Contributor:
Neal Chen, MD, Mass General Brigham Sports Medicine hand specialist and chief of the Hand & Arm Center at Massachusetts General Hospital

When you have an arm, wrist or hand injury, surgery might seem like the default choiceespecially when you want to get back into the game quickly. But there are actually other, non-surgical options depending on your injury and several other factors.

Non-surgical treatments can deliver big wins for many sports medicine injuries, while helping sidestep the possible risks of surgical treatment. However, there are some instances where an operative procedure simply delivers the biggest returns.

"We want to make sure that everybody has the opportunity to have treatment that is nonsurgical," says Neal Chen, MD, hand specialist for Mass General Brigham Sports Medicine, and chief of the Hand & Arm Center at Massachusetts General Hospital. "So we like patients to optimize their non-operative options before electing to go on a surgical path."

Choosing to pursue or forgo arm, wrist or hand surgery takes research, an open conversation with your care team, and some personal reflection. Here are some things to consider in making the decision:

Is Hand Surgery Always Necessary?

The short answer is no. Relieving pain and restoring function are the ultimate goals of orthopedic treatment for hand, wrist or arm injuries. If you can achieve those through more conservative treatments, you can avoid surgery, particularly for injuries that are mild to moderate.

"Deciding on surgery has to do with more than just your injury type and its severity. Your age, activity level and athletic status factor in, too."

Corticosteroid injections can often improve functionality and relieve chronic hand pain when over-the-counter medications or physical therapy aren't enough. Conservative treatment is also the go-to for problems like golfer's elbow and tennis elbowwith the latter often resolving on its own within 12 to 18 months. And around three quarters of mallet finger cases can be treated with splints alone.

There are still some instances where surgery should be the first choice. Operative procedures often give the best results for severe sports injuries. For instance, a badly broken or crushed wrist will likely need wrist surgery to reset the bones so the injury can heal properly.

Assessing Your Options

"Deciding on surgery has to do with more than just your injury type and its severity. Your age, activity level and athletic status factor in too," Chen says.

Someone who plays basketball or tennis recreationally, for example, may be more willing to take a slow-and-steady approach with a physical therapist. But a professional or Division 1 college athlete might choose surgery if it'll help them get back in the game faster.

After thoroughly evaluating your injury, your sports medicine care team can walk you through different treatment scenarios. Making an informed decision that aligns with your goals and expectations is important.

When talking with your surgeon, consider asking things like:

  • What are the benefits of arm, wrist or hand surgery, and how long will they last? Could I need additional surgery in the future?
  • What percentage of patients have success with arm, hand or wrist surgery?
  • What are the alternatives to surgery, and do they offer a similar outcome?
  • What will post-surgery recovery look like? When can I return to my normal activities?
  • What happens if I don't have surgery? Will the condition get worse or could it eventually resolve?
  • Will I need physical therapy after surgery?

Getting a Second Opinion for Hand Surgery

When possible, it makes sense to get your second opinion from an orthopedic specialist who has extensive experience treating your type of arm or hand injury. It's also a good idea to seek out a specialist who's part of a multidisciplinary team, like the Mass General Brigham Sports Medicine team. A collaborative approach to treatment gives you access to a range of specialists who can help fully coordinate your care, and ultimately, help you bounce back faster.

When to Choose Surgery

Opting to undergo surgery is a personal choice. It's often the best route for severe sports injuries, but even for milder ones, surgery might make sense if more conservative treatments aren't improving your pain or helping you reach your function goals.

"The surgical pathway may be more consistent in terms of getting the results you want, especially if there may be irreversible problems if we don't proceed with surgery," Chen says.

Ultimately, it's up to patients and their doctors to make the right decision for them. So do your research, get your physician's advice and think about your own values and preferences. When you add it all up, chances are, the best game plan will be clear.

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Request an appointment with a Mass General Brigham Sports Medicine specialist. The call center is available Monday through Friday, 8 am -  5 pm. Our dedicated team is committed to providing expert care for your sports injury. Please use the form below or call 617-726-0500 to determine the care that is best for you.

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