PROCEDURES
Shoulder and Elbow
The shoulder and elbow represent some of the most mechanically complex joints in the body — and some of the most consequential when they fail. Whether the problem is degenerative, traumatic, or the result of years of overhead demand, the goal is the same: restore function with the least intervention necessary, and the most durable result possible. For cases that require surgery, I perform both arthroscopic and open procedures, including joint replacement at both the shoulder and elbow, with experience in complex revision and fracture patterns that many general orthopedic surgeons refer out.
Shoulder arthritis
Primary and revision; anatomic and reverse total shoulder arthroplasty (TSA).
Shoulder arthritis encompasses a spectrum — from early cartilage loss manageable with activity modification and biologics, to end-stage joint destruction requiring replacement. I perform both anatomic TSA, which reconstructs the native geometry of the joint, and reverse TSA, which is indicated when the rotator cuff is deficient or when revision surgery requires a more stable construct. For patients who have had a prior replacement that has failed or loosened, revision arthroplasty is among the most technically demanding procedures in shoulder surgery — and one I perform regularly.
Rotator cuff tears
Arthroscopic and open repair; partial, full-thickness, and massive tears.
Rotator cuff tears range from small partial-thickness lesions that respond well to rehabilitation and biologic augmentation, to massive, retracted tears that require complex reconstruction or tendon transfer. I approach each case based on tear pattern, tissue quality, patient age, and functional demand — not a one-size protocol. Arthroscopic repair is appropriate for most tears; select massive or revision cases benefit from open or mini-open techniques. Biologic augmentation at the time of repair is an option worth discussing for patients who want to optimize the healing environment from the start.
Shoulder instability
Bankart repair, Latarjet procedure; recurrent anterior and posterior dislocation.
Recurrent shoulder instability — the shoulder that keeps coming out — is a mechanical problem that rarely resolves without addressing the underlying structural deficit. For patients with intact bone stock, arthroscopic Bankart repair restores the labral bumper that keeps the humeral head seated. When significant bone loss is present on the glenoid or humeral head, the Latarjet procedure — which transfers the coracoid process to augment the anterior glenoid — provides more reliable long-term stability. Posterior instability, which is frequently misdiagnosed, is also treated surgically when conservative measures fail.
AC joint injuries
Acute and chronic acromioclavicular separation; reconstruction and stabilization.
Acromioclavicular separations range from mild sprains requiring no intervention to complete dislocations that leave the clavicle visibly displaced and the shoulder mechanically compromised. Acute high-grade separations in active patients are best addressed surgically within the first few weeks; chronic separations that were initially managed nonoperatively and remain symptomatic can also be reconstructed, though the surgical approach differs. The goal in either case is restoring the relationship between the clavicle and the coracoid, and with it, normal scapular mechanics.
Biceps tendon pathology
Proximal biceps tenotomy and tenodesis; distal biceps rupture repair.
Biceps pathology presents at both ends of the muscle. At the shoulder, the long head of the biceps tendon is a frequent and underappreciated source of anterior shoulder pain — one that often persists despite rotator cuff treatment if not addressed directly. Tenotomy (releasing the tendon) or tenodesis (reattaching it at a lower point) resolves this reliably, with the choice between them informed by patient age, activity level, and cosmetic preference. At the elbow, a distal biceps rupture — typically felt as a sudden pop with heavy lifting — requires prompt surgical repair to restore full elbow flexion and supination strength.
Shoulder impingement / bursitis
Arthroscopic subacromial decompression and bursectomy.
Subacromial impingement and bursitis represent some of the most common sources of shoulder pain, and also some of the most overtreated. A meaningful percentage of patients improve with physical therapy, activity modification, and targeted injection — and surgery should not be the first answer. For patients who have genuinely exhausted conservative options and continue to have mechanical symptoms from a narrowed subacromial space, arthroscopic decompression and bursectomy reliably reduce pain and restore comfortable overhead function.
SLAP tears
Arthroscopic superior labrum repair or biceps tenodesis depending on age and activity.
SLAP tears — injuries to the superior labrum where the biceps tendon attaches — are frequently identified on MRI and just as frequently overtreated. The clinical picture matters more than the imaging finding: many SLAP tears are incidental, and surgery is indicated only when the tear is clearly symptomatic and has failed appropriate conservative management. When surgery is warranted, the choice between labral repair and biceps tenodesis depends on patient age, activity demands, and the specific tear pattern — a decision made in the context of a real conversation, not a standing protocol.
