General aspects of surgery
of the hand

Human hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, play sports or express emotions.

To do these activities, our hands require sensation, movement and strength which is provided by complex structure of nerves, vessels, gliding tendons, moving joints and muscle contraction.

Pain and other problems in the hands, wrist and arm can be caused by injury, certain activities or other health problems.

Some of the conditions in the hand may need Steroid injections which can be done in an outpatient clinic.

Carpal tunnel:
Carpal tunnel syndrome (CTS) is a relatively common condition that causes pain, numbness and a burning or tingling sensation in your hand and fingers due to pressure on the Median Nerve which runs in the middle of the wrist and palm. Symptoms of CTS can range from mild to severe. People with mild to moderate symptoms usually respond well to non-surgical treatment, such as wrist splints and corticosteroids injections.

However, more severe cases usually require surgery to reduce the pressure on the median nerve. This is a relatively minor open surgical procedure where a cut is made through the front of your wrist to release the nerve. This can be done under general or local anesthetic as a day case. My personal preference is a local anesthetic.

Following surgery you may experience pain during the first few days but this should decrease quickly in 1 – 3 weeks. This pain normally responds well to medication. You will be encouraged to keep your hand elevated above your heart for the first few days after surgery to limit swelling. Resting your hand up on pillows while in bed will help with this. Moving your fingers after the surgery will also help with your recovery. You will be able to resume most of your everyday activities within 2 – 3 weeks. Sports may take longer.

Trigger finger:
‘Trigger finger’ happens when a tendon in your finger, which usually allows it to bend, becomes inflamed and catches on a pulley that is located at the base of your finger. This catching can cause a clicking sound in your finger and your finger may get locked in a bent position. Trigger finger can sometimes be treated with anti-inflammatory medication. It can also be treated with anti-inflammatory medication or an injection of a steroid around the inflamed area. You will usually only need surgery if other forms of treatment haven't worked.

Trigger finger release is usually under local anaesthetic and you will be given an injection into the palm of your hand. The tendon is released by making a cut through the pulley and sheath that surrounds it. Your stitches will be removed about 10 – 12 days after surgery. Some people feel tenderness, discomfort and swelling around the area of their scar for a while after the operation.

A ganglion cyst sometimes known as a “bible cyst” (coming from a legend that treatment by pounding the cyst with a bible would disperse the ganglion) appears on or around joints and tendons and joints in the hand and foot. However, it can also appear in almost any part of the body that has joints and tendons. The cyst is harmless and the size of the cyst can vary over time. Sometimes disappearing altogether. It is most frequently located around the wrist and on the fingers.

A ganglion cyst can be aspirated which is a simple procedure but cysts recur in more than 50% of cases. Quite often, surgical excision is required. You will be encouraged to move your fingers and wrist soon after surgery. Stitches are removed after two weeks. You will normally be able to resume everyday activities and work within about 2 – 3 weeks.

Dupuytren’s contracture:
Dupuytren’s contracture is a progressive disorder that affects the palmar fascia causing the fibrous tissue to shorten and thicken (link for more information). This contracture results in the finger bending towards the palm and thus interfering with hand function. Most commonly affects the ring finger, followed by the little finger and then the middle finger but can affect any digit. Some patients develop “Dupuytren’s Disease” where it affects a large part of the palm and can cause multiple deformities. This can interfere significantly with function. Many patients with minor non progressive contracture do not need surgical treatment.

Surgical treatment — Dupuytren’s contracture:
The exact timing of surgery varies. It is usually performed when the deformities interfere with the function (link for more information). Procedures include: Fasciotomy – the contracted cord is divided in the palm, the finger, or both, using a blade or the bevel of a needle. Once partial section has been achieved the finger is extended causing the fibrous band to snap. Fasciectomy – short segments of the cord or the entire cord are removed or the entire cord is removed. Dermofasciectomy – the cord and overlying skin is removed followed by skin grafting). The procedure is usually done under regional block or general anaesthetic as a day case. Regional fasciectomy is the most common procedure undertaken for Dupuytren’s contracture. Quite often, the vessels and nerves supplying the fingers are surrounded by the Dupuytren tissue and may get damaged producing some numbness of the fingers which most of the time does not cause any functional problems. Slow wound healing is also a problem. Depending on the initial deformities, night splints and physiotherapy may be necessary. Depending on the deformity everyday activities and work can be resumed in a few weeks following surgery.