Hand Surgery Treatments
Carpal tunnel syndrome
Carpal tunnel syndrome (CTS) occurs when one of your main nerves, called your median nerve, becomes compressed in the wrist passageway, known as your carpal tunnel. The median nerve manages sensation and movement of your hands and when trapped it causes hand pain, tingly hands and hand clumsiness.
The reason your median nerve becomes squeezed is often not known, other than swollen tissues inside your carpal tunnel or narrowing of the tunnel. However, there are risk factors that increase your likelihood of acquiring the syndrome. These include: family history, pregnancy, hand injury, repetitive work, being female and medical conditions such as thyroid problems, diabetes or rheumatoid arthritis.
If your CTS is mild, non-surgical treatments such as a splint or steroid injection may relieve your symptoms. If these aren’t successful or if permanent nerve damage is possible, surgery will be advised.
Carpal tunnel release surgery, also known as carpal tunnel decompression, is a day case procedure performed under local anaesthetic. It takes less than half an hour and involves your surgeon cutting your carpal tunnel roof to reduce the pressure on your median nerve.
Mr Erman Melikyan, Consultant Orthopaedic Hand Surgeon at New Hall Hospital, Salisbury, discusses the Carpal Tunnel Syndrome, including the common symptoms, what the effects of the carpal tunnel syndrome includes and treatment options available for those with carpal tunnel:
Cubital tunnel syndrome
Cubital tunnel syndrome, or ulnar nerve entrapment, happens when your ulna nerve become trapped at your elbow.
Initially you may feel numbness and a tingly sensation in your ring and little fingers. This may develop into hand pain and weakness. You may feel these symptoms more if your elbows have been bent for long periods or if you’ve been leaning on your elbow.
Your hand surgeon will use a nerve conduction test to make a diagnosis. If your impulses are slow this indicates the nerve is compressed.
Cubital tunnel surgery may be required to prevent permanent nerve damage. It is a day case procedure carried out under general anaesthetic, taking around an hour. Surgery will cut the roof of your cubital tunnel to release pressure on the ulnar nerve where it passes through this tunnel.
Thumb arthritis occurs due to the trapezium bone in your wrist at the base of your thumb being affected by osteoarthritis (wear and tear). If you’ve thumb arthritis, you’ll feel pain where your thumb joins your wrist. It’s often first noticed when you knock or sprain your thumb or wrist. Thumb arthritis is more common in women aged 50 years and above, but many men suffer from it too.
Your hand specialist will diagnose thumb arthritis based on their expertise and an x-ray.
Initially steroid injections are often recommended to treat thumb arthritis.
For long term pain relief, thumb arthritis surgery such as a day case procedure called trapeziectomy will be performed under general anaesthetic. It takes approximately one hour and involves removing the trapezium bone.
Joint replacements in fingers
Osteoarthritis and rheumatoid arthritis can cause pain, swelling and stiffness in your finger joints.
Your hand specialist will make a diagnosis using x-ray and their expert opinion.
Joint replacement surgery is normally recommended to offer long term pain relief of these painful joints. It’s a day case operation most often performed under local anaesthetic. Surgery typically takes around 45 minutes for each joint. Your surgeon can replace several joints during one operation.
Your hand specialist may consider alternative treatments for arthritic joints including steroid injections and surgical joint fusion.
Dupuytren’s contracture occurs when the skin in your palm and fingers becomes thickened and tight. It can progress and cause your fingers to be permanently bent and unable to fully straighten.
Your hand specialist will be able to diagnose this disorder by sight and without any tests.
There are a number of surgeries to treat this condition ranging from cutting a fibrous band in the palm of your hand to removing all of the affected skin and replacing it with skin grafts. Your hand surgeon will recommend the most appropriate treatment based on the severity of your contracture.
Needle fasciotomy, an outpatient procedure, is most often performed for Dupuytren’s contracture. It’s done under local anaesthetic and involves dividing the thickened skin to release the tightness in your hand that's forcing your finger to bend. Open fasciotomy is sometimes used to treat more severe cases of Dupuytren’s contracture.
Ganglions are harmless fluid filled cysts or lumps. They are typically found on your wrist or hand, and in particular on the back of your wrist or on your fingertips. It’s not known what causes ganglions. They can cause no symptoms or they can be painful. Larger ganglions can be unsightly.
Your hand specialist will be able to diagnose a ganglion by examination alone.
You can leave your ganglion untreated if it’s not causing you pain or distress. The most successful treatment for ganglion removal is minor surgery called an excision. It’s performed as an outpatient procedure under local anaesthetic and simply involves removing the ganglion. Unfortunately, ganglions can return to the same site in the future.
Breaks and fractures of hand bones
Hand bone breaks and fractures are common injuries that result in pain, swelling, stiffness and reduced use of the injured hand.
They are usually diagnosed by your hand surgeon’s evaluation and x-rays.
Treatment will depend on the diagnosis. It’s best to treat a fracture within one week of the break. Most breaks and fractures of the hand bone are treated using a splint or cast.
For fractures that require surgery, your hand surgeon will set your bone, holding it together using miniature plates, screws, pins and wires. The bone setting should take around three weeks and be up to full strength after three months.
Fracture treatment is usually covered by health insurance policies and may be a more convenient option than your local NHS fracture clinic.
If you’ve had an x-ray and initial diagnosis elsewhere, please bring copies of your x-rays on CD Rom or your phone to negate the need to repeat them.
Wrist pain is common. It may happen spontaneously or because of an old or new injury, and can be due to problems in your bones, tendons, ligaments and nerves in your wrist.
Often multifaceted investigations are necessary to accurately diagnose wrist pain. These include: x-ray, CT scan, MRI scan, ultrasound, arthroscopy and nerve conduction tests. Once your hand specialist understands the cause of your wrist pain they can recommend appropriate treatment.
New Hall Hospital offers direct access to a hand specialist and comprehensive high quality diagnostic services to allow rapid diagnosis of your wrist pain. Your hand specialist will recommend the best treatment for your individual wrist complaint.