 Why Visit a Hand Surgeon?
A qualified hand surgeon is specially trained to diagnose your
hand condition and to recommend appropriate treatment options.
Not every visit to a hand surgeon results in hand surgery. Hand
surgeons often recommend non-surgical treatment options to assist
you. Sometimes, they may refer you to a hand therapist for more treatment.
Hand surgeons are specialists in hand care. If you have pain in
your fingers, hand, wrist or arm, or have other upper-extremity related
concerns, you may want to consult a hand surgeon.
Common Diagnoses
- Tennis elbow - Stress tendonitis
on the lateral epicondyle. Tennis elbow is an inflammation around
the bony knob on the outer side of the elbow. It occurs when the
tissue that attaches muscle to the bone becomes irritated. The
bony knob is called the lateral epicondyle. The
most common symptom of tennis elbow is pain on the outer side of
the elbow and down the forearm. You may have pain all the time
or only when you lift things. The elbow may also swell, get red,
or feel warm to the touch. Your treatment will depend on how inflamed
your tendon is and may include rest and medication, exercises and
therapy, anti-inflammatory injections and surgery.
- Carpal Tunnel Syndrome - Carpal tunnel syndrome
is a condition brought on by increased pressure or a pinched nerve
at the wrist. Symptoms may include numbness, tingling, and pain
in the arm, hand, and fingers. There is a space in the wrist called
the carpal tunnel where the median nerve and nine tendons pass
from the forearm into the hand. Carpal tunnel syndrome happens
when pressure builds up from swelling in this tunnel and puts pressure
on the nerve. When the pressure from the swelling becomes great
enough to disturb the way the nerve works, numbness, tingling,
and pain may be felt in the hand and fingers. Usually the cause
is unknown. Pressure on the nerve can happen several ways: swelling
of the lining of the flexor tendons, called tenosynovitis; joint
dislocations, fractures, and arthritis can narrow the tunnel; and
keeping the wrist bent for long periods of time. There may be a
combination of causes.
Symptoms can often be relieved without surgery. Identifying and treating
medical conditions, changing the patterns of hand use, or keeping the wrist
splinted in a straight position may help reduce pressure on the nerve. Wearing
wrist splints at night may relieve the symptoms that interfere with sleep.
Anti-inflammatory medication taken by mouth or injected into the carpal tunnel
may help relieve the carpal tunnel symptoms.
When symptoms are severe or do not improve, surgery may be needed to make
more room for the nerve. Pressure on the nerve is decreased by cutting the
ligament which forms the roof (top) of the tunnel on the palm side of the
hand. Incisions for this surgery may vary, but the goal is the same — to
enlarge the tunnel and decrease pressure on the nerve. Following surgery,
soreness around the incision may last for several weeks or months. The numbness
and tingling may disappear quickly or slowly. It may take several months
for strength in the hand and wrist to return to normal. Carpal tunnel symptoms
may not completely go away after surgery, especially in severe cases
- Dupuytren's Contracture - Dupuytren’s
disease is an abnormal thickening of the fascia (the tissue between
the skin and the tendons in the palm) that may limit movement of
one or more fingers. In some patients, a cord forms beneath the
skin that stretches from the palm into the fingers. The cord can
cause the fingers to bend into the palm so they cannot be fully
straightened. Sometimes, the disease will cause thickening over
the knuckles of the finger. It can also occur in the soles of the
feet.
The cause of Dupuytren’s is unknown and there is no
permanent cure. The disease is usually painless. This is a
non-cancerous condition. Dupuytren’s disease mostly affects
white people with ancestors from Northern Europe. It occurs
more often in men than in women, and usually starts after age
40. In many cases, the disease runs in families.
Dupuytren’s disease occurs slowly. It is usually noticed
as a small lump or pit in the palm. This tends to occur near
the crease of the hand that is closest to the base of the ring
and little fingers. With time, a cord may develop between the
palm and the fingers. The disease is usually noticed when the
palm cannot be placed flat on an even surface, such as a table
top.
There is no permanent cure for Dupuytren’s disease.
Surgery can relieve the bending of the fingers into the palm,
but the condition can return with time. The goal of surgery
for Dupuytren’s disease is to restore the use of the
fingers. Your doctor should advise you on whether surgery is
recommended in your case.
-
Peripheral Nerve Disorders - Nerves are the “electrical
wiring” system in all people that carry messages from the
brain to the rest of the body. A nerve is like an electrical
cable wrapped in insulation. A ring of tissue forms a cover to
protect the nerve, just like the insulation surrounding an electrical
cable. Nerves are fragile and can be damaged by pressure, stretching,
or cutting. Injury to a nerve can stop signals to and from the
brain causing muscles not to work correctly, and you may lose
feeling in the injured area. When a nerve is cut, both the nerve
and
the insulation are broken. Pressure or stretching injuries can
cause the fibres carrying the information to break and stop the
nerve from working, without damaging the cover.