Proximal humerus fractures
ORIF and arthroplasty; periprosthetic and complex comminuted patterns.
Fractures of the proximal humerus — the ball-and-socket end of the upper arm — span an enormous range of severity. Many can be managed nonoperatively with good results. When surgery is indicated, the options include open reduction and internal fixation with modern locking plate systems, hemiarthroplasty, or reverse total shoulder arthroplasty — with the choice driven by fracture pattern, bone quality, patient age, and functional goals. Periprosthetic fractures, which occur around a previously placed shoulder implant, represent a particularly complex subset that requires careful preoperative planning and implant-specific expertise.
Scapular / clavicle fractures
ORIF for displaced clavicle fractures; scapular fractures including glenoid.
Displaced clavicle fractures in active patients have increasingly clear evidence supporting surgical fixation over nonoperative management — shorter recovery, lower nonunion rates, better functional outcomes. Scapular fractures are less common and more variable; most heal without surgery, but fractures involving the glenoid articular surface or those with significant displacement can lead to long-term shoulder dysfunction if not addressed. Glenoid fractures in particular require careful evaluation and, when indicated, precise surgical reconstruction to preserve joint congruity.
Elbow arthritis
Total elbow arthroplasty; primary and post-traumatic arthritis.
Elbow arthritis — whether primary or the result of prior trauma or inflammatory disease — can be profoundly disabling, limiting the simple mechanics of lifting, reaching, and load-bearing that most people take for granted. Total elbow arthroplasty is a reliable option for appropriately selected patients, though it carries important activity restrictions that require a direct conversation about lifestyle and expectations. Post-traumatic arthritis following prior fracture or dislocation represents a distinct and technically demanding subset, often requiring careful management of prior hardware and scar tissue.
Lateral epicondylitis (tennis elbow)
Open and arthroscopic débridement; chronic refractory cases.
Lateral epicondylitis is among the most common elbow complaints — and among the most frequently mismanaged. The vast majority of cases resolve with time, activity modification, and targeted rehabilitation. Surgery is reserved for the minority of patients with truly chronic, refractory symptoms that have persisted despite adequate conservative treatment including physical therapy and, where appropriate, orthobiologic intervention. When surgery is indicated, both open and arthroscopic débridement of the degenerative tissue at the extensor origin are effective, with return to full activity typically expected within a few months.
Medial epicondylitis (golfer's elbow)
Open débridement and repair of flexor-pronator origin.
Medial epicondylitis follows a similar clinical course to its lateral counterpart but involves the flexor-pronator muscle origin on the inside of the elbow — a region that also lies in close proximity to the ulnar nerve. Careful clinical evaluation is important to distinguish pure medial epicondylitis from concurrent cubital tunnel syndrome, which can present similarly and requires different management. When surgery is appropriate, open débridement and repair of the flexor-pronator origin reliably addresses the degenerative tendon tissue driving symptoms.
Elbow instability / UCL tears
UCL reconstruction (Tommy John); lateral and posterolateral rotatory instability.
Ulnar collateral ligament tears are well known in the context of overhead throwing athletes, where UCL reconstruction — Tommy John surgery — has become a reliable path back to competitive sport. Less recognized is that elbow instability presents in non-athletes as well, and that lateral and posterolateral rotatory instability — where the elbow subluxates with certain movements — is frequently missed or attributed to other causes. A careful clinical examination, often supplemented with stress imaging, is the key to accurate diagnosis and appropriate surgical planning.
Distal humerus fractures
ORIF; total elbow arthroplasty for comminuted patterns in older patients.
Distal humerus fractures are among the most technically demanding fractures in the upper extremity — involving the articular surface of the elbow joint and requiring precise reconstruction to restore mechanics and prevent stiffness. In younger patients and those with reasonable bone quality, open reduction and internal fixation with dual-column plating is the standard. In older patients with severe comminution or poor bone stock, primary total elbow arthroplasty can offer faster recovery and comparable long-term function — a decision made on a case-by-case basis.
Olecranon fractures
ORIF with tension band or plate fixation; olecranon bursitis excision.
The olecranon — the bony prominence at the back of the elbow — is a common fracture site, particularly after a direct fall. Most displaced fractures require surgical fixation to restore the pull of the triceps muscle and elbow extension strength. Fixation options include tension band constructs and plate fixation, with the choice depending on fracture pattern and bone quality. Olecranon bursitis — inflammation of the fluid-filled sac overlying the olecranon — is a separate and common condition; when chronic, infected, or refractory to conservative care, surgical excision is straightforward and effective.
