Hand & Microvascular Surgery

Hand Surgery

Hand surgery is a broad term used to cover a variety of procedures to restore hand, wrist and finger function. Among the many reasons for hand surgery are injuries, infections, congenital birth defects, degenerative changes and rheumatic diseases such as osteo and rheumatoid arthritis.

Among the most common hand injuries are those that damage the nerves in the hand which can lead to loss of both feeling and function. While some can heal on their own, others require surgery. Nerves that have been cut or severed, may be able to be fixed by reattaching it to the other end of the nerve – or via a nerve graft replacing the damaged nerve with those taken from other areas of the body. Nerve entrapment can be addressed through decompression of the nerves.

Due to the important function of the hand, the quicker diagnosis and treatment is sought, the greater the chance of a full recovery. Among the most common hand procedures are:

Carpal Tunnel Release

A very common and treatable condition, Carpal Tunnel Syndrome should be addressed by a physician as early as possible and underlying causes such as diabetes or arthritis should be treated first. Caused by pressure on the median nerve often triggered by overuse, arthritis, fracture or diabetes, carpal tunnel release addresses the ligament to relieve pressure on the nerve.

Dupuytren’s fasciectomy

Dupuytren’s disease occurs when scar-like tissue forms beneath the skin of the fingers and the palm and eventually contracting, forcing one or more fingers to permanently curl up into the palm. Treatment of this contracture depends on the severity and the underlying condition of the affected individual.

Trigger Finger Release

A condition in tendon causing a finger becomes stuck in a bent position and then snapping straight when the hand is extended. The goal of trigger finger release is to free up the flexor tendon allowing it to glide more easily through the tendon sheath.

Tendon Repair

While finger tendons can sometimes heal with the help of a splint to help prevent further damage, repair may require surgical intervention. The procedure involves an incision in the wrist, hand or finger locate and reattach the ends of the divided tendon.

Ganglion Cysts Removal

Ganglion cysts are non-cancerous growths filled with a jellylike fluid. They commonly develop along the tendons or joints of the hands or wrists. Some cysts do not require treatment but when they press on the nerve and cause pain, they need to be surgically removed.

Cubital and Radial Tunnel Syndrome

Not as commonly known as their relative carpal tunnel syndrome, cubital tunnel syndrome and radial tunnel syndrome can also cause severe pain, tingling, and muscle weakness in the hands and forearms.

Cubital tunnel syndrome, also known as ulnar neuropathy, is caused by increased pressure on the ulnar nerve. This nerve passes near the skin’s surface in the area of the inside elbow commonly known as the funny bone. It can result from abnormal bone growth in the elbow or from intense or repetitive activity that increases pressure on the ulnar nerve (ex: baseball pitchers have an increased risk due to the twisting motion used in throwing certain pitches). However, it’s more likely to develop from repeatedly leaning on your elbow, especially on a hard surface, bending the elbow for long periods of time such as while sleeping, talking on the phone, or playing an instrument.

Symptoms Can Include…

• Numbness/tingling in the hand or fingers when the elbow is bent and/or while sleeping
• Hand pain
• Aching felt inside of the elbow
• Muscle weakness causing a weak grip

Radial tunnel syndrome is caused by increased pressure on the radial nerve. This nerve runs by the bones and muscles of the forearm and elbow. Causes can include injury, inflammation of surrounding tissue, fatty tumors/lipomas or bone tumors.

Because the radial nerve primarily affects the muscles, symptoms of radial tunnel syndrome rarely include numbness or tingling. Rather they present as a piercing or stabbing pain at the back of the hand/top of the forearm, especially when trying to straighten the wrist and fingers. It is often confused with tennis elbow, which is a bit higher up near the outer elbow.

Diagnosis can often be made by a physical examination and possibly with the results of electromyography (EMT) and a nerve conduction study. Left untreated, both cubital tunnel syndrome and radial tunnel syndrome can lead to permanent nerve damage. Treatment will be determined based on the extent of nerve damage. In addition to stopping the repetitive activity that is causing the problem, a splint or brace may help as might other conservative options. If those are unsuccessful, the entrapped nerve can be released via surgery.

Tarsal Tunnel Syndrome

Similar to carpal tunnel syndrome which occurs in the wrist, tarsal tunnel syndrome is a compression of the posterior tibial nerve which runs from the inside of the ankle into the bottom of the foot.

Tarsal Tunnel Syndrome Causes Include…

• Severely flat feet, or collapsed arches
• Growths, lesions, masses in the tarsal tunnel or near the tibial nerve
• Varicose veins in the membrane surrounding the tibial nerve
• Arthritis
• Injuries such as an ankle sprain or fracture
• Diabetes which makes the nerve vulnerable to compression

Tarsal Tunnel Syndrome Symptoms

Tarsal tunnel syndrome can cause pain, numbness or tingling along the tibial nerve as well as in the sole of the foot or inside the ankle. The pain can vary from a sharp, shooting pain to a sensation of pins and needles to an electric shock. Symptoms vary greatly. While some people experience symptoms that progress gradually, others’ symptoms begin very suddenly. Symptoms can be aggravated by physical activity but those who’ve had the condition for a long time can experience pain or tingling at rest. Night-time awakening is a common complaint.

Treating tarsal tunnel syndrome depends on the underlying cause. Initial treatments may include rest with anti-inflammatory medications (including nonsteroidal anti-inflammatory drugs) or steroid injections. Surgery, called tarsal tunnel release, is often required to release the tight tunnels and relieve the compressed nerve.

Phantom Pains with Amputations

While researchers don’t know the exact cause of Phantom Limb Pain (PLP), a possible explanation involves the rewiring of the nerves in parts of the spinal cord and brain when they lose signals from the missing arm or leg. As a result, pain signals are sent – a common response when the body senses something is wrong. Nerve end scars form and they may be painful. Phantom pains can last for seconds, minutes, hours or days. While they often diminish in frequency and duration during the first six months, many continue to experience some level of these sensations for years.

PLP Triggers

Certain activities or conditions seem to trigger PLP including:

• Touch
• Urination or defecation
• Sexual intercourse
• Angina
• Cigarette smoking
• Barometric pressure change
• Herpes zoster
• Exposure to cold or heat

It’s helpful to let your physician know of your particular triggers.

PLP Treatment

Treating PLP effectively takes a multipronged approach. Medications of several different categories in combination with non-medication treatments seem to be most effective. These are targeted to interrupting the pain signals in your brain or spinal cord and your brain’s interpretation of these signals. Nerve end scars called neuromas found at predictable sites often need to be removed, and the nerve ends may need to be re-routed deeper into a cushion of muscle or window of bone. A variety of additional therapies can also be helpful.