Plastic surgeons undergo extensive training in treating common hand conditions, from degenerative conditions such as osteoarthritis to complex hand injuries including replantation of amputated digits. As a plastic surgeon, I employ the most modern hand surgery techniques so that not only does this improve your function but also the appearance of your hands.
I will examine you and discuss the best method of treatment for your problem, which can range from simple splinting, steroid injections to surgery if warranted. If surgery is required I will discuss the procedure in detail, including anaesthesia, surgical technique (incision locations), risks / complications and recovery – which require you to work closely with hand therapists for weeks to months and require time off normal activities.
Common conditions treated include;
Often the most commonly performed procedure in hand surgery is to repair injured hands that can damage of the underlying bones, tendons, nerves and/or blood vessels. By employing plastic surgery principles that are applied else where in the body, including grafting (tendons, nerves, bone, skin), flaps (moving new tissue with its underlying blood supply to the injured site) and microsurgery (replantation) we are able to restore the function and appearance of significant hand injuries.
Carpal Tunnel Syndrome
The carpal tunnel is a tight space at the front of your wrist, which the tendons and one of the major nerves (median nerve) to the hand pass through. If the pressure within this space increases due to conditions such as disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, or repetitive motions it may causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome. The symptoms are often worse at night and may be relieved by shaking or dangling the hand out of the bed
Treatment includes, activity modification, splint at night, steroid injection. If symptoms persist, then surgery may be required. During the operation, an incision is made in the middle of the palm/wrist to decompress the median nerve. The results of the surgery will depend in part on how long the condition has existed and how much damage has already been done to the nerve. For that reason, it’s a good idea to see a doctor early if you think you may have carpal tunnel syndrome.
De Quervain’s Tendonitis is brought on by irritation of tendons across the wrist at the base of the thumb, which causes pain on movement of the thumb and wrist leading to difficulty with pinch activities. The pain may come on gradually or suddenly and may radiate down the thumb or up the forearm. Other symptoms include swelling at the site of pain, ‘clicking’ or ‘snapping’ and numbness on the back of the thumb.
Treatment includes splinting, anti-inflammatory medication, and steroid injection around the tendons, which may help reduce swelling and pain. In some cases, simply stopping the aggravating activities may relieve symptoms. When symptoms are severe or do not improve, surgery is often recommended. The tight fibrous tissue around the tendons is released to make room for the irritated tendons, which prevents irritation occurring.
Trigger finger is a common condition affecting the fingers. The fingers may click or lock due to catching or irritation of tendons on the pulleys that hold the tendons in place. Swelling can develop in the tendon, which causes more irritation and further swelling
Treatment includes with rest, anti-inflammatory medication and steroid injection around the inflamed tendon, which can relieve symptoms and sometimes ‘cure’ the condition. If symptoms persist or recur, then surgery is usually recommended.
Dupuytren’s contracture is an abnormal thickening of the underlying tissue on the palm side of the hands. Thick, scar-like tissue forms beneath the skin on the palm and extend into the fingers, pulling them toward the palm and restricting movement and normal activities. The progression of the condition is unpredictable; it usually develops in mid-life and has no known cause (although may have strong family history)
While surgery is the only treatment for Dupuytren’s contraction, treatment is not required for simple nodules or cords. Surgery aims to straighten the fingers and improve function. The operation must be done precisely, since the nerves and arteries that supply the fingers are often tightly bound up in the abnormal tissue. The results of the surgery will depend on the severity of the disease and sometimes skin grafts or flaps may be required. You can usually expect significant improvement in function, however requires extensive hand therapy and splinting in the recovery period. Despite surgery, the disease may recur and the fingers may begin to bend into the palm once again.
Ganglion cysts are common lumps that appear around the wrist, base of the fingers or over the joints on the back of the fingers. These lumps are generally not painful but may be of concern due to their appearance. They may fluctuate in size and may disappear spontaneously.
Those ganglions that disappear spontaneously require no treatment and for those that are persisting but are not causing problems require no more than simple reassurance. They however may be removed due to discomfort or concern with the appearance of the lump. Surgery aims to remove the ganglion and a small cuff of joint capsule from which the ganglion arises, performed through an incision directly over the swelling.
Osteoarthritis occurs when the smooth cartilage at the end of bones wear away, resulting in increased pain and swelling as the bones rub against each other during movement. Over time there may be further joint damage leading to destruction of the surround supporting joint capsule and ligaments leading to impaired function. Osteoarthritis is a common problem that tends to affect middle-aged women, while there may be history of injury the cause is largely unknown (there is a family history of osteoarthritis). It is common to experience osteoarthritis in the fingers and wrist or at the base of the thumb.