Radial head fractures
ORIF and radial head arthroplasty; terrible triad injury management.
Radial head fractures are the most common elbow fractures in adults and range widely in severity. Minimally displaced fractures are treated nonoperatively with early motion; displaced or comminuted fractures may require fixation or radial head replacement to restore elbow stability and forearm rotation. The so-called "terrible triad" — a fracture-dislocation pattern involving the radial head, coronoid process, and lateral ligament complex — is one of the most challenging injuries in elbow surgery, requiring a systematic approach to each component to achieve a stable, functional result.
Elbow contracture / stiffness
Arthroscopic and open elbow contracture release.
The elbow is uniquely prone to stiffness following injury, surgery, or prolonged immobilization — a consequence of its tight capsular anatomy and the rapid fibrosis that follows trauma. Significant loss of motion can be functionally disabling, limiting everything from personal hygiene to occupational tasks. When contracture release is indicated, both arthroscopic and open techniques are available, with the approach determined by the severity and location of the contracture, the presence of hardware, and prior surgical history. A structured postoperative therapy program is essential to maintaining the motion gained at surgery.
Hand And Wrist
The hand is the most functionally precise region of the musculoskeletal system — and the one patients notice most immediately when something goes wrong. Even small deficits in motion, strength, or sensation translate directly into lost capability at work and in daily life. Hand and wrist surgery demands a level of technical precision and anatomic familiarity that comes only from subspecialty fellowship training. I treat the full spectrum of hand and wrist pathology, from common outpatient procedures to complex fractures, arthritis reconstruction, and tendon surgery.
Distal radius fractures
Volar locking plate ORIF; complex intra-articular patterns.
Distal radius fractures — wrist fractures — are among the most common fractures seen across all age groups, from young patients after high-energy trauma to older patients after low-energy falls. Not all require surgery, but fractures with significant displacement, shortening, or articular involvement generally do. Volar locking plate fixation has become the standard of care for most operative cases, allowing stable fixation and early motion. Complex intra-articular patterns — those that fragment the joint surface itself — require meticulous reduction and are among the most technically demanding fractures in the hand and wrist.
Scaphoid fractures
Percutaneous and open screw fixation; scaphoid nonunion with bone grafting.
The scaphoid is the most commonly fractured carpal bone, and also the most commonly missed — often initially dismissed as a wrist sprain. Its tenuous blood supply makes it uniquely vulnerable to nonunion and avascular necrosis when fractures go unrecognized or are inadequately treated. Acute fractures in active patients are increasingly treated surgically with headless compression screw fixation, which allows earlier return to activity. Established nonunions — fractures that have failed to heal — require more complex reconstruction, typically involving bone grafting to restore vascularity and structural integrity to the scaphoid.
Wrist arthritis (SNAC/SLAC)
Proximal row carpectomy; four-corner fusion; total wrist arthroplasty.
Scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) are the two most common patterns of progressive wrist arthritis, both resulting from chronic carpal instability that alters load distribution across the joint. When the arthritis is localized, motion-preserving procedures — proximal row carpectomy or four-corner fusion — can eliminate the arthritic contact while preserving a functional range of motion. When arthritis is diffuse and pan-carpal, total wrist arthroplasty or complete wrist fusion are the remaining options, each with distinct tradeoffs in motion and load-bearing capacity that warrant careful discussion.
TFCC tears / wrist instability
Arthroscopic TFCC repair and reconstruction; DRUJ stabilization.
The triangular fibrocartilage complex (TFCC) is the primary stabilizer of the ulnar side of the wrist and the distal radioulnar joint (DRUJ) — and a common source of ulnar-sided wrist pain that is frequently underdiagnosed. TFCC tears may result from acute injury or develop through chronic repetitive loading, and their significance depends as much on the associated instability as on the tear itself. Arthroscopic repair is appropriate for peripheral tears with good healing potential; central tears and chronic instability patterns may require formal reconstruction. DRUJ instability, when present, must be addressed concurrently to restore forearm rotation and wrist mechanics.
Wrist ganglion cysts
Arthroscopic and open excision; dorsal and volar ganglia.