When nerve fibres are cut, the end of the fibre farthest from the brain
dies, while the insulation stays healthy. The end that is closest to the
brain does not die, and after some time may begin to heal. If the insulation
was not cut, new fibres may grow down the empty cover of the tissue until
reaching a muscle or sensory receptor. If both the nerve and insulation
have been cut and the nerve is not fixed, the growing nerve fibres may
grow into a ball at the end of the cut, forming a nerve scar or neuroma.
A neuroma can be painful and cause an electrical feeling when touched.
To fix a cut nerve, the insulation around both ends of the nerve are sewn
together. The goal in fixing the nerve is to save the cover so that new
fibres may heal and work again. If a wound is dirty or crushed, your physician
may wait to fix the nerve until the skin has healed. If there is a space
between the ends of the nerve, the doctor may need to take a piece of nerve
(nerve graft) from another part of the body to fix the injured nerve. This
may cause permanent loss of feeling in the area where the nerve graft was
taken.
Once the nerve cover is fixed, the nerve generally begins to heal three
or four weeks after the injury. Nerves usually grow one inch every month
depending on the patient’s age and other factors. This means that
with an injury to a nerve in the arm above the fingertips, it may take
up to a year before feeling returns to the fingertips. The feeling of pins
and needles in the fingertips is common during the recovery process. While
this can be uncomfortable, it usually passes and is a sign of recovery.
-
Trigger Finger - Stenosing tenosynovitis, commonly
known as trigger finger or trigger thumb, involves the pulleys
and tendons in the hand that bend the fingers. The tendons work
like long ropes connecting the muscles of the forearm with the
bones of the fingers and thumb. In the finger, the pulleys form
a tunnel under which the tendons must glide. These pulleys hold
the tendons close against the bone. The tendons and the tunnel
have a slick lining that allows easy gliding inside the pulleys.
Trigger finger/thumb happens when the tendon develops a nodule (knot) or
swelling of its lining. When the tendon swells, it must squeeze through
the opening of the tunnel (flexor sheath) which causes pain, popping, or
a catching feeling in the finger or thumb. When the tendon catches, it
produces inflammation and more swelling. This causes a vicious cycle of
triggering, inflammation, and swelling. Sometimes the finger becomes stuck
(locked) and is hard to straighten or bend.
Causes for this condition are not always clear. The medical
conditions of rheumatoid arthritis, gout, and diabetes may be
associated with trigger finger/thumb symptoms. Trigger finger/thumb
may start with discomfort felt at the base of the finger or thumb.
A thickening may be found in this area. When the finger begins
to trigger or lock, the patient may think the problem is at the
middle knuckle of the finger or the top knuckle of the thumb.
The goal of treatment in trigger finger/thumb is to eliminate
the catching or locking and allow full movement of the finger
or thumb without discomfort. Swelling around the flexor tendon
and tendon sheath must be reduced to allow smooth gliding of
the tendon. The wearing of a splint or taking anti-inflammatory
medication by mouth or an injection into the area around the
tendon may be recommended to reduce swelling. Treatment may also
include changing activities to reduce swelling.
If non-surgical forms of treatment do not improve symptoms,
surgery may be recommended. The goal of surgery is to open the
first pulley so the tendon will glide more freely. Active motion
of the finger generally
begins immediately after surgery. Normal use of the hand can
usually be resumed once comfort permits. Some patients may feel
tenderness, discomfort, and swelling about the area of their
surgery longer than others. Occasionally, hand therapy is required
after surgery to regain better use.
- Ganglion Cysts - Ganglion cysts are very common
masses (lumps) that sometimes grow in the hand and wrist. The cysts
are generally found on the top of the wrist, on the palm side of
the wrist, the end joint of a finger (mucous cysts), and at the
base of a finger. Ganglion cysts usually come from nearby joints
or tendon sheaths. There is no specific cause. These cysts can
be painful, especially when they first appear or with constant
or strenuous use of the hand. Ganglions often change in size and
may disappear completely. These cysts are not malignant (cancerous).
The diagnosis of a ganglion cyst is usually based on where
the cyst is and what it looks like. Your hand surgeon may recommend
X-rays to rule out problems in nearby joints.
Treatment of ganglion cysts may be simply watching for any
changes. However, if the cyst is painful, limits activity,
or its appearance is unacceptable to the patient, other treatment
may be recommended. Treatment may include removing fluid from
the cyst with a needle and/or the wearing of a splint to keep
the hand or wrist from moving. If these nonsurgical treatments
fail, surgery to remove the cyst may be recommended by your
hand surgeon.
The goal of surgery is to remove the source of the cyst. This
may require removal of a portion of the joint capsule or tendon
sheath next to the ganglion. If the ganglion is removed from
the wrist a splint may be recommended following surgery. Some
patients may feel tenderness, discomfort, and swelling at the
site of their surgery a little longer than others, but full
activity can be resumed once comfort permits. While surgery
offers the best success in removing ganglions, these cysts
may return.
Patient
Services - More on Hand & Upper Limb
* Source: American
Society for Surgery of the Hand; Hand Diagram: Australian Orthopaedic
Association |
