Hand and Wrist

1) Carpal tunnel release

Carpal tunnel syndrome is a common condition characterized by pressure on the median nerve as it travels through a narrow passageway in your wrist called the carpal tunnel. This pressure can result in symptoms such as pain, numbness, tingling, and weakness in the hand and fingers. Factors contributing to carpal tunnel syndrome include repetitive hand movements, wrist injury, certain health conditions like diabetes or arthritis, and even pregnancy.

When is Carpal Tunnel Release Surgery Recommended?

While non-surgical treatments such as splinting, medication, and physical therapy are often effective in managing mild to moderate carpal tunnel syndrome, surgery may be necessary for severe cases or when conservative measures fail to provide relief. Your healthcare provider will evaluate your symptoms, medical history, and conduct diagnostic tests to determine if surgery is the best course of action.

Understanding Carpal Tunnel Release Surgery

Carpal tunnel release surgery is a common and relatively straightforward procedure designed to alleviate pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel. This surgical intervention aims to widen the tunnel and reduce compression on the nerve, thereby relieving symptoms and improving hand function.

Types of Carpal Tunnel Release Surgery

Open Carpal Tunnel Release: In this traditional approach, a small incision is made in the palm of the hand, allowing the surgeon to access the carpal tunnel directly. The ligament is then divided to decompress the median nerve. Open surgery may require a longer recovery period compared to minimally invasive techniques.

Endoscopic Carpal Tunnel Release: This minimally invasive procedure involves making one or two small incisions in the wrist or palm. A thin tube equipped with a camera (endoscope) is inserted, providing the surgeon with a clear view of the carpal tunnel. Specialized instruments are used to cut the ligament, minimizing tissue trauma and promoting faster recovery.

Recovery and Rehabilitation

Following carpal tunnel release surgery, you may experience some discomfort, swelling, and stiffness in the hand and wrist. Your healthcare provider will provide specific instructions on post-operative care, including wound care, pain management, and exercises to restore strength and flexibility. Most patients can resume light activities within a few days to weeks, with full recovery typically achieved within several months.

Benefits of Carpal Tunnel Release Surgery

• Alleviation of pain, numbness, and tingling
• Restoration of hand function and grip strength
• Improvement in quality of life and productivity
• Prevention of further nerve damage and complications

It's important to note that while carpal tunnel release surgery can provide significant relief for many individuals, outcomes may vary, and there are inherent risks associated with any surgical procedure. Be sure to discuss your concerns, expectations, and treatment options with your healthcare provider to make informed decisions about your hand and wrist health.

2) Scaphoid Fracture Fixation

The scaphoid bone is situated near the base of the thumb and plays a crucial role in wrist movement and stability. A scaphoid fracture occurs when there is a break or crack in this bone, typically due to trauma. Symptoms of a scaphoid fracture may include pain, swelling, tenderness in the wrist, difficulty gripping objects, and limited range of motion.

When is Scaphoid Fracture Fixation Recommended?

While some scaphoid fractures may heal with conservative treatments such as immobilization in a cast or splint, others may require surgical intervention, particularly if the fracture is displaced or fails to heal properly. Your healthcare provider will conduct a thorough evaluation, including imaging tests like X-rays or MRI scans, to determine the extent of the injury and the most appropriate course of treatment.

Understanding Scaphoid Fracture Fixation Surgery:

Scaphoid fracture fixation surgery involves stabilizing the fractured bone with internal fixation devices such as screws, pins, or plates. The goal of this procedure is to realign the bone fragments, promote healing, and restore wrist function. Depending on the severity and location of the fracture, your surgeon may recommend one of the following surgical approaches:

Open Reduction Internal Fixation (ORIF): In this traditional approach, a small incision is made in the wrist, allowing the surgeon to directly access the fractured scaphoid. The bone fragments are then realigned, and specialized implants, such as screws or plates, are used to hold the bone in place while it heals.

Percutaneous Screw Fixation: This minimally invasive technique involves making small incisions or using a needle to insert screws across the fracture site, without the need for a large surgical exposure. Percutaneous screw fixation offers several potential benefits, including reduced tissue trauma, faster recovery, and smaller scars.

Recovery and Rehabilitation

After scaphoid fracture fixation surgery, you will need to follow a comprehensive rehabilitation program to optimize healing and regain strength and mobility in your hand and wrist. Your healthcare provider will provide specific guidelines on post-operative care, including immobilization with a splint or cast, exercises to improve range of motion and strength, and gradual return to normal activities.

