Hand Surgery

De Quevain Sundrome (Gamers Thumb)

A tenosynovitis or inflammation of the covering, sheath or tunnel of the distal forearm that controls the movement of the thumb. Symptoms include pain, tenderness and swelling over the thumb side (radial) of the wrist with difficulty/pain with gripping. Non-surgical treatment involves injection of corticosteroids which can be effective in many patients. Surgical treatment is a simple procedure that involves the release of the sheath at the distal radius first dorsal compartment and is highly effective in resolving this condition.  Recovery is often quick once the wound is healed, and recurrence is rare.

A Trigger Finger or Trigger Thumb

A disorder that is characterized by catching, snapping or locking of the involved flexor tendon and is associated with hand dysfunction and pain. The lay term of trigger finger is utilized because when a patient’s finger unlocks, it often pops back suddenly like a releasing a trigger of a gun. Non-surgical treatment entails injection of corticosteroids which can be effective in some patients. Surgical intervention is a simple surgery that involves the release of a pulley in the hand is very effective to resolve the condition. Recovery is often quick once the wound is healed and recurrence is rare.

Carpal Tunnel Syndrome (CTS)

A common hand/wrist condition causing paresthesia’s (numbness, tingling, pain, etc) to the hand, thumb, index finger, and middle finger.  Carpal tunnel can be multifactorial resulting in compression of the median nerve at the wrist, left untreated CTS can cause irreversible/permanent nerve and muscle damage.  Median nerve compression increases with trauma, inflammatory processes, medical conditions, workplace factors Tories and is more common in females.  Treatments include physical therapy, massage, wrist splinting, anti-inflammatories, corticosteroids injections and surgery.  Surgery is performed through a small incision in the palm in an outpatient/same day surgery setting.

Ulnar Nerve Compression

 A paresthesia (numbness, tingling, weakness) in the ulnar nerve distribution.  It presents with numbness of the ring and small fingers and hand weakness.  Similar to carpal tunnel syndrome, ulnar neuropathy is a nerve compression, but of the ulnar instead of median nerve.  Treatment includes both non-surgical and surgical techniques.  Compression of the ulnar nerve can occur at the wrist or elbow.  Decompression or release can be accomplished by ulnar nerve transposition into a position of less pressure.  This procedure is performed in an out-patient/same day surgery setting.

Dupuytren’s Contracture

An inflammation and thickening of the tissues just under the skin of the palm.  Fibrous knots/cords develop pulling the fingers in a bent position.  Everyday activities such as reaching into a pocket, shaking hands, or putting on clothing can become difficult.  The two fingers most affected are the ring and pinky fingers.  These cords can become tender and sometimes with pressure but are usually painful painless.  Males over 50 of Northern European decent, family history, diabetes, use of alcohol and tobacco are all associated with increased risk of the disease. Treatment involves disruption of the contracted cords.  This can be done by needle, enzyme injections, or surgery.  Needling is a percutaneous (no incision) technique used to break the bands below the skin.  It is less invasive, but has the highest rate of recurrence.  Enzyme injection is also a percutaneous procedure involving the injection of medicine that “digests” the cords.  Injection with enzyme has the disadvantage of increased discomfort compared to needling. Surgical intervention is the operative removal of the cords beneath the skin. Surgery has the best joint release, but requires post-operative physical therapy.

Hand Trauma

Can be a simple skin laceration or involve disruption of subcutaneous tissues, ligaments, tendons, bones, nerves or vessels.  Each hand trauma treatment has the goal of functional restoration of the hand.  This may include repair of flexor or extensor tendons followed by physical therapy and or fracture reduction and fixation using pins, wires, plates, and screws.  Nerve and vessel repair may also be required utilizing magnification via a microscope.  Every case is different and a tailored approach is required for optimal outcome.