UH Hand Surgeon Heals Humanity’s Essential Tools

UH Clinical Update | November 2023

People use their hands for hundreds of specific tasks each day, but our hands are also one of the ways through which we interact with the world.

Jonathan Macknin, MD

Yet, says Jonathan Macknin, MD, FAAOS, “While they are right there, in front of everyone, we don’t think about them.” Sometimes people don’t notice others’ hands either, he observes, even when they are missing a finger.

Board certified in orthopedic surgery/hand surgery, Dr. Macknin serves as Medical Director of Hand & Upper Extremity and Chairman, Department of Surgery, at UH Geauga Medical Center.

Roots of a fascination: It was during one of his medical school rotations that he first operated on someone’s injured hand during a trauma call: “That’s when I knew I wanted to do this - as soon as I did the first one.”

Part of it was the immense satisfaction he felt at being able to physically correct a condition or injury for the patient and the fairly immediate results for the patient of his doing that.  

Another powerful draw was the hand’s anatomy, which meant surgically working with soft issue and bone, sometimes with screws, or performing extremely delicate nerve repairs.

Those feelings of satisfaction have never faded, Dr. Macknin says.

Recently, Dr. Macknin was one of the physicians honored through a “Dinner with the Doc” Cliff Appreciates honor. He was nominated by Marlea Miano, MD, Chief Medical Officer at UH Geauga Medical Center, for his exemplary efforts in advancing systemness.

Leadership at UH Geauga: Dr. Miano says that includes his chairing the UH Geauga Medical Center surgery department during the COVID-19 crisis; assisting with hand call at UH Cleveland Medical Center; working closely with orthopedic residents and thoughtfully engaging them; and changing surgical practices to drive greater value for patients and improving efficiency for the UH system.

Dr. Macknin also served as the voice of the medical staff during a recent crisis situation at UH Geauga, ensuring transparent communications that enhanced trust between clinicians and leaders. And he was also lauded for always engaging in crucial conversations in a respectful and productive manner.

A medical family: Jonathan Macknin was born and raised in Cleveland, graduating from Beachwood High School; both of his parents were physicians. A career in medicine seemed fairly logical and interesting to him. His mother, Carol Macknin, MD, was between her first and second year of medical school when he was born; she became a psychiatrist and is now semi-retired. His father, Michael Macknin, MD, is a pediatrician who works at UH Rainbow Babies & Children’s Hospital at the UH Rainbow Babies & Children’s Ahuja Center for Women & Children.

Dr. Macknin graduated from the University of Pennsylvania, having majored in Biological Basis of Behavior, and then graduated from its medical school. He completed a general surgery internship at Case Western Reserve University School of Medicine, followed by the Allen Research Fellowship in its Department of Orthopaedics. He also served his residency in orthopedics there, followed by a hand fellowship at the University of Connecticut School of Medicine.

He re-joined UH in January 2018.

Diverse problems, diverse solutions: There is a huge variety of conditions that leads patients to see a hand surgeon.

Of course, there is trauma, the worst of which are what Dr. Macknin calls “high-energy” injuries, such as those from a gunshot wound, or car or ATV accident.

Other injuries occur more frequently in older adults, many of whom might suffer a wrist fracture because of osteoporosis. “That is a huge part of the wrist fracture practice, but we can often treat those non-operatively,” he says. “A lot depends on the alignment, the patient’s activity level and neurological involvement.”

On the trauma side, he performs surgery on fractured wrists and fingers, and tendon or nerve injuries. “With hand surgery, as is true for many things, it becomes so important to treat patients in a timely fashion. The faster we get their hand or fingers moving, the better the outcome.”

Especially delicate hand or wrist surgeries are those done on athletes, musicians and artists, whose work or career might depend on near 100 percent recovery and mobility.

The elective part of his practice is mostly nerve, tendon and arthritis-related, says Dr. Macknin, with arthritis most commonly seen in the base of the thumb or in the wrist. “The most common elective issues that I treat are carpal tunnel syndrome and various tendon irritations.”

In recent years, he has seen carpal tunnel syndrome more frequently in younger patients. While typing and repetitive motions can aggravate carpal tunnel syndrome, they have not been shown to cause it. But, he says, “We do know that vibrational activities like construction can cause carpal tunnel syndrome.“

Another common condition that Dr. Macknin sees for treatment is “trigger finger” – technically known as stenosing tenosynovitis. This affects the tendons that flex the fingers and thumb, usually resulting in a sensation of locking or catching when the fingers are flexed or straightened, because the tendon/tendon sheath has become irritated and swollen. 

There are many hand conditions that respond well to conservative treatment and do not require surgery. “Some conditions respond really well to occupational therapy, bracing or steroid injections,” he says.

Opportunity to innovate: For those who need surgery, he says a big shift in his practice in the past couple of years is the ability to do many cases using only local anesthesia, with no tourniquet. Not needing anesthesia can make procedures safer and allows patients the freedom to drive themselves and to eat before their procedure. Avoiding use of a tourniquet can make procedures more comfortable for patients.

“I feel so fortunate to be back in Cleveland practicing at University Hospitals,” says Dr. Macknin. “We have amazing assets at UH, including the wonderful staff in our offices, the operating room and the hospital. I also have great supportive colleagues I get to interact with regularly and amazing hand therapists that provide top-notch care for my patients. The team work of the entire staff at University Hospitals is what allows me to deliver the best care to my patients.”

To nominate a physician for this honor, you can obtain the form here.