Benefits of Scaphoid Fracture Fixation Surgery

• Restoration of wrist stability and function
• Alleviation of pain and discomfort
• Reduced risk of long-term complications such as arthritis or wrist instability
• It's important to adhere to your healthcare provider's recommendations and attend follow-up appointments to monitor your progress and address any concerns or complications that may arise during the recovery process.

Remember, with proper treatment and rehabilitation, you can overcome a scaphoid fracture and get back to doing the things you love with confidence and comfort.

3) Base Of Thumb Fracture Fixation

The thumb plays a pivotal role in hand function, facilitating essential tasks such as gripping, grasping, and pinching. Consequently, any injury to the thumb, especially at its base, can significantly impact daily activities. A base of thumb fracture occurs at the joint where the thumb meets the hand, known as the first carpometacarpal joint.

Causes

Base of thumb fractures typically result from trauma, such as a fall onto an outstretched hand or a direct blow to the thumb. These fractures are prevalent among individuals engaged in activities that involve repetitive thumb motions or those with weakened bones, such as in osteoporosis.

Symptoms

Symptoms of a base of thumb fracture include pain, swelling, bruising, tenderness at the base of the thumb, limited range of motion, and difficulty gripping objects.

Treatment Options

Conservative Management: Minor fractures may be managed conservatively with immobilization using a splint or cast, along with pain management and physical therapy.

Surgical Fixation: For more severe fractures or cases where conservative measures fail to provide relief, surgical intervention may be necessary.

Surgical Procedure - Base of Thumb Fracture Fixation: During the surgical procedure for base of thumb fracture fixation, the surgeon will typically:

• Make an incision over the base of the thumb.
• Realign the fractured bone fragments to their proper position.
• Utilize various fixation methods, such as pins, screws, wires, or plates, to stabilize the fracture and promote proper healing.
• Close the incision with sutures.

Recovery and Rehabilitation: After surgery, patients will undergo a period of rehabilitation, which may include:

• Immobilization of the thumb with a splint or cast.
• Physical therapy exercises to restore range of motion, strength, and function.
• Follow-up appointments with the surgeon to monitor healing progress.

Outcome

With appropriate treatment and rehabilitation, most individuals with base of thumb fractures can expect significant improvement in symptoms and a return to normal activities. However, the specific outcome may vary depending on the severity of the fracture, the effectiveness of treatment, and individual factors such as age and overall health.

Conclusion

Base of thumb fracture fixation is a surgical procedure aimed at restoring the function and stability of the thumb following a fracture. By providing comprehensive information about the condition, its causes, treatment options, and expected outcomes, we aim to empower individuals to make informed decisions about their healthcare. If you or a loved one is experiencing symptoms of a base of thumb fracture, we encourage you to consult with a qualified healthcare professional for proper evaluation and management.

4) Flexion Tendon Repair

Flexion tendons are vital structures in your hand and wrist that allow for bending or flexing movements. They play a crucial role in everyday activities such as gripping objects, typing, and writing. However, when these tendons are injured or damaged, it can severely impact your ability to perform these tasks and diminish your overall quality of life.

The Need for Flexion Tendon Repair

Injuries to the flexion tendons can occur due to various reasons, including trauma, lacerations, repetitive stress, or degenerative conditions. When a flexion tendon is torn or severed, it typically requires surgical intervention to restore proper function. Without timely and appropriate treatment, the affected hand and wrist may experience stiffness, weakness, and limited mobility.

The Surgical Procedure

Flexion tendon repair surgery involves carefully reattaching the torn or severed tendon to its original insertion point on the bone or using grafts to bridge the gap if necessary. The procedure is typically performed under local or general anesthesia, depending on the extent of the injury and the patient's preferences.

During the surgery, the surgeon makes small incisions to access the damaged tendon and repair it using specialized techniques and materials. In some cases, additional procedures such as tendon transfers or tenolysis (removal of scar tissue) may be performed to optimize outcomes.

Recovery and Rehabilitation

Recovery from flexion tendon repair surgery requires patience, commitment, and adherence to a structured rehabilitation program. Initially, the hand and wrist may be immobilized with a splint or cast to protect the repaired tendon and promote healing. As healing progresses, controlled movement exercises, hand therapy, and gradual strengthening exercises are introduced to restore function and prevent stiffness.

