Symptoms
Common symptoms
- Comprehensive hand & wrist evaluation
- Same-day imaging at most offices
- Conservative-first care plan tailored to your goals
- Coordinated specialty referrals when needed
- In-network insurance for most major carriers
Wide-Awake Hand Surgery
— no IV, no fasting, same hour home.
Many hand and wrist procedures at LAOSS are done with local anesthesia only — no IV sedation, no general anesthesia, no tourniquet. The technique is called WALANT (Wide-Awake Local Anesthesia No Tourniquet), and it changes the recovery experience entirely.
Live · Now Accepting
Comfortable, conversational, fast.
You're awake and talking to your surgeon throughout — and home before lunch.
WALANT
Technique
Key takeaways
- Local anesthesia only — no IV sedation, no general anesthesia, no tourniquet.
- No fasting required — eat normally before your appointment.
- Same-hour return home for most cases — no recovery room observation.
- You're awake and can talk to your surgeon during the procedure — they can ask you to move the hand to verify the repair.
Overview
About wide-awake hand surgery (walant)
Wide-Awake Hand Surgery (WALANT) is part of the comprehensive hand & wrist care we offer at LAOSS. Below, we walk through the anatomy involved, who benefits from this service, what it looks like at our clinics, and the recovery and risk considerations to weigh.
Our specialists move stepwise — start with the least-invasive option that fits, escalate only when it doesn't.
Patient education
Watch: What Does a Hand Surgeon Do?
Your hands are highly complex and sensitive organs. The hand's bones, muscles, nerves, blood vessels and other soft tissues can be damaged by injury or disease. Hand surgeons are doctors who specialize in these issues. They make sure your hands, wrists, and forearms work well.
Animations licensed from ViewMedica · Swarm Interactive
Anatomy of the hand & wrist — carpal bones, tendons, and the median nerve.
Anatomy
Inside the hand & wrist.
The hand and wrist are an intricate stack of small bones, tendons, and nerves that let you grip, pinch, and feel.
What this service covers
What we offer with wide-awake hand surgery (walant).
Causes
Common causes
- New patients exploring an orthopedic complaint
- Existing LAOSS patients continuing care
- Patients seeking a second opinion
- Athletes and active adults of every age
How LAOSS care works
How we start treatment
When you book with LAOSS for wide-awake hand surgery (walant), here's the flow:
- Initial visit — detailed history, focused exam, on-site X-ray when needed
- Diagnosis & plan — most patients leave with imaging-confirmed answers and a written treatment plan
- Treatment — whether that's PT, an injection, or surgery, your specialist stays involved at every step
- Follow-up — measured benchmarks, direct line to your care team, plan adjustments as recovery progresses
Treatment options
Hand & wrist care, conservative-first.
We start with the least-invasive option that fits — and escalate only when it doesn't.
Conservative care
Step 1Conservative care first
Non-surgical options designed to relieve pain, restore movement, and avoid the OR when possible.
- Custom splinting & bracing
- Image-guided steroid injections
- Hand therapy with a CHT-certified PT
- Activity & ergonomic modification
- PRP for chronic tendinopathy
Surgical care
When neededSurgical options when needed
Minimally invasive and reconstructive procedures performed by board-certified orthopedic surgeons.
- Wide-awake (WALANT) hand surgery
- Carpal tunnel release
- Trigger finger release
- Wrist or thumb joint reconstruction
- Fracture fixation
Surgeon expertise
Why experience matters.
Why experience matters
Hand & wrist care is highly technique-dependent. Volume, training, and judgment together determine the outcome you feel six months later.
- Precise diagnosis from imaging and exam
- Conservative-first care that avoids unnecessary surgery
- Technique refined over thousands of cases
- On-site imaging + coordinated PT through your in-network provider
The LAOSS approach
Our hand & wrist specialists move stepwise — start with the least-invasive option that fits, escalate only when it doesn't.
- Same-day imaging at most offices
- PT coordinated in your insurance network
- Board-certified specialists performing the procedures themselves
- Direct access to your specialist between visits
Candidacy
Am I a candidate?
If most of these match your situation, an evaluation with a hand & wrist specialist is the next step.
You may be
You may be a candidate if
These signs typically point toward this service being a good fit.
- Hand & wrist pain or dysfunction lasting more than a few days
- Swelling, instability, or noticeable change in function
- Symptoms that limit walking, lifting, sleep, or work
- Previous treatment that didn't fully resolve the problem
- Imaging or exam findings that suggest an underlying issue
Evaluation
What evaluation includes
Your first visit is built to give you an answer the same day, not just another referral.
- Detailed history — onset, mechanism, what makes it better or worse
- Hands-on exam focused on the affected joint or region
- On-site imaging at most offices (X-ray, ultrasound)
- Clear plan with options ranging from conservative to surgical
- Same-day or next-day scheduling for any follow-up tests
ImportantSeek urgent evaluation for sudden severe pain, numbness, progressive weakness, loss of bowel or bladder control, or any sign of infection (fever, increasing redness or swelling).
