the neck, which can cause similar symptoms. Sometimes, surgery may be needed to relieve the pressure on the nerve. This can involve releasing the nerve, moving the nerve to the front of the elbow, and/or removing a part of the bone.
Nerve Injury and Repair
Nerves are critical to the body's function, providing sensory input and motor control of the extremities. When damaged from a traumatic laceration, tumor removal, or surgery, these critical nerve functions are lost. This results in patients having pain, numbness, and inability to perform certain movements directly related to nerve damage. Early recognition of the nerve injury and referral to a peripheral nerve specialist allows for timely surgical intervention to repair the damaged peripheral nerve to restore lost function and minimize future deficits. Nerve recovery is slow even with appropriate treatment and sometimes needs to be augmented with nerve transfer or tendon transfer procedures to optimize outcomes.
If you have sustained a traumatic laceration or have had a recent surgery where there is concern for a peripheral nerve injury, seek medical evaluation as soon as possible. Early surgical intervention is critical to overall patient improvement. Examples of a peripheral nerve injury include:
- Finger or hand lacerations resulting in numbness and pain beyond the site of injury
- Shoulder or elbow dislocations with loss of sensation or extremity function
- Soft tissue or nerve tumor removal surgery with postoperative pain, tingling, or loss of function
Radial Tunnel Syndrome
Radial tunnel syndrome is a set of symptoms that include fatigue or a dull, aching pain at the top of the forearm with use. Although less common, symptoms can also occur at the back of the hand or wrist.
The symptoms are caused by pressure on the radial nerve, usually at the elbow. The radial nerve is one of the three main nerves in the arm. It runs from the neck to the back of the upper arm. Next, it crosses the outside of the elbow and goes down to the forearm and hand. At the elbow, the radial nerve enters a narrow tunnel formed by muscles, tendon, and bone. This is called the radial tunnel.
Peripheral nerve surgeries are often performed by surgeons with little training in peripheral nerve disorders. Patients often present to our clinic complaining of their continued experience of pain, tingling, and numbness despite prior surgery to repair or decompress their damaged nerves.
Revisional peripheral nerve surgery can be a very powerful tool to diminish these negative symptoms and allow patients to recover to a more functional level. Re-exploration of the area often reveals the peripheral nerves to be incompletely decompressed, as in the case of persistent tingling and numbness in patients having had a prior carpal tunnel decompression. Patients with prior nerve repairs who are still experiencing issues are often found to have a neuroma, or tangled nerve regrowth, preventing further clinical improvement. These conditions are amenable to surgical treatment and will not improve with continued observation.
If you have had a prior nerve decompression, such as a carpal or cubital tunnel release and have not had any clinical improvement, schedule an appointment for an evaluation. Recent cases of revisional nerve surgeries:
- Persistent tingling and numbness in the ring and small finger of a patient who had a prior ulnar nerve decompression. The patient was told to keep waiting for improvement despite no clinical signs of change. A revisional procedure was performed that showed the ulnar nerve to be encased in a dense scar. The ulnar nerve was freed from its scarring and also transposed into a new location to prevent future nerve compression.
- Dense numbness and tingling in a patient with two prior carpal tunnel decompressions. A revisional procedure was performed demonstrating a scarred median nerve that had been partially lacerated by the initial treating surgeon. The median nerve was dissected out of the scarred tissue and placed in a healthy tissue bed with a vascularized fat flap to help cover it.