Ganglion cysts are the most common soft tissue masses of the hand and wrist — benign, fluid-filled outpouchings that arise most often from the scapholunate ligament on the dorsum of the wrist, or from the radiocarpal joint volarly. Many are asymptomatic and require no treatment. When cysts are painful, enlarging, or functionally limiting, excision is reliable and effective. Arthroscopic excision offers the advantage of directly visualizing and addressing the underlying ligament pathology that gives rise to the cyst — which may contribute to lower recurrence rates compared to open excision alone.
De Quervain tenosynovitis
First dorsal compartment release; open and ultrasound-guided.
De Quervain tenosynovitis is inflammation of the tendons at the base of the thumb — the abductor pollicis longus and extensor pollicis brevis — as they pass through a tight fibrous tunnel at the radial styloid. It is particularly common in new parents and those with repetitive thumb and wrist use. Most cases respond to splinting, activity modification, and corticosteroid injection. When symptoms persist, surgical release of the first dorsal compartment is straightforward, highly effective, and typically performed as a brief outpatient procedure with rapid recovery.
Trigger finger
A1 pulley release; open and percutaneous technique.
Trigger finger occurs when the flexor tendon catches or locks within the A1 pulley at the base of the finger, producing the characteristic clicking, locking, or inability to fully straighten the digit. Corticosteroid injection resolves the majority of cases without surgery. For patients with recurrent triggering or a digit that is locked in flexion, A1 pulley release — performed open or percutaneously — is one of the most reliable minor procedures in hand surgery, with immediate restoration of smooth tendon gliding and a recovery measured in days rather than weeks.
Dupuytren contracture
Fasciectomy; Xiaflex collagenase injection; needle aponeurotomy.
Dupuytren contracture is a fibroproliferative condition of the palmar fascia that causes progressive finger flexion contracture — most commonly of the ring and small fingers — and can significantly limit hand function over time. Treatment options exist along a spectrum of invasiveness: needle aponeurotomy disrupts the cord percutaneously in the office; Xiaflex (collagenase clostridium histolyticum) injection enzymatically weakens the cord before manipulation; and surgical fasciectomy directly excises the diseased tissue. The right choice depends on the severity of contracture, the joints involved, and the patient's goals and tolerance for recurrence risk — a conversation worth having early, before contracture becomes severe.
Hand / finger fractures
Metacarpal and phalangeal ORIF; K-wire fixation; complex periarticular patterns.
Fractures of the hand and fingers are among the most common orthopedic injuries — and among the most consequential when managed inadequately. Malrotation, shortening, or articular incongruity in a finger can translate into lasting grip weakness, stiffness, and functional impairment that patients notice with every task. Many fractures can be managed with splinting and early supervised motion; those with significant displacement, rotation, or articular involvement require surgical fixation. The choice between K-wire fixation and formal plate-and-screw constructs depends on fracture geometry, location, and the soft tissue envelope — decisions that require both technical judgment and an understanding of hand rehabilitation.
Finger joint arthritis
PIP and MP arthroplasty; DIP fusion; pyrocarbon and silicone implants.
Arthritis of the finger joints affects grip strength, pinch mechanics, and the fine motor tasks that define hand function. At the DIP joint — the fingertip knuckle — fusion is the most reliable option, trading a small arc of motion for a pain-free, stable joint. At the PIP and MP joints, arthroplasty with silicone or pyrocarbon implants can restore functional motion while relieving pain, with implant selection guided by the joint involved, the patient's activity demands, and the status of the surrounding soft tissue. These are nuanced decisions that benefit from a detailed conversation about what the patient actually needs the hand to do.
Flexor / extensor tendon injuries
Zone I–V flexor repair; extensor repair and reconstruction; tenolysis.
Tendon injuries of the hand demand both technical precision and a sophisticated understanding of rehabilitation — because the outcome depends as much on how the tendon heals as on how well it was repaired. Flexor tendon injuries are classified by zone, with Zone II — the "no man's land" between the A1 and A4 pulleys — historically the most challenging due to the dual-tendon anatomy and tight pulley system in that region. Extensor injuries, while often perceived as simpler, carry their own complexity, particularly at the PIP joint. When adhesions limit tendon gliding after primary repair, tenolysis — surgical freeing of the tendon from surrounding scar — can restore motion that therapy alone cannot recover.
