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ELECTIVE HAND SURGERY

Ganglion

This is the most common type of benign tumour affecting hand function. It is a myxomatous (gel-like) degeneration of joints (ligamentous capsule) and tendon sheath.
They initially present as painless lumps, usually on the back of the wrist and finger joints and occasionally on the front.
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Eventually, ganglions interfere with hand movement and become painful with prolonged hand use.
The treatment is surgical excision. However, there is a significant recurrence rate after such treatment. To minimise this, the hand needs to be rested post operatively and normal use reintroduced gradually.

Carpal Tunnel Syndrome

Compression of the median nerve that passes through the carpal tunnel at the wrist is known as carpal tunnel syndrome. Initially it manifests as nocturnal tingling and numbness of the thumb and fingers (usually excluding the little finger). Gradually this becomes more common, occurring at any time of the day, eventually becoming permanent. The result is ongoing numbness, discomfort and loss of dexterity.
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The diagnosis is usually confirmed with nerve conduction studies. Treatment consists of releasing the constrictive tunnel by a small incision at the base of the palm. Outcomes are generally very successful, but if the condition is neglected, loss of feeling may remain permanently.

Tenosynovitis/Trigger Finger

To ensure minimal friction with tendon movement, the tendons are bathed in a lubricant called synovial fluid. This is produced by a highly vascularized tissue which surrounds the tendons, called the synovium. It is also present around the joints and lubricates them. Synovium may become inflamed, resulting in increased friction with tendon gliding. This friction may eventually result in nodules developing on the tendon and thickening of the tendon sheath. These thickenings and nodules may suddenly "catch" during tendon movement and may only release with forced manipulation of the digit. This results in a sudden release or "triggering" effect of the finger.
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There are many possible causes of this type of tenosynovitis, the most common being inflammatory conditions such as rheumatoid arthritis or prolonged repetitive movements as occur in some occupations. The underlying causes need to be addressed where possible, but once established, trigger finger needs surgical release. This is performed by a small incision in the palm of the hand.
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Tenosynovitis may also affect the wrist tendons (e.g. DeQuervain's syndrome), resulting in painful movement of the wrist. These conditions may respond to conservative management, (e.g. rest, splints, anti-inflammatory medication and injections of steroids) but if this fails, then surgical release is indicated.

Dupuytren's Disease

This is a fibromatosis (benign scar-like growths) of the hand's palmar fascia. It may also involve the soles of feet, and penis (rarely). It presents as thickened cords under the skin which may be tender and eventually pull the finger towards the palm, restricting normal extension. It usually presents in males after the third decade of life, but may occur in both genders and at earlier stages. People of northern European or Celtic extraction have a much higher risk of this as do those who have diabetes, certain types of liver diseases, take certain long-term medications or are involved in occupations which result in repeated percussions to the hands (such as the use of pneumatic impact drill).
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Treatment involves surgical resection of the cord. Surgery needs to occur as soon as restricted finger extension has set in. Excessive delay may result in permanently bent fingers which cannot be fully straightened. Delay also makes the operation technically more difficult and increases the risk of injury to local nerves and vessels which may become encased in the infiltrative fibrous tissues.

Arthritis

Rheumatoid arthritis is one of the most destructive of joint pathologies of the hand. It may also involve the tendons. This complex condition often needs long term rheumatologist management. Treatment is medical in the early stages, but when the condition becomes severe and advanced, then surgical correction may be recommended. There are a host of possible operations and your hand surgeon will be able to advise you. Osteo-arthritis is the most common type of arthritis of the hand and develops with age related wear and tear of the joint.
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Treatment is usually conservative, but occasionally surgery may be performed, especially if there is advanced destruction of joints resulting in ongoing pain and significant loss of function. In such cases the joint may be replaced or fused. The choice of operation is tailored to the patient's needs.

 

 
 
PLASTIC SURGERY AND COSMETIC SURGERY in Adelaide. Dr Peter Sylaidis - Accredited Plastic Surgeon and Cosmetic Surgeon -- © Sylaidis Plastic Surgery 2009 - Adelaide, South Australia