Hand & Wrist Surgery
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Hand & Wrist Surgery
Your hands and wrists are essential tools that allow you to work, play and perform everyday activities.How well the hand and wrist interact depends on the integrity and function of the ligaments, tendons, muscles, joints and bones. Problems in any of these can affect upper extremity function, causing disruptions at home and work and negatively impacting quality of life.
The human hand itself is very complex and delicate in structure. Hand surgery requires a completely different surgical approach from a qualified hand and wrist surgeon whether treating fractures, arthritis or deformities. Hand surgery traditionally includes treatment of the entire hand, wrist and forearm.Again, this whole region works as a single unit, and the dysfunction of a single part needs consideration of the whole. An additional year of training is required for those orthopaedic surgeons seeking certification in hand and wrist surgery.
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Common Hand Conditions
Here are some of the most common conditions that our hand specialists treat:
Common types of Hand surgery?
Carpal tunnel release - Carpal tunnel syndrome occurs when pressure is put on the median nerve as it passes through your wrist under the carpal tunnel ligament. This results in pins and needles and numbness in your fingers. Surgery is sometimes needed to ease pressure on the nerve.
Dupuytren’s contracture fasciectomy - Dupuytren’s contracture is a condition caused by tissue forming in the palm of your hand and your fingers. It’s often painless may only cause only skin nodules, but it can also form bands that make your fingers curl down into your palm. You may need surgery to remove the tissue and release your fingers, although it’s not always possible to make this completely better.
Trigger finger release - If you have trigger finger, the affected finger can often bend normally but becomes stuck in a curled position. This is caused by the tendon which allows your finger to bend becoming thickened, so it becomes stuck in the tunnel where the tendon enters your finger. You may need to use your other hand to help 'trigger' your finger straight – which is where the condition gets its name from.
You may be referred to a hand therapist for a splint to be made for you to stop your finger triggering while you’re using it. A local injection helps in most cases. If this fails, you may need a minor day-case operation to open the tunnel and free the tendon. You should recover in one to two weeks.
Tendon repair - There are two main groups of tendons that control your hand and wrist:
Sometimes these tendons can tear or snap, which is called tendon rupture. Tendon rupture in your hand and wrist isn’t common, and when it occurs it’s usually as a result of rheumatoid arthritis or other types of inflammatory arthritis. You’ll need early treatment if surgery is to be successful and to protect the other tendons in your hand from rupture.
In many cases undamaged flexor tendons from other fingers are used to repair the ruptured tendon. If the tendon has ruptured because it has rubbed against rough bone in your wrist, the bone will have to be smoothed or removed to prevent the repaired tendons from rupturing again.
Ganglion removal - A thick fluid called synovial fluid helps joints and tendons move slowly. Sometimes this fluid leaks out of the joint or tendon sheath. The fluid then becomes very thick and sticky, and it may form pockets of fluid (cysts) known as ganglions. These ganglions:
Ganglions sometimes disappear on their own, but if they become painful or reduce movement the fluid can sometimes be drainined using a needle. You may need minor surgery to remove them, although it's likely that they'll come back.
Knuckle (MCP joint) replacement - Rheumatoid arthritis of the knuckles (metacarpophalangeal or MCP joints) may cause damage and deformity, with the result that your fingers 'drift' sideways away from your thumb. This may be very painful and greatly reduce hand function. If it becomes difficult to use your hand, surgery can be carried out to replace your knuckles with small man-made (artificial) joints that act as flexible hinges. This operation reduces pain, improves the positioning of your fingers and so improves hand function.
Trapeziectomy (removal of the trapezium) - Your trapezium is a bone in your wrist at the base of your thumb. If you have arthritis in the joint here, it may cause pain and make simple tasks more difficult. The pain often comes and goes, and the condition will often become painless over time. But if your pain carries on, you may need an operation to remove the joint and your trapezium.
Sometimes surgeons may make sure you can’t move your thumb/wrist for a couple of weeks to allow for scar tissue to fill the gap removing the trapezium leaves, or occasionally they use a tendon to fill the space.
Common types of wrist surgery?
Wrist joint replacement - Wrist joint replacement isn’t yet a common operation. The aim is to keep some wrist movement and get rid of pain.
Wrist fusion - Wrist fusion may be suggested if your wrist is badly damaged. This is where the bones in your wrist are fixed to the bones in your hand. This reduces pain and increases strength but usually stops you moving your wrist up and down. However, you’ll probably find it easier to turn your hand.
The possible advantages of hand and wrist surgery
The main advantages of hand and wrist surgery can be:
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