Reconstructive And Peripheral Nerve
Peripheral nerve surgery sits at the intersection of microsurgery, reconstructive planning, and a deep understanding of how the nervous system responds to injury — and to intervention. Recovery after nerve injury is measured in months to years, not weeks, and outcomes depend critically on the timing of treatment, the precision of repair, and the rehabilitation that follows. I treat the full spectrum of nerve compression and injury, from common entrapment syndromes to complex nerve reconstruction following trauma or tumor resection. I also offer peripheral nerve stimulation (PNS) for the management of chronic pain — one of the few orthopedic surgeons in the region to do so — providing a surgical option for patients who have exhausted conventional pain management and are looking for a durable, non-opioid alternative.
Carpal tunnel syndrome
Open and endoscopic carpal tunnel release.
Carpal tunnel syndrome — compression of the median nerve at the wrist — is the most common peripheral nerve entrapment, producing the characteristic numbness, tingling, and nocturnal awakening that most patients recognize before they arrive. Mild to moderate cases respond well to splinting and activity modification; when symptoms are severe, persistent, or accompanied by thenar muscle weakness, surgical release is indicated and highly effective. Both open and endoscopic techniques are offered, with the approach tailored to the patient's anatomy, prior surgery, and occupational demands. Earlier intervention, before permanent nerve damage occurs, produces better outcomes — a point worth emphasizing to patients who have been symptomatic for years.
Cubital tunnel syndrome
In-situ decompression and anterior transposition of the ulnar nerve.
Cubital tunnel syndrome is the second most common peripheral nerve entrapment — compression of the ulnar nerve at the elbow producing numbness in the ring and small fingers, intrinsic muscle weakness, and the characteristic difficulty with fine pinch and grip that patients often attribute to aging or overuse. When conservative measures fail, surgical decompression is reliable. The choice between simple in-situ decompression and anterior transposition of the nerve — moving it to the front of the elbow — depends on the severity of compression, the presence of nerve subluxation, and prior surgical history. Advanced cases with intrinsic wasting require careful counseling about realistic recovery expectations.
Radial tunnel / PIN compression
Posterior interosseous nerve decompression; radial tunnel release.
Radial tunnel syndrome and posterior interosseous nerve (PIN) compression are among the most frequently missed diagnoses in elbow and forearm pain. Both involve compression of the radial nerve or its deep branch as it passes through the radial tunnel near the lateral elbow — a region that overlaps anatomically with lateral epicondylitis, leading to frequent misdiagnosis and years of unsuccessful treatment. Pure radial tunnel syndrome presents as pain without motor deficit; PIN compression produces weakness of finger and wrist extension without sensory loss. When the diagnosis is confirmed and conservative management has failed, surgical decompression is effective and often dramatically clarifies a clinical picture that has been unclear for years.
Peripheral nerve injuries
Nerve repair, grafting, and conduit; targeted muscle reinnervation (TMR).
Peripheral nerve injuries — whether from trauma, laceration, tumor, or iatrogenic causes — represent some of the most consequential and least reversible injuries in the upper extremity. The biology of nerve regeneration is slow and finite: axons regrow at approximately one millimeter per day, which means that delays in diagnosis or treatment translate directly into permanent functional loss. Primary nerve repair, when possible, produces the best outcomes. When a gap exists, nerve grafting — using expendable sensory nerves as conduits — or synthetic nerve conduits bridge the defect. Targeted muscle reinnervation (TMR), originally developed for amputees, is an increasingly applied technique for managing painful neuromas and optimizing prosthetic control in patients with limb loss.
Chronic pain / Peripheral nerve stimulation (PNS)
Implantable peripheral nerve stimulation for refractory chronic pain.
Chronic pain following nerve injury, surgery, or complex regional pain syndrome represents one of the most difficult management challenges in musculoskeletal medicine — and one where conventional treatment frequently falls short. Peripheral nerve stimulation is an implantable, non-opioid neuromodulation approach that delivers targeted electrical signals to a specific peripheral nerve, interrupting the pain pathway at its source rather than masking it systemically. I am one of the few orthopedic surgeons in the region offering PNS implantation — a reflection of the belief that surgeons who understand peripheral nerve anatomy are best positioned to deliver this therapy precisely and safely. For carefully selected patients who have not responded to conservative pain management, nerve blocks, or prior surgical intervention, PNS offers a meaningful and durable option worth discussing.
Upper Extremity ATX — Fellowship-trained hand, upper extremity, and peripheral nerve surgery. Located at the Austin Surgical Plaza – 6818 Austin Center Blvd, Suite 207, Austin TX. Better care, by design.
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