The duration of recovery varies depending on the extent of the injury, the surgical technique used, and individual factors such as age and overall health. However, most patients can expect to regain significant function within a few months of surgery with diligent rehabilitation efforts.

Benefits of Flexion Tendon Repair

• Restores mobility and functionality to the hand and wrist
• Improves grip strength and fine motor skills
• Reduces pain and discomfort associated with tendon injuries
• Enhances overall quality of life and independence

Conclusion

Flexion tendon repair surgery is a highly effective treatment option for restoring function and mobility to the hand and wrist following injuries or conditions affecting the flexor tendons. By understanding the procedure and actively participating in rehabilitation, patients can achieve optimal outcomes and regain confidence in their ability to perform daily activities.

If you're experiencing symptoms of a flexion tendon injury or have been advised to undergo surgery, consult with a qualified orthopedic surgeon or hand specialist to explore your treatment options and develop a personalized care plan tailored to your needs. With timely intervention and proper management, you can overcome the challenges posed by flexion tendon injuries and reclaim your active lifestyle.

5) Extensor Tendon Repair

Extensor tendons are the ones that enable you to straighten your fingers and thumb. These tendons run along the back of your hand and wrist, allowing you to extend your fingers to grasp and hold objects. When these tendons are injured, whether due to trauma or overuse, it can severely impact your hand function.

Extensor tendon repair surgery is a procedure performed to address injuries to these tendons. It involves the surgical repair of damaged or severed extensor tendons in the hand and wrist to restore function and mobility.

Reasons for Extensor Tendon Repair

• Traumatic Injuries: Commonly caused by lacerations, crush injuries, or sports-related accidents.
• Tendon Ruptures: Complete or partial tears of the extensor tendons due to trauma or overuse.
• Tendon Lacerations: Sharp cuts or wounds that sever the extensor tendons.
• Tendon Adhesions: Scar tissue formation that restricts tendon movement.
• Preparing for Surgery: Before the surgery, your healthcare provider will conduct a thorough examination and may order imaging tests to assess the extent of the injury. You may be advised to stop certain medications, such as blood thinners, and refrain from eating or drinking for a specified period before the surgery.

The Surgical Procedure

Anesthesia: You will be given anesthesia to ensure you are comfortable and pain-free during the procedure. This may be local anesthesia with sedation or general anesthesia, depending on the extent of the surgery and your medical history.

Incision: The surgeon will make a precise incision over the injured area to access the damaged tendon.

Tendon Repair: The damaged or severed ends of the tendon are carefully identified and stitched back together using specialized sutures or techniques.

Closure: Once the repair is complete, the incision is closed with sutures or surgical staples.

Recovery and Rehabilitation

• Immobilization: After surgery, your hand and wrist may be placed in a splint or cast to protect the repaired tendon and promote healing.
• Physical Therapy: A structured rehabilitation program will be prescribed to gradually restore strength, flexibility, and function to the hand and wrist.
• Follow-up Care: Regular follow-up appointments will be scheduled to monitor progress, remove sutures, and adjust the treatment plan as needed.

Risks and Complications

While extensor tendon repair surgery is generally safe and effective, complications may occur, including infection, stiffness, reduced range of motion, tendon re-rupture, and nerve damage. It's essential to follow your surgeon's instructions carefully and report any unusual symptoms promptly.

Benefits of Extensor Tendon Repair

• Restores hand function and mobility
• Improves grip strength and dexterity
• Reduces pain and discomfort associated with tendon injuries
• Facilitates a faster return to daily activities and work

Conclusion

Extensor tendon repair surgery is a specialized procedure aimed at restoring function and movement to the hand and wrist following injuries to the extensor tendons. With advancements in surgical techniques and rehabilitation protocols, the outlook for patients undergoing this surgery is generally positive. If you've experienced an injury to your extensor tendons, consult with a qualified hand surgeon to explore your treatment options and determine the best course of action for your recovery.

6) Wrist Fusion

Wrist fusion surgery, also known as arthrodesis, is a procedure aimed at stabilizing the wrist joint by fusing the bones together. This is typically recommended when other treatment options, such as medication, physical therapy, or less invasive surgeries, have failed to provide relief from wrist pain or instability.

During the surgery, the surgeon removes any damaged cartilage and then secures the bones of the wrist together using metal plates, screws, or rods. Over time, these bones fuse together, creating a solid, stable joint. While this limits the flexibility of the wrist, it often eliminates pain and allows for improved function.

