Dr. O'Donnell treats wrist and forearm fractures, scaphoid and other carpal injuries, TFCC tears, carpal tunnel syndrome, De Quervain's tenosynovitis, trigger finger and thumb base arthritis. His patients include athletes who fell on an outstretched hand, cyclists and skaters, new parents with wrist pain from lifting an infant, and adults in Coral Gables and Miami whose hands go numb at night or whose thumb hurts opening a jar.
Most of these conditions are treated without an operation, and the treatment is defined. A wrist fracture that is undisplaced, or that holds its position after a reset, goes into a cast with X-rays repeated weekly for three weeks. Carpal tunnel starts with a night splint and, if needed, an ultrasound-guided injection, which also predicts the response to surgery. A TFCC tear is splinted for four to six weeks. Trigger finger and De Quervain's usually settle with a single injection. Surgery is recommended when specific criteria are met: a fracture outside the alignment limits or slipping in the cast, constant numbness or thumb weakness from carpal tunnel, a tendon still locking after injections, or a wrist still catching after splinting. Dr. O'Donnell performs volar plate fixation, carpal tunnel and De Quervain's release, trigger finger release and wrist arthroscopy, and the plate or release lets motion begin within one to two weeks rather than after six weeks of immobilization.
Therapy after surgery follows Dr. O'Donnell's written protocols for motion, grip and return to sport. Operations are outpatient at Bayside Surgery Center; patients outside South Florida can upload X-rays or an MRI through mymedicalimages.com and arrange telemedicine consults and post-operative visits.
When to see a specialist
A sore wrist after a fall or a week of heavy typing often improves with a few days in a brace. The following signs need an examination and usually an X-ray within a day or two:
- A visibly bent or swollen wrist or forearm after a fall, or pain that stops you gripping
- Tenderness in the hollow at the base of the thumb after a fall, even with a normal X-ray, which is how a scaphoid fracture presents
- Numbness in the thumb, index and middle fingers that is now constant rather than only at night, or a weak or wasted thumb muscle
- A finger that locks bent and must be straightened with the other hand
- Clicking or pain on the little-finger side of the wrist when turning a key or a doorknob
- Pain at the base of the thumb with pinching that has lasted more than 6 weeks
How Dr. O'Donnell decides between rehab and surgery
Fractures are decided on measurements. A distal radius fracture is treated in a cast when the joint surface is level and the alignment sits within accepted limits after any reset; when it is displaced, involves the joint, or slips on the weekly X-ray, Dr. O'Donnell fixes it with a volar plate, usually within one to two weeks of injury, because the plate allows early motion and avoids a malunited wrist. A both-bone forearm fracture in an adult is almost always plated, since rotation of the forearm depends on both bones healing at the correct length.
Nerve and tendon conditions are decided on severity and response. Carpal tunnel syndrome with intermittent night symptoms gets six to twelve weeks of splinting and an injection; constant numbness, thumb weakness or a moderate-to-severe nerve study means waiting risks permanent nerve damage, and release is recommended without a prolonged trial. Trigger finger and De Quervain's get one, sometimes two, injections; a finger that still locks or a thumb still painful after that is released, a short outpatient procedure with motion the same day.
Hand & Wrist conditions we treat 7
Hand & Wrist procedures 3
Rehabilitation protocols
Dr. O'Donnell's written physical therapy protocols for this joint, shared with your therapist and progressed on criteria rather than dates.
Frequently asked questions
Is my wrist broken or sprained?
Swelling, a visible change in shape, and pain that stops you gripping or bearing weight through the hand point to a fracture, but a sprain can look similar. An X-ray answers the question in most cases; a scaphoid fracture can be missed on the first film, so tenderness at the base of the thumb is treated as a fracture until a repeat X-ray or MRI clears it. Same-week appointments are kept for suspected fractures.
Do I need surgery for carpal tunnel?
Not if symptoms are intermittent and mostly at night. A night splint and an ultrasound-guided injection control mild and moderate cases, and many patients need nothing more. Release is recommended for constant numbness, thumb weakness or wasting, a moderate or severe nerve study, or symptoms that return after splinting and injection. The operation takes about 15 minutes and night symptoms usually stop within days.
How long is a wrist fracture in a cast?
About six weeks for a fracture treated without surgery, followed by six to eight weeks of therapy for motion and grip. After volar plate fixation there is no cast: a removable splint is worn for comfort and wrist motion begins within one to two weeks, with lifting restrictions until the bone has healed at about six weeks. Desk work is possible within days either way.
Can a TFCC tear heal without surgery?
Most stable tears become comfortable within six to twelve weeks of splinting, and a degenerative central tear often settles even though the disc itself does not heal. Surgery is considered for a tear that still catches after splinting, or a peripheral tear causing instability, which has a blood supply and can be repaired. If the ulna is long on X-ray, shortening it addresses the cause.
