Understanding Hand Surgery
WellStar hand surgeons diagnose and treat a variety of conditions related to the structures of the hand, wrist and forearm. In many cases they also treat the elbow, arm and shoulder. Hand surgeons are typically orthopedic, plastic or general surgeons with additional training. Certification by the American Society for Surgery of the Hand requires advanced surgical training and a rigorous certifying examination.
These specialized doctors understand and treat the complex interworking of the many bones, joints, ligaments, tendons, muscles, nerves, skin and vessels. A hand injury can involve many of these structures, which must all work together for optimal function and comfort. The hands are complex, in part because they operate by “remote control.” That means the muscles that operate the fingers are located in the palm and forearm.
Although they are known as hand surgeons, these doctors are hand specialists who offer many non-surgical solutions to problems ranging from unusual bumps on the hand and fingers to more complex conditions. Depending on the diagnosis recommended treatments can include medication, splints, therapy or injections. Your physician will discuss the range of possibilities with you and help you make the most appropriate choice.
Patients are often referred to a WellStar hand surgeon by another doctor, such as an internist, pediatrician or family practitioner.
Conditions and Symptoms
Patients visit hand surgeons for many conditions including injury or trauma. Patients visit hand surgeons for many conditions including injury or trauma.
Common symptoms include:
- Difficulty with daily or occupational tasks
- Animal bites
- Lumps and bumps on the fingers and hand
- Tingling and numbness
Common hand conditions include the following:
Arthritis is inflammation of the joints caused by a wearing down of the cartilage that coats the joints. Arthritis, especially at the base of the thumb, is quite common in patients over age 40. Women tend to get arthritis of the hand more than men and some people, such as dentists, are at occupational risk.
Carpal Tunnel Syndrome is caused by a pinched median nerve due to a narrowing of the space in the wrist known as the carpal tunnel. Symptoms, which may develop slowly over time, include numbness, tingling and pain in the arm, hand and fingers. The cause of carpal tunnel syndrome is often unknown but arthritis, joint dislocations, fractures and keeping the wrist bent for long periods can contribute to a narrowing of the carpal tunnel.
Cubital Tunnel Syndrome is caused by pressure on the ulnar nerve at the elbow, the site known as the “funny bone.” The results are numbness, tingling and pain in the elbow, forearm, hand and/or fingers. A long period of bending the elbow, including during sleep, can cause the pressure.
Dupuytren’s Disease is an abnormal thickening of tissue beneath the skin that causes lumps and pits within the palm and can extend into the fingers. If cords and lumps cause the fingers to bend into the palm the condition is known as Dupuytren’s Contracture. The disease may be associated with biochemical factors and is more common in men and in people of Northern European decent.
De Quervain’s Tendonitis is inflammation of the wrist tendons, which causes the area around a tendon to swell and enlarge. The result is pain when moving the thumb and wrist, making a fist, grasping or holding objects. New repetitive activity, wrist fracture and hormones and wrist positions common to new mothers can be causes.
Ganglion Cysts are lumps of unknown cause that occur on either side of the wrist, the base of the finger on the palm side and the top of the end joint of the finger. A ganglion cyst is filled with clear fluid or gel, can change in size or disappear and is not necessarily painful.
Trigger Finger (or trigger thumb) involves the pulleys and tendons that bend the fingers. The tendons connect the muscles of the arm to the bones of the fingers and thumb. The pulley at the base of the finger becomes thick and the tendons no longer slide easily through the pulley. The effect may be pain, a popping or a catching feeling in the finger or thumb as the tendon catches, which can result in inflammation and swelling. The precise causes of trigger finger are not clear.
Diagnosis of Hand Conditions
Your WellStar hand surgeon will use a variety of means to diagnose your condition.
- Physical examination
- Medical history and detailed questions about your symptoms, level of function/discomfort, lifestyle and occupation
- Observation of various hand maneuvers to determine function and area of pain
Tools and Tests
Tests that can help determine the presence of various diseases and conditions include:
- Imaging procedures such as X-ray, CT, MRI and ultrasound
- Video fluoroscopy to observe detailed movement of the hand
- Electromyography [ee-LEK-tro-my-AH-grafee] or EMG to measure electrical activity of the muscles
- Nerve conduction studies
Treatment of Hand Conditions
Based on the diagnosis and its severity, your physician may recommend non-surgical options such as:
- Changing the pattern of hand or elbow use
- Reducing activities that put stress on the problem area
- Using a splint
- Aspiration of a cyst
- Anti-inflammatory medications to reduce inflammation and swelling
- Steroid injection into the problem area
- Hand therapy
An accident or other trauma, as well as other conditions, may require surgery if other options are not feasible or successful. The type and scope of surgery differ according to the diagnosis. For example, surgery for trigger finger is performed as an outpatient under local anesthesia. In cases of severe pain from thumb arthritis your doctor may recommend a more complex procedure such as joint reconstruction or joint fusion. Surgery is also an option for relieving nerve compression.
Surgery is often followed by splinting and hand therapy to ensure the best outcome.
Your doctor will discuss the details of any proposed operation, including where and how the procedure will be done, what recovery will be like and any post-surgery restrictions.