Indications for Wrist Fusion Surgery

Wrist fusion surgery may be recommended for various conditions, including:

• Severe Arthritis: Arthritis can cause significant pain and stiffness in the wrist joint, making everyday activities challenging. Wrist fusion surgery can help alleviate these symptoms and improve wrist function.
• Wrist Instability: Chronic instability in the wrist, often due to ligament damage or previous injuries, can lead to pain, weakness, and limited mobility. Wrist fusion surgery can stabilize the joint, reducing symptoms and improving overall function.
• Failed Previous Surgeries: In cases where previous surgeries have not provided the desired outcome, wrist fusion surgery may be considered as a salvage procedure to restore stability and function.

Benefits of Wrist Fusion Surgery

While wrist fusion surgery may sound intimidating, it offers several benefits for individuals struggling with wrist pain and instability:

• Pain Relief: By eliminating movement in the affected joint, wrist fusion surgery can significantly reduce or even eliminate chronic pain.
• Improved Stability: Fusion creates a stable joint, which can enhance grip strength and overall wrist stability.
• Enhanced Functionality: While wrist fusion restricts some wrist movements, many individuals find that they can still perform most activities of daily living with little to no difficulty.
• Long-Term Solution: Wrist fusion surgery provides a long-term solution for chronic wrist problems, potentially avoiding the need for ongoing treatments or repetitive surgeries.

Recovery and Rehabilitation

Recovery from wrist fusion surgery varies from person to person but typically involves a period of immobilization followed by physical therapy to regain strength and mobility. Your healthcare team will provide detailed instructions on post-operative care and rehabilitation exercises to optimize your recovery.

Conclusion

Wrist fusion surgery is a valuable option for individuals suffering from severe wrist pain or instability. By stabilizing the joint and relieving symptoms, it can greatly improve quality of life and restore functionality. If you're considering wrist fusion surgery, consult with a qualified orthopedic surgeon to discuss your options and determine the best course of action for your unique situation.

7) Ganglion Excision

Ganglion cysts are noncancerous lumps that typically develop along tendons or joints in the hand or wrist. These cysts are filled with a thick, jelly-like fluid and can vary in size from small pea-sized lumps to larger masses. While ganglion cysts are usually harmless, they can cause pain, weakness, and limited mobility, particularly if they press on nearby nerves or interfere with joint movement.

Indications for Ganglion Excision Surgery

Ganglion excision surgery may be recommended if:

• Symptoms Persist: If conservative treatments such as splinting, aspiration, or anti-inflammatory medications fail to provide relief, surgery may be considered.
• Discomfort Affects Daily Life: Ganglion cysts causing significant pain, weakness, or interference with daily activities may warrant surgical intervention.
• Cosmetic Concerns: In some cases, individuals may opt for surgery to remove ganglion cysts for cosmetic reasons, particularly if they are large or unsightly.

The Ganglion Excision Procedure

Ganglion excision surgery is typically performed under local or general anesthesia on an outpatient basis, meaning you can go home the same day. During the procedure:

• Incision: The surgeon makes a small incision over the ganglion cyst.
• Cyst Removal: The cyst and its associated stalk, if present, are carefully dissected and removed from the surrounding tissues.
• Closure: The incision is closed with sutures, and a sterile dressing is applied.

Benefits of Ganglion Excision Surgery

Ganglion excision surgery offers several benefits for individuals with symptomatic ganglion cysts:

• Pain Relief: Removing the ganglion cyst can alleviate discomfort and pain, allowing for improved hand and wrist function.
• Prevention of Recurrence: While ganglion cysts may recur following surgery, the risk of recurrence is generally lower compared to nonsurgical treatments such as aspiration.
• Improved Mobility: By removing the cyst, surgical intervention can restore joint mobility and reduce limitations in hand and wrist movements.

Recovery and Rehabilitation

Recovery from ganglion excision surgery is typically relatively quick, with most individuals able to resume light activities within a few days. Your healthcare provider will provide specific instructions on post-operative care, including wound care and restrictions on activities.

Conclusion

Ganglion excision surgery is an effective treatment option for individuals experiencing pain and discomfort due to ganglion cysts in the hand or wrist. By removing the cyst and addressing associated symptoms, this surgical procedure can significantly improve quality of life and restore functionality.