Recovery
Your hand & wrist recovery roadmap.
Recovery is rarely a straight line — but a clear plan with measurable milestones makes the path predictable.
01Days 0–14
Right after care
In the first two weeks we focus on protecting the hand & wrist, calming inflammation, and restoring basic motion.
- Activity modification with clear do/don't guidance
- Ice, elevation, and pain control as needed
- Gentle range-of-motion within safe limits
- Follow-up scheduled to track healing
02Weeks 2–8
Rehabilitation
Targeted physical therapy rebuilds strength, mobility, and confidence in the hand & wrist.
- Progressive strengthening and neuromuscular work
- Manual therapy and soft-tissue treatment
- Sport- or job-specific movement re-training
- Coordinated PT through your in-network provider
03Months 2+
Long-term care
Once function is restored, the focus shifts to keeping you there — and catching any recurrence early.
- Return-to-activity plan with measured benchmarks
- Home program tailored to your sport or job
- Maintenance visits or imaging if symptoms change
- Direct line back to your specialist if needed
Risks & considerations
What to weigh before you decide.
We talk through the risks and benefits with every patient — informed consent is a conversation, not a form.
General
General considerations
Every orthopedic intervention carries a small set of standard risks. We screen, prepare, and monitor for these on every patient.
- Infection (rare with modern technique and prophylaxis)
- Bleeding or bruising at the treatment site
- Reaction to anesthesia or medications
- Need for additional procedures in some cases
Specific
Hand & wrist-specific considerations
Some risks are tied to the structures we're treating in the hand & wrist. We discuss these in detail at your visit so you can weigh them against the benefits.
- Temporary stiffness or weakness during recovery
- Incomplete pain relief in a small percentage of cases
- Nerve or vessel irritation near the treatment area
- Need for follow-up therapy to fully restore function
Your care team
Meet our hand & wrist specialists
At LAOSS, our hand & wrist specialists combine advanced surgical expertise with a patient-first approach. From minimally invasive techniques to comprehensive rehab coordination, our physicians bring decades of experience to every case. Trusted across Los Angeles, our team is dedicated to restoring mobility, relieving pain, and helping you return to the activities you love.
Your care team
Specialists, not generalists.
About this care
Reliable wide-awake hand surgery (walant) care starts here
At LAOSS, expert care is close to home. With same- or next-day appointments at eight Los Angeles–area offices, you'll never wait weeks or months for answers. Whether you need physical therapy, injections, or surgery, you'll receive coordinated, personalized care every step of the way.
Call or schedule online today to begin your recovery with a trusted hand & wrist specialist in Los Angeles.
Patient reviews
What patients say about us.
★★★★★4.97,500+ Google reviews
Dr. Pelton has been my ortho for years. The whole practice is run beautifully. Quick to get appointments, knowledgeable staff, and a doctor who actually remembers you.
Roberto Castillo
East LA, CA · 17 May 2025
Common questions
Wide-awake hand surgery — FAQ.
- No. The local anesthetic numbs the surgical area completely before any incision is made. Most patients describe it as feeling pressure or movement but no pain. Many sleep, listen to music, or chat with the surgeon during the procedure.
- There's a brief sting from the initial numbing injection — similar to a dental shot. Our hand surgeons use a slow-injection technique that minimizes even that. After the injection, the area is numb for the entire procedure.
- Yes — as long as only one hand is involved and your other hand is fine to drive. Because there's no IV sedation or general anesthesia, you're not impaired afterward. We do recommend planning a calm rest of the day.
- Fasting before surgery is required to prevent vomiting under general anesthesia. Since WALANT uses no general anesthesia, there's no need to skip food or water. Eat normally before your appointment.
- Yes — WALANT procedures are billed as standard hand surgery codes and covered by insurance the same way traditional hand surgery would be. Because we don't need an OR or anesthesiologist, the procedure is often less expensive for both you and your insurance.
- Patients with severe anxiety about being awake, certain complex hand or wrist conditions requiring extended OR work, or patients who specifically prefer traditional anesthesia. Your LAOSS hand surgeon will discuss whether WALANT is right for your specific case.
- In a procedure room at the LAOSS office, not in a hospital OR. The room is fully sterile and equipped for hand surgery — but feels more like a clinic exam room than a hospital surgical suite.
Ready to learn more
Book a hand consult with LAOSS.
Our hand surgeons will evaluate your condition and let you know whether wide-awake surgery is the right approach. Same-week appointments available at our East LA, Wilshire, Tarzana, Encino, and Glendale offices.
Booking now
21 specialists · 8 offices
Greater Los Angeles
On-site X-raySame visit
Most insurers acceptedIn-network