Should you Consider Hand or Wrist Surgery?

 

Dramatic advances have been made in recent years in treating patients with hand injuries, degenerative disorders, and birth defects of the hand. At the forefront of these advances have been orthopedic specialists whose major interest is improving both function and appearance. Orthopedic surgeons undergo intensive training in hand surgery, and they treat patients with a wide range of hand problems.

This information is designed to give you a basic understanding of the most common hand problems-what they are, what surgeons can do for them, and the results you can expect. It can't answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

Hand Surgery Considerations

If you're considering hand surgery, a consultation with a orthopedic surgeon is a good place to start. The surgeon will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the procedure in detail, including where the surgery will be performed (in the surgeon's office, an outpatient surgery center, or a hospital), the anesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.

Don't hesitate to ask your orthopedic surgeon any questions you may have during the initial consultation-including any concerns you have about the recommended treatment and the costs involved. (Since hand surgery is performed primarily to correct physical abnormalities, it usually is covered by insurance. Check your policy or call your insurance carrier to be sure.)

Orthopedic Hand Surgery Risks

All Orthopedic Surgery Carries Some Uncertainty and Risk

Thousands of successful hand orthopedic operations are performed each year. While the procedures are generally safe when performed by a qualified and experienced orthopedic surgeon, complications can arise.

In all types of orthopedic hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified orthopedic surgeon and by closely following their advice.

A qualified hand surgeon is trained to diagnose and treat all problems related to these different structures in the hand, wrist, and forearm.

Hand surgeons have received specialized additional training in the treatment of hand problems beyond their board certified specialty training in orthopedic surgery, plastic surgery, or general surgery. To become members of the prestigious societies, hand surgeons must have completed a full year of such additional training and must pass a rigorous certifying examination.

Many hand surgeons also have expertise with problems of the elbow, arm, and shoulder. Some hand surgeons treat only children, some treat only adults and some treat both. Common problems treated include:

Hand and Wrist

The team members of the Dallas Orthopedic Institute evaluate and manage problems involving pain or injury in the arm, forearm, wrist, and hand. Patients frequently come to us for the management of:

• Fractures and dislocations
• Sprains, strains, and muscle or ligament tears
• Injuries to tendons, nerves, or vessels
• Numbness or weakness in the hand or arm (including carpal tunnel syndrome)
• Arthritis
• Contractures
• Swelling or inflammation

Osteoarthritis

 

Surgical Treatment

In most cases, the patient knows best and actually tells the doctor when it is time for surgery. The goal is to restore as much function as possible and to eliminate the pain or reduce it to a tolerable level. One type of surgery is joint fusion, in which the arthritic surface is removed and the bones on each side of the joint are fused together, eliminating motion from the problem joint. Joint fusion may be used to relieve pain and correct deformities that interfere with functioning. Another approach is joint reconstruction, in which the degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. Once the degenerated portion of the joint surface is removed, it may be replaced with rolled-up soft tissue, such as a tendon, or with a joint replacement implant. Which type of surgery is used depends on the particular joint(s) involved, your activities, and your own needs. Your hand surgeon can help you decide which type of surgery is the most appropriate for you.

 

Carpal Tunnel Syndrome

 

Surgical Treatment

Pressure on the nerve is decreased by cutting the ligament that forms the roof (top) of the tunnel on the palm side of the hand. Incisions for this surgery may vary, but the goal is the same: to enlarge the tunnel and decrease pressure on the nerve. Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and wrist to return to normal. Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.

 

Cubital Tunnel Syndrome

 

Surgical Treatment

Many surgeons will recommend shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. The nerve may be placed under a layer of fat, under the muscle, or within the muscle. Some surgeons may recommend trimming the bony bump (medial epicondyle). Following surgery, the recovery will depend on the type of surgery that was performed. Restrictions on lifting and/or elbow movement may be recommended. Therapy may be necessary. The numbness and tingling may improve quickly or slowly, and it may take several months for the strength in the hand and wrist to improve. Cubital tunnel symptoms may not completely resolve after surgery, especially in severe cases.

 

Treatment of de Quervain's Tendonitis

 

Surgical Treatment

 

The surgery opens the compartment to make more room for the inflamed tendons, which breaks the vicious cycle where the tight space causes more inflammation. Normal use of the hand can usually be resumed once comfort and strength have returned. Your hand surgeon will advise the best treatment for your situation.

 

Distal Radius Fracture

 

Surgical Treatment

If your orthopedic surgeon feels that the position of the bone is not acceptable for the future function of your arm, and that it cannot be corrected or kept corrected in a cast, he or she may recommend an operation. There are many ways of performing surgery, including reducing the fracture in the operating room without making an incision (closed reduction), or by making an incision (open reduction) to improve the alignment of the bone. In the operating room, your orthopedic surgeon may choose to hold the bone in the correct position with only a cast, or by inserting metal (usually stainless steel or titanium) pins, a plate and screws, an external fixator, or any combination of these techniques.

 

If you are suffering from hand or wrist pain, please contact our office immediately to schedule an evaluation.

 

Dallas Orthopedics Institute
 9330 Poppy Drive
Dallas , TX 75218