8) De Quervain’s Release

De Quervain's tenosynovitis is a painful condition that affects the tendons on the thumb side of your wrist. These tendons, responsible for the movement of your thumb, can become swollen and irritated, leading to discomfort and limited mobility in the wrist and thumb area. Common symptoms include pain, swelling, and difficulty gripping or pinching.

When Surgery is Necessary

In most cases, De Quervain's tenosynovitis can be managed with conservative treatments such as rest, splinting, and anti-inflammatory medications. However, if symptoms persist despite these interventions, or if the condition is severe, surgery may be recommended.

De Quervain's Release Procedure

De Quervain's Release, also known as De Quervain's tenosynovectomy, is a surgical procedure aimed at relieving the pressure on the affected tendons by enlarging the tendon sheath tunnel. During the procedure:

• Anesthesia: You will typically be given local anesthesia to numb the area, although in some cases, general anesthesia may be used.
• Incision: The surgeon will make a small incision at the base of your thumb or on the side of your wrist, depending on the technique preferred.
• Release: The surgeon will then carefully cut open the constricted tendon sheath, allowing more room for the tendons to move freely without causing pain or irritation.
• Closure: Once the procedure is complete, the incision will be closed with stitches or surgical tape.

Recovery Process

After the surgery, you may experience some discomfort and swelling, which can be managed with pain medications and ice packs. It's essential to keep the operated hand elevated to reduce swelling and follow any post-operative instructions provided by your surgeon diligently.

Physical therapy may be recommended to help restore strength and mobility to the wrist and thumb gradually. Most individuals can resume light activities within a few weeks, but it may take several months to fully recover and return to strenuous activities or sports.

Conclusion

De Quervain's Release surgery can offer significant relief for individuals suffering from persistent symptoms of De Quervain's tenosynovitis. While it's essential to explore conservative treatments first, surgery can be a highly effective option for those who have not found relief through other methods. If you're considering De Quervain's Release or have any questions about the procedure, don't hesitate to consult with a qualified healthcare professional for personalized guidance and care.

9) Trigger Finger/Thumb Release

Trigger finger/thumb, medically known as stenosing tenosynovitis, is a condition where one of your fingers or your thumb gets stuck in a bent position and then straightens with a snap — like a trigger being pulled and released. This occurs when the flexor tendon becomes inflamed or thickened, making it difficult for it to glide smoothly within the sheath.

Indications for Surgery

While trigger finger/thumb can often be managed with non-surgical treatments such as rest, splinting, and corticosteroid injections, surgery may be recommended if symptoms persist or worsen. Common indications for trigger finger/thumb release surgery include:

• Failure of conservative treatments.
• Persistent pain and stiffness.
• Inability to straighten the affected finger/thumb.
• Impaired hand function affecting daily activities.

The Surgical Procedure

Trigger finger/thumb release surgery is a relatively simple outpatient procedure usually performed under local anesthesia. Here's what typically happens during the surgery:

• Preparation: You'll be positioned comfortably, and the surgical site will be cleaned and sterilized.
• Anesthesia: Local anesthesia will be administered to numb the hand and wrist, ensuring you feel no pain during the procedure.
• Incision: Your surgeon will make a small incision at the base of the affected finger/thumb or in the palm, depending on the location of the problematic tendon.
• Release: The surgeon will carefully cut the tight portion of the flexor tendon sheath to create more space for the tendon to move freely.
• Closure: The incision will be closed with stitches, and a bandage or dressing will be applied.

Recovery and Rehabilitation

Recovery from trigger finger/thumb release surgery is usually swift, with many patients experiencing relief from symptoms almost immediately. Here are some key points regarding the recovery process:

• Postoperative Care: You'll be given specific instructions on wound care, hand elevation, and exercises to promote healing and prevent stiffness.
• Returning to Activities: Most patients can resume light activities within a few days and return to work within a week, depending on the nature of their job.
• Physical Therapy: Your surgeon may recommend hand therapy to help regain strength and range of motion in the affected finger/thumb.

Potential Risks and Complications

While trigger finger/thumb release surgery is generally safe and effective, as with any surgical procedure, there are potential risks and complications to be aware of. These may include:

• Infection
• Bleeding
• Nerve damage
• Scar tissue formation
• Recurrence of symptoms

Conclusion

Trigger finger/thumb release surgery is a commonly performed procedure that can provide significant relief for individuals suffering from the symptoms of this condition. If you're experiencing persistent finger/thumb stiffness, pain, or locking, consult with a hand surgeon to determine whether surgical intervention is the right option for you.