The goal of hand surgery is generally to restore the form and function of the hands, increasing pain-free range of motion. Top hand surgeons use these safe, effective procedures to help improve the lives of patients on a daily basis. The many types of hand surgery can be divided into the following groups.
Hand Surgery Categories
Skin flaps and grafts are done using a section of skin from elsewhere on your body to close an injury. Skin flaps involve grafting skin along with attached muscle and blood vessels and are used to repair more serious skin and tissue damage.
Tendon repairs. Tendons run alongside bones, attaching them to muscle for movement and they can be damaged or severed. Primary tendon repair is typically done when a recent injury is being treated and closed, the same day it occurred or within the week (delayed primary repair). Secondary tendon repair (often involving tendon grafts from elsewhere in your body) is done at 3 or more weeks after an accident or injury.
Nerve repair. This surgery can be used to restore feeling to your hand when damaged or severed nerves can’t carry messages from or to the brain. Nerve damage may heal without treatment in mild cases. An experienced hand surgeon can reattach severed nerves or perform nerve grafts from another part of your body in an effort to restore nerve function and sensation to the hand.
Compartment release (fasciotomy) is a surgery used to limit damage from trauma by relieving pressure in the affected “compartment” of the hand and removing damaged tissue. Compartments are small areas bounded by bone or fibrous tissue (facia), containing blood vessels and nerves. If left untreated, compression can compromise circulation leading to tissue death and amputation.
Joint replacement (arthroplasty) is done to replace finger joints, when destroyed/damaged by arthritis, for example. Artificial joints are made out of plastic, metal or parts of your own tendon.
Replantation is the reattachment of fingertips, fingers or parts of the hand that have been amputated in a traumatic accident. This complex surgery requires advanced microsurgery and may require multiple surgeries in the most serious cases.
Common Types of Hand Surgery
Basal Joint Arthritis Surgery
Arthritis of the basal joint (at the base of the thumb) is quite common, especially in women over 40 or individuals with past injuries in the area. With age and use, the cartilage can wear away, leaving bones to rub against one another with movement. Arthritis tends to worsen over time, being degenerative in nature. For basal joint disease, surgery is often the only long-term option.
As with most hand ailments discussed here, patients may find temporary relief from splints, ibuprofen to limit swelling and steroid injections into the joint. Injections may provide relief for a few months, but the treatment can only be repeated a few times before becoming harmful to your health.
The following symptoms gradually worsen:
- Pain when doing daily activities that involve pinching, like turning a doorknob
- Swelling, aching and soreness at the base of the thumb
- A visible bump over the thumb joint
- Weakening grip and limited range of motion
- Basal joint arthritis patients also often have carpal tunnel problems due to proximity
Surgical Options for Basal Joint Arthritis
Another of the more common types of hand surgery, this involves removing the joint (or a portion of it) and replacing it with a tendon graft from elsewhere in the body or crafting an artificial tendon. Another option may be to fuse the joint, but this will limit movement.
Carpal Tunnel Surgery
One of the most common types of hand surgery is carpal tunnel surgery. Wrist anatomy includes carpal bones on 3 sides, with the transverse ligament across the top, making up the carpal tunnel of the wrist.
These structures surround the median nerve, which extends from forearm to hand (through the carpal tunnel), controlling the base-of-thumb muscle and bringing sensation to the thumb and fingers. Flexor tendons, which bend the thumb and also extend through the carpal tunnel.
Carpal tunnel syndrome involves swelling around the wrist tendons, crowding and putting pressure on the median nerve. The swollen tissue is the synovium, which serves to “oil” the tendons so that the fingers move easily and smoothly.
There are a number of causes that bring about carpal tunnel syndrome, including: smaller wrists, which can run in families, aging, repetitive motion and secondary to other medical conditions, such as RA (rheumatoid arthritis), basal joint arthritis, diabetes and thyroid problems.
Symptoms include:
- Pins and needles feeling in the hand
- Hand pain
- Shooting shock-like pain in the thumb and fingers, extending up the arm
- Thumb weakness
Where symptoms are severe and non-invasive treatments have not worked, surgery is a good option. In fact, surgery early on can help avoid irreversible atrophy of thumb muscles.
Surgical Options for Carpal Tunnel Syndrome
The goal of many types of hand surgery (including this one) is to release the pressure on the median nerve by dividing the transverse ligament, which, as it grows back together, will provide more room in the tunnel for the nerve and relieve pressure.
In some patients, anatomy dictates that only an open surgical approach will work, with an incision in the palm. (A surgeon with plastic surgery training will ensure that the scar is hidden in a palm crease.) Some patients may enjoy a shorter recovery with an endoscopic procedure.
Trigger Finger Surgery
Trigger finger involves finger and thumb tendons, which help you bend your digits. If you have this condition, your thumb or finger(s) will “catch” or hesitate when you try to straighten them—before “popping” out straight.
In some cases, the fingers can become “locked” in the curled position, curled into the palm. This is caused by the flexor tendons catching on the sheath tissue that holds them next to your finger bones. Normally the tendons slip smoothly through the sheath. In trigger finger, nodules or bumps develop on the tendon and the sheath may thicken, making smooth movement impossible.
Symptoms include:
- Catching of fingers when straightening
- Locking of fingers in the curled position
- Lump on the palm
- Pain and swelling
Surgical Treatment for Trigger Finger
Trigger finger release surgery is done to give the tendon free and smooth movement and widen the sheath. The sheath is cut and when it grows back together, it is bigger/looser. The surgery is often performed through a tiny incision in the palm or with the tip of a needle (percutaneously).
De Quervain’s Tendinosis Surgery
De Quervain’s tendinosis comes from irritated tendons and/or a swollen tendon sheath, which causes crowding/pressure around the thumb base. Tendons cannot move smoothly through their lubricated sheath.
The condition may be brought about by being overused and is most often found in women at times of hormonal change such as pregnancy or middle age. The condition also affects people with RA (rheumatoid arthritis).
Symptoms:
- Pain on the thumb and along that side of the wrist when making a fist, gripping or turning your wrist, such as when turning a doorknob to open a door
- Swelling in the painful area
- A “catching” feeling, or hesitation, when moving your thumb
Surgery for De Quervain’s Tendinosis
Surgery can help by opening the thumb compartment and/or enlarging the sheath over the inflamed tendons to allow smoother, less painful or pain free movement.
Dupuytren’s Contracture Release Surgery
Dupuytren’s contracture is an often painless thickening of tissue under the palm and finger skin. The exact causes are unknown but it occurs most often in men and people of Scandinavian and Northern European descent and it may run in families. Risk increases with age and could be secondary to medical conditions like diabetes or lifestyle habits like drinking alcohol.
Symptoms:
Nodules under the skin of the palm and fingers, gradually becoming thick, tight and fibrous bands of tissue.
Tissue may gradually contract and cause affected fingers to curl toward the palm, making it difficult to grasp objects.
Types of Hand Surgery for Dupuytren’s Contracture
The goal of surgery is to remove or release the thick bands to allow greater finger motion. A skin graft may be needed if a large amount of diseased tissue is removed. Choose an expert hand surgeon for best results from this and other complex types of hand surgery.
See the Hand Surgery Specialist at Cohen/Winters
If you’re living with hand pain, numbness or restricted movement, it’s time to learn which types of hand surgery might benefit you. Please contact Cohen/Winters Aesthetic & Reconstructive Surgery in Bergen County for a personalized consultation.
