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Hand Surgery

Overview

Surgery For Hand Conditions

Elective hand surgery is a very wide complex field of surgery. This is because hand function is critically important to everyday life – to work, to live, to create, to gesture and to care for yourself and others at the least. The many small bones, long and short tendons, nerves and vascular structures in your upper limb and hand must work in absolute harmony in order for your hand to execute complex everyday manipulative function.

The intricate nature of these structures is hence why many plastic surgeons are commonly called upon to treat hand pathologies – including but not limited to: fractures, nerve and tendon compression problems, contractures, small hand tumours and arthritis.

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Hand surgery and x ray
Carpal Tunnel Release

Carpal Tunnel Release

This operation is often required if you are suffering from carpal tunnel syndrome. The median nerve is a structure which travels from your neck into the hand. There are various points along the way when it may be susceptible to compression, and this commonly occurs in the wrist – in a small “tunnel” underneath a thick band of tissue.

Compression of this nerve at the wrist causes numbness of some or most of the thumb, index, middle and part of the ring fingers, which you may find is much worse at night time, or during activities such as driving, using tools, or even whilst using the phone. As time progresses, the ability to use the small muscles in the hand may also become compromised – at which point you may find dropping things and the inability to open jars a real problem in your everyday life.

A carpal tunnel release is performed to relieve your median nerve of this compression, thereby allowing it to function again.

Trigger Finger Release

Does your finger catch or “lock” when you try and bend it fully? If so, you may be experiencing a trigger finger. The name is very fitting, as once the digit is “locked”, the only way to unbend the finger is often with the aid of your other hand – hence the term “trigger”.

It is a common disorder where the tendon sheath is too narrow for the flexor tendon to glide through, hence becoming stuck during motion. Release is performed to relieve your tendon of this compression, thereby allowing it to function again with full range of motion.

Trigger Finger
Dupuytrens Contracture

Dupuytren's Contracture Release

This is a condition where one or more of your fingers become permanently stuck in a bent (flexed) position. This condition normally starts with nodules developing under the skin in your palm, which evolve overtime into long cords of disease within the tissues of the palm. You may experience pain and discomfort with these early nodules – especially if you are using your hands a lot everyday for manual labour.

Treatment may also be considered if your hand cannot lay completely flat on a table. Surgery may range from simple excision to complex procedures with tissue flaps and/or grafts, depending on the severity of your disease at the time it’s addressed.

De-Quervain’s Release

De-Quervain’s syndrome is a condition affecting a compartment in the back of your wrist, which may cause tendon compression. This commonly results in wrist pain, especially when you are gripping things or rotating your wrist, and commonly upon using your thumb.

Symptoms are commonly aggravated by repetitive manual duties. In selected cases, steroid injection may help to relieve symptoms acutely, but surgery may be required to release the tight wrist tendon compartment if you are experiencing more severe and chronic symptoms.

Dequervain Syndrome Release
Small hand tumour

Small Hand Tumours

Small hand tumours are relatively common. A lump in your hand, wrist or finger may be a ganglion, lipoma (benign fat lump), cyst, or other types of benign tumours.

Malignant tumours are rare but do exist. it is therefore important to seek medical advice early to ensure the correct investigation, diagnosis and treatment is made. Removal of benign tumour lumps often require intricate dissection of tendinous and neurovascular structures

What to Expect

Surgery, Recovery & Post Operative

Recovery time and progress will be different depending on your symptoms, injury and presentation at the very least. Your follow-up will be closely monitored at our practice, and in majority of cases rehabilitation will be organised through a private hand therapist close to your area of residence. This ensures adequate mobilisation protocols and scar care post-operative, in order to maximise your recovery and facilitate early return to work, duties and tasks.

It is important for you to seek medical assistance as early as possible to address these hand and upper limb troubles, for left untreated for a prolonged period of time, recurrent compression, irritation and inflammation of various structures may lead to a very slow (and in some cases, incomplete) recovery post-operatively.

Every surgery carries some degree of risk. These will be explained and discussed with you during your initial consultation, if you are considering to proceed with any surgery. Some of the possible general complications may include:

  • Wound infection or breakdown (requiring dressings and/or antibiotics)
  • Pain and discomfort around the wound sites
  • Haematoma (blood clot which may require evacuation)
  • Bleeding (which may necessitate blood transfusion)
  • Deep vein thrombosis (a blood clot in the leg, which in rare occasions, may travel to the lungs and become life threatening)
  • Hypertrophic, stretched or keloid scar
  • Anaesthetic complications depending on local or general anaesthetic (which will be addressed by your anaesthetist)

Your Next Step

Discuss Your Hand Condition

Book a consultation to discuss your hand condition and surgery or to get a second opinion from a qualified plastic surgeon.