Hand Surgery

Many hand surgery advances have been made in recent years to correct imperfections caused by injury or birth defects. Hand surgery may also be performed to correct the effects of a traumatic injury, inflammatory disorders, a surgical procedure, aging or occasionally for purely cosmetic reasons. Hand surgeons strive to provide the best care possible for hand surgery patients and work closely with occupational therapists and other surgeons to achieve an optimal result. Hand surgery is often covered by insurance.

In addition, services include the evaluation and management of a wide range of work-related upper extremity disorders. Hand surgery services extend to peripheral nerve compression disorders of the upper and lower extremity such as carpal tunnel syndrome or tarsal tunnel syndrome.

Hand surgery techniques vary, depending upon the reason for the procedure. Common reasons to be referred to a hand surgeon include:

• Carpal tunnel syndrome, in which pressure builds up in the passageway through the wrist carrying tendons and one of the hand's major nerves. This can happen as a result of arthritis, injury, fluid retention during pregnancy, thyroid disease, overuse or repetitive motions. Surgery involves cutting the tissue that presses on the nerve to release the pressure.
  
  We perform this procedure either open or endoscopically. The transverse carpal ligament is released either with an open incision or by introducing a scope through a small incision in the wrist. Recovery depends on the method used but can be quick, often with return to full activities within a few weeks.

• Congenital defects that interfere with proper hand growth in children, such as the fusing together of two fingers (known as syndactyly). Surgery involves cutting the tissue that connects the fingers, then grafting skin from another part of the body. Other common defects include short, missing or deformed fingers or portions of the wrist, immobile tendons and abnormal nerves or blood vessels.

• Dupuytren's contracture, a disorder of the tissue just under the skin in which thick, scar-like bands form under the skin of the palm and fingers, restricting motion. Surgery is a precise procedure that involves carefully removing the bands of thickened tissue, freeing the joints and allowing the fingers to move more normally. Recovery can take several weeks, and often requires some time in hand therapy. Depending on the severity of the contracture, some patients qualify for an enzymatic injection that may help alleviate the degree of contracture.

• Traumatic injury to the tendons, nerves, blood vessels and joints; fractured bones; burns; cuts and other soft tissue injuries to the skin. In cases of injury, a variety of innovative techniques can be used including: plating or pinning of fractures; tendon repairs, grafts, or transfers; nerve repairs, grafts or transfers; blood vessel repair or reconstruction; skin grafting or flap surgery; and in certain indicated situations replantation can be performed.

• Rheumatoid arthritis, a chronic disorder of inflammation of the joints that can deform finger and wrist joints and force them into positions that impede movement. Surgeons can repair or reconstruct many areas of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, implanting artificial joints or fusing joints.

• Brachial Plexus Injuries, these can be the result of sharp injuries in the shoulder and neck area from motorcycle accidents and falls, or from birth related trauma. The brachial plexus, which is a meeting of nerve origins, can be stretched, torn or lacerated as a consequence of these accidents. Damage to these nerves can cause pain, numbness, and weakness from the shoulder to the hand. Management of these difficult problems depends on the cause and can vary from direct nerve repair to nerve transfers.

Other common indications for evaluation of surgery include:

• Degenerative arthritic conditions, i.e., osteoarthritis of the hand and wrist

• Additional peripheral nerve entrapments, i.e., cubital tunnel syndrome or tarsal tunnel syndrome

• Wrist arthroscopy

• Microsurgery

• Other Plastic Surgery related services, our surgeons are trained in plastic surgery and are able to address other reconstructive needs as well 

Hand surgery is often performed using regional anesthesia with sedation. Patients return home with dressings or splints that must be kept elevated above the heart. In addition, our patients enjoy a close working relationship with our hand therapists postoperatively and  sometimes preoperatively depending on the condition.

For more information about hand and plastic surgery services please call 401-444-3327.