There are a number of hand conditions that can be remedied by surgery. Hand surgery aims to restore function and/or alleviate pain.
Common hand conditions that are amenable to surgery are listed.
Carpal Tunnel Syndrome - a very common condition that causes tingling and numbness in the thumb, index and middle fingers as well as hand clumsiness and weakness. It is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. It is often spontaneous in onset but can be related to pregnancy, arthritis, obesity, hypothyroidism and occupations that require repetitive gripping activities in cold environments. Surgical decompression is performed to take pressure off the nerve and allow it to provide normal sensory and power.
Cubital Tunnel Syndrome - a condition that causes tingling and numbness in the ring and little fingers as well as hand clumsiness and weakness. It is caused by compression of the ulnar nerve as it passes through the cubital tunnel in the elbow. Surgical decompression is performed to take pressure off the nerve and allow it to provide normal sensory and power.
Dupuytren’s Contracture - an inherited condition that causes scarring within the fascia of the palm which creates longitudinal cords that then extend down into the digits. The cords then shorten creating tension on the digits progressively bending them towards the palm. This effects hand function as patients are unable to fully straighten their digits. Surgery is performed to excise the restrictive cord thereby allowing the digit to straighten.
Ganglions - cystic lumps that typically develop on the front or back of the wrist. They develop spontaneously and are initially asymptomatic, as they enlarge they can cause pain which limits hand function. Surgery is performed to excise the cyst and the underlying joint capsule which acts as the nidus for the cyst.
Digital Mucous Cysts - cystic lumps that develop at the end joints of the digits. They are related to arthritis and typically develop spontaneously. Initially they are asymptomatic but can become tender, especially if they are knocked. They can also cause fingernails to deform. Surgery is performed to excise the cyst and the underlying joint capsule which acts as the nidus for the cyst.
Trigger Digits - digits that lock in a bent position. Can be associated with arthritis or occupations with heavy repetitive manual work. In the early stages they can be treated by a steroid injection, if this fails then surgical release is required.
It is recommended that you have a referral from your family GP or physiotherapist as they need to be part of the management plan. Once the referral is received it will be triaged for urgency and then you will be contacted by the office staff to arrange an appointment. You will be offered an appointment to review the hand and your general health. The majority of minor hand operations are suitable to be performed after injections of local anaesthesia. If it is unsuitable for local anaesthesia excision then arrangements will be made for admission to hospital for surgery under general anaesthesia.
Following hand surgery you may experience some swelling and bruising. Discomfort is usually mild and readily controlled by elevating the operated site, minimal exertion and having pain relief medication available, such as paracetamol or ibuprofen. You will be provided with post-operative instructions which include wound care advice, typically after surgery you will be able to shower but will need to keep the surgical site dry for three days. A follow-up appointment will be provided to check the wound, remove sutures and provide scar management advice. Following this dressing change you should then be able to get the lighter dressing wet in the shower. After hand surgery there will always be a permanent scar, however the scar will mature with time and it is important to follow the advice provided. It is unusual to have a poorly cosmetic scar or have wound healing issues such as wound separation or infection. If you need rehabilitation then a referral will be made to a physiotherapist for management of strength, motion, swelling and splinting. Depending on the type of surgery your time to return to work and driving will vary, this information will be covered at your initial pre-operative appointment.