Orthopaedic hand surgery is a broad term that includes different types of procedures. The procedure may be carried out for many reasons, including:
- Degenerative disease (to the hand’s structures)
- Congenital (or defects that are present at birth)
- Hand injuries
- Rheumatic diseases (i.e. osteoarthritis and rheumatoid arthritis)
The type of surgery that will be performed on the hand will depend on the underlying cause. Some of the most common hand surgeries include:
Dupuytren’s Contracture Fasciectomy
Dupuytren’s contracture is a condition characterized by tissue formation in the fingers and the palm of the hand. It is said to be associated with red-headed European men who are alcoholics. While often painless, the condition can cause skin nodules to form. In some cases, the condition can cause bands to form, resulting to the curling down of the fingers into the palm. In similar cases, surgery might be performed to remove the tissue and release the fingers.
The procedure is often performed as a day case so staying in the hospital won’t be required.
Generally, it will take 2 to 3 weeks for the skin to heal. After 12 weeks, patients can already make full use of their hands again. A night extension splint may be recommended but will not always be required. Aside from monitoring hand function and movement, a hand therapist can also teach patients hand exercises.
The synovial fluid is a thick lubricating fluid that helps the tendons and the joints to glide smoothly. When the synovial fluid leaks out of the tendon sheath or the joint, it can become very sticky and thick and form cysts (pockets of fluid). These pockets of fluid are called ganglions. Ganglions are:
- Hard or firm when pressed
- Often develops in the back of the wrist (however, it can also form elsewhere)
- Commonly associated with osteoarthritis (especially when it develops in the wrist and the tips of the fingers)
While ganglions may sometimes disappear on their own, draining using a needle might be required when it reduces movement and becomes painful. However, removing the ganglions will require minor surgery under local anaesthesia.
Trigger Finger Release
In trigger finger, the finger affected can often bend normally but can become stuck in a curled position, whilst straightening is painful. The condition occurs when the tendon which allows the finger to bend thickens and becomes stuck in the tunnel.
To “untrigger” the finger straight, you may need to use your other hand, thus the name trigger finger. To stop the finger from triggering while you are using it, using a splint might be recommended. If splinting fails, steroid injections can be administered and may be ultrasound-guided for more accuracy. However, if these conservative approaches prove futile, a minor day-case procedure will be carried out to open the tunnel and free the tendon. Full recovery can be expected in a month or two.
Artificial Joint Replacement
Rheumatoid arthritis of the knuckles may cause deformity and damage. This can result to the fingers “drifting” sideways and away from the thumb. The condition can significantly reduce hand function and can be severely painful. When using the hand becomes extremely challenging, surgery will be performed to replace the knuckles with small artificial joints (which acts as flexible hinges). The procedure can enhance finger positioning, minimize pain, and improve hand function significantly.
Carpal Tunnel Release
When there is undue pressure on the median nerve as it passes through the carpal tunnel, carpal tunnel syndrome develops. The condition can result to numbness and a pins and needles sensation in the fingers. In some cases, carpal tunnel syndrome surgery might be required to ease nerve pressure. Patients will have to wear a bulky bandage on the hand and wrist for a week or two after the surgery and stitches will be removed after 10 to 14 days.
While patients can already use their hands again by that time, doing heavy tasks is still prohibited. However, it is important to make it a point to move the fingers to keep the tendons and the nerve from getting caught up in the scar tissue (which can develop after the surgery). Patients should be able to fully recover in a month or two although getting all the feeling back in the hand will take a while longer especially if they have had the condition for a long time. In some cases, the scar may become sensitive and may ache for a few months. Fortunately, it usually goes away on its own even without treatment.
Two primary groups of tendons are responsible for controlling the hand and the wrist:
- Flexor tendons (makes gripping and curling of the fingers possible)
- Extensor tendons (makes opening the fingers up possible)
When those tendons snap or tear, a tendon rupture occurs. Tendon ruptures are rare. When it occurs, the condition is often attributed to rheumatoid arthritis or other forms of inflammatory arthritis. Early treatment is necessary to protect the other tendons from rupturing and for surgery to be successful. In a lot of cases, the undamaged flexor tendons (from other fingers) will be used to repair the ruptured tendon. Wearing a splint day and night will be recommended to protect the tendon while it heals. At least 6 weeks will be required for the repaired tendons to heal and it will take at least 2 to 3 months before the affected hand can recover fully.