Pushing the Boundaries of Hand Care

At North Texas Hand Center, innovation isn't just a goal—it's our standard of care. We combine advanced microsurgical techniques with cutting-edge diagnostic technology to provide minimally invasive solutions that prioritize your comfort and rapid recovery.

The Value of In-Office Procedures

Key Clinical Benefits

Faster Recovery: Minimally invasive techniques allow patients to return to daily life sooner.
Cost-Effective: Avoid expensive hospital and facility fees associated with traditional operating rooms.
Wide Awake Activation: Real-time 'Wide Awake' activation of the flexor tendon ensures optimal excursion and clinical results during the procedure.
Lower Risk: Local anesthesia significantly reduces the systemic risks associated with general anesthesia or heavy sedation.

*Eligibility for in-office procedures depends on individual insurance authorization and coverage details.

List of In-Office Procedures

• Carpal Tunnel Release: Both Open and Ultrasound Guided

• Cubital Tunnel Release

• Fasciectomy

• Needle aponeurotomy

• Soft Tissue/Tumor Excision (cyst, lipoma, etc.)

• Tennis Elbow Repair

• De Quervain's release

• Excision of Flexor/Extensor tendon

• Muscle Repair (palmar)

• Tendon Repair

• Trigger Finger Release

Registry Recognition: Dr. Hilliard is honored to be listed as a reference for needle aponeurotomy on the International Dupuytren Society website, recognizing his expertise in the field.

Dupuytren's Treatments

Why We Favor Needle Aponeurotomy

Needle Aponeurotomy

Needle Aponeurotomy (NA) is a minimally invasive technique that provides significant clinical advantages for patients with Dupuytren's Contracture:

Immediate Results: Patients often experience full finger extension immediately following the procedure.
Lower Cost: Significantly more affordable than enzyme-based treatments or formal surgery.
Minimally Invasive: Performed under local anesthesia with no incisions, reducing the risk of skin complications.
Rapid Recovery: Most patients return to normal activities within 24-48 hours.

Collagenase Injections

While collagenase injections (enzymatic fasciotomy) are an alternative, they carry comparative drawbacks that patients should consider:

Longer Recovery: Requires a multi-day process involving an injection followed by a cord manipulation visit.
Enzymatic Reactions: Potential for significant swelling, bruising, and skin tears due to the enzymatic action.
Cost Barriers: High medication costs often make this a less accessible option for many patients.
Delayed Results: The mechanical breaking of the cord happens days after the initial treatment.

Sweet S, Blackmore S "Surgical and therapy update on the management of Dupuytren's disease" Journal of Hand Therapy, 2013; 27, 77-84
Zhou, Chao et al. “Comparative Effectiveness of Needle Aponeurotomy and Collagenase Injection for Dupuytren's Contracture: A Multicenter Study.” Plastic and reconstructive surgery, 2017

References

Photo: Acumed, 2026

Arthritis: Restoring Thumb Mobility

CMC arthroplasty with the Acu-sinch tightrope suspension technique is a highly effective procedure for treating thumb base arthritis. Unlike traditional methods, this advanced approach uses a specialized Acu-sinch suspension system to support the thumb metacarpal, preventing bone-on-bone contact after removing the arthritic trapezium bone. This innovation eliminates the need for harvesting a tendon from the forearm, resulting in less surgical trauma, a faster recovery, and more predictable long-term mobility and strength for your grip.

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Precision Ultrasound-Guided Carpal Tunnel Release

Minimally Invasive: Tiny incision often needing only an adhesive bandage.
Rapid Procedure: Typically completed in under 10 minutes.
Safety First: Local anesthesia avoids general sedation risks.
Fast Recovery: Return to normal activities significantly sooner.

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Photos (logo and statistic graphic): Sonex, 2026

Targeted Pain Relief

Ultrasound-guided injections provide unparalleled precision for pain management. By visualizing the needle in real-time, we ensure the therapeutic medication is delivered exactly to the site of inflammation or injury, such as joint spaces or around nerves, maximizing effectiveness while minimizing discomfort and risk to surrounding tissues.