The requirement for hand surgery can arise from a range of different medical problems.
As both hands and wrists are made up of complex network of bones, muscles, tendons and ligaments, they can be subject to injury or repetitive strain.
Hand issues which may require surgery under local anaesthetic include;
- Carpal Tunnel Syndrome
- De Quervains Syndrome
- Dupuytren’s Disease
- Ganglion Cyst
- Trigger Finger
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a condition that causes tingling and numbness in the hand and arm, caused by a compressed nerve in the carpal tunnel, the narrow passage on the palm side of your wrist.
Carpal tunnel symptoms are experienced gradually with the first signs usually being numbness or tingling in your thumb, index and middle fingers that comes and goes.
Over time, the discomfort may be felt in your wrist and the palm of your hand.
Many people with this condition also experience weakness in the hand and it is not uncommon to drop objects due to a weakness of the thumb’s pinching muscles.
Each patient presenting with carpal tunnel syndrome, has individual requirements which will impact potential treatment plans. One of the biggest factors in your GP recommending you for surgery, may be your current quality of life and how significantly this could be improved with surgical intervention.
A full consultation with one of our Plastic Surgeons will determine the correct treatment plan for you.
Carpal Tunnel Surgery
Most patients will only require this surgery if it is deemed that their symptoms are severe enough to warrant this. If your symptoms are mild, you are under 30 or you have only experienced effects for a short time, there may be a more appropriate non-surgical treatment available.
Carpal tunnel relief surgery or carpal tunnel decompression involves cutting the carpal ligament which is connected to the bones in your wrist to form the carpal tunnel. Your median nerve runs through this tunnel along with several tendons.
Pressure can build in the carpal tunnel on the median nerve and inhibit it working properly causing symptoms.
De Quervain’s Syndrome
De Quervain’s syndrome is a condition which affects tendons where they run through a tunnel on the thumb side of the wrist. Although not harmful, this condition can limit function and often causes some degree of pain.
Symptoms of De Quervain’s include tenderness along the thumb to the wrist when pressure is applied and pain when the thumb is mobilised. Swelling often accompanies these symptoms and is most notable when compared with the same spot on the opposite wrist.
Surgery for De Quervain’s
Although alternative treatments may be the preferred course of action, sometimes surgical intervention is required, and pain relief is usually rapid following the procedure.
This surgery is usually conducted under local anaesthetic and involves surgical decompression of this tendon tunnel. During the process, an incision is made to widen the tunnel by slitting the top of it, releasing pressure and giving the tendons underneath more room to move.
Following surgery, the patient may experience temporary numbness or pain where the nerves have been gently manipulated. Pain management will be discussed with you prior to your surgery and you should continue this as advised.
Dupuytren’s disease or Dupuytren’s contracture, is a common condition whereby nodules appear in the ligaments under the skin on the palm of the hand. The nodules are sometimes uncomfortable on pressure but in many cases this discomfort eases over time.
In some instances, these nodules extend to form cords that pull the finger towards the palm and prevent straightening of the fingers.
Without corrective surgery, one or more fingers may become permanently fixed in this bent position.
There are different surgeries which can be undertaken as treatment for Dupuytren’s contracture. Your Consultant will discuss treatment options in more detail and will advise on the best course of treatment for you.
Your surgery can be completed under local anaesthetic, allowing you to return home the same day as your surgery following the necessary aftercare guidance as detailed by your Consultant.
Ganglion cysts are benign lumps which commonly develop along tendons or joints of the wrist and hand. They contain a thick clear fluid and are usually easily diagnosed as they generally tend to be smooth and round. Ganglion cysts usually arise spontaneously but they can develop as a result of previous injury or at the onset of arthritis.
Treatment options for Ganglion Cyst
Although ganglion cysts are harmless, and many will disappear spontaneously, others may cause pain depending on their size and location. If persistent, these may require further intervention to treat them.
Treatment options include:
Immobilisation– inactivity of the affected area, using either a splint or a brace, will cause the cyst to reduce in size, and as it does so, this will release pressure on the nerves relieving any pain.
Aspiration– this involves using a fine needle to drain any fluid from the cyst. There is some likelihood the cyst will recur with this treatment.
Surgery– During surgery, the surgeon will remove the cyst and the stalk that attaches it to the tendon or joint. Even with surgery there is a still a risk of recurrence.
Trigger finger is a painful condition in which a thumb or finger, bends and locks in position.
Symptoms of trigger finger include pain at the site of triggering in the palm of the hand and tenderness when pressure is applied in this area.
Patients with trigger finger will also experience a clicking or locking sensation when moving the affected finger.
Symptoms are often worse first thing in the morning as long periods of immobility can cause stiffness to develop in the fingers overnight. Patients will find they often require to apply pressure from the opposite hand to straighten out the affected trigger finger once locked in position.
Treatment options for Trigger finger
There are different treatment options for this condition and these will be discussed in detail at your consultation. These options include
Splinting– which holds the finger in a straight position.
Steroid Injection– this does relieve symptoms in the majority of cases, however, often several injections are required. Surgery may be required if further triggering persists.
Surgical decompression of the tendon– surgical intervention for treating this condition will be required if non-surgical options have been unsuccessful. The decision to proceed with surgery will be dependent on how much pain or loss of function you have. Surgery will be conducted under local anaesthetic and involves your surgeon making a small incision in the palm of the hand to remove the fibrous tissue affecting movement in the finger.
Any potential complications will be discussed with you by your Consultant prior to your surgery along with any specific measures to help prevent complications.
Most patients are encouraged to mobilize the hand immediately following surgery. It is common to feel tenderness in the palm but keeping the hand elevated will help to reduce any inflammation.
Although your incision will heal within a few weeks, it may take several months for full function and mobility to be restored in the affected hand.