Hand surgery procedures are usually performed to repair injured hands. These include injuries to the tendons, nerves, blood vessels, joints, as well as fractured bones, burns, cuts, and skin wounds. Modern techniques have greatly improved the surgeon’s ability to restore function and appearance, even in severe injuries. Among the techniques now used by hand surgeons are:
- Grafting – the transfer of skin, bone, nerves, or other tissue from a healthy part of the body to the injured part
- Flap surgery – moving the skin, along with its underlying fat, blood vessels, and muscle, from a healthy part of the body to the injured site
- Replantation or transplantation – restoring amputated fingers or hands using microsurgery