Hand Surgery, Carpal Tunnel, & Dupuytren’s Disease

Carpal Tunnel Syndrome

Carpal tunnel release is the procedure of choice for carpal tunnel syndrome, which is compression of the median nerve at the wrist causing symptoms such as pins and needles, numbness in some of the fingers. It can also cause pain at the wrist waking the patient up at night. Patients often say they hang the hand out the side of the bed at night to try and relieve the symptoms.

What's Involved

The procedure involves a short vertical incision over the wrist and division of a ligament that decompresses the nerve. This is a relatively straightforward procedure, and takes about 30 minutes. The hand is bandaged after surgery for 2 weeks, but the hand is functional straight after.

Recovery time, and return to work is between 2 -4 weeks. Failure to address this syndrome results in permanent numbness and eventual weakness of the hand

Cubital Tunnel Syndrome

This procedure involves releasing or decompressing the ulnar nerve on the inside of the elbow. Symptoms of this syndrome include pins and needles or numbness in the little finger and ring finger. At its severest form it can cause a clawing type deformity of the fingers.

What's Involved

The procedure involves a longitudinal incision on the inside of the elbow and releasing various structures that can compress the nerve. It usually takes about 45 minutes and can be done as a day case. Recovery is about 2 weeks.

Trigger Finger

Trigger finger is when the tendon that flexes your finger gets caught under one of the ligaments due to localised swelling.

What's Involved

The operation takes about 15 minutes and involves a small incision in the palm and releasing the ligament that it gets caught under. Recovery is about 2 weeks.

Osteoarthritis of the Thumb Joint (Trapeziectomy and Ligament Reconstruction)

Arthritis of the thumb joint is a painful condition where the base of the thumb becomes deformed, there is pain and weakness on using the thumb. A trapeziectomy is an effective operation for relieving the symptoms of arthritis. The procedure involves an incision along the base of the thumb, removal of the arthritic piece of bone (trapezium) and then reconstructing one of the thumb stabilising ligaments.

What's Involved

This procedure takes about 90-120 minutes and can be a day case or overnight stay in hospital. The thumb must stay in a splint for about 8 weeks in order to ensure healing and stability of the thumb.

Arthritis of the Finger Joints

Arthritis of the finger joints is a painful condition causing deformity of the joint, pain, and weakness. A joint replacement is often the procedure of choice.

What's Involved

This operation takes about 90 minutes and is performed as a day case or overnight stay in hospital. Recovery from the operation takes about four weeks. A plaster or splint is worn for 2 weeks.

Ganglions

Ganglions are caused by a weakness in the joint capsule. They are commonly found around the wrist but can also be found along tendons and on finger joints. They present as small round swellings (cyst like structures) under the skin. They are harmless but can be associated with aching of the joint.

What's Involved

The procedure involves removal of the ganglion and closure of the defect in the joint capsule. The procedure is performed as a day case under sedation. Recovery is typically 2 weeks.

Dupuytren’s Disease Surgery

Dupuytren’s disease or ‘Vikings disease’ is a benign condition of the hand causing bands of contractile tissue to form in the hand and fingers which if left untreated, can lead to a fixed flexion deformity of the finger. There is also a non-surgical option involving an injection of an enzyme called collagenase. This injection is currently not on the PBS. This has an impact on your ‘out of pocket’ costs.

What's Involved

The procedure of choice is a fasciectomy, which involves an incision along the cord and removal of the tissue. Other less invasive procedures are also available in certain circumstances, and these include mere division of the cord (needle aponeurotomy), or a limited fasciectomy where only a small amount of the disease is removed (usually in the elderly when you just want to correct a deformity).

Tendon Repairs

Cuts to the finger or forearm can divide tendons. This leaves a person unable to bend or straighten a finger. Repairs to tendons are a complex procedure that involves a long rehabilitation period with the hand therapist.

What's Involved

The operation usually takes about an hour. It is performed as a day case in hospital. Within the next 3 days, an appointment is made with the hand therapist to begin 10-12 weeks of hand therapy in combination with splinting.

Nerve Repairs

Nerves may be cut following certain types of trauma. Nerve repair requires microsurgical expertise. The operation can be performed as a day case but requires post-operative hand therapy for sensory re-innervation.

Fractures

Broken bones in the hand as a result of trauma can sometimes be managed with splinting alone, or may need surgery, If the bone has moved significantly from its original position then it will need some form of metalwork to stabilise the bone until bone healing occurs. Placement of metalwork can be temporary or permanent depending on the type of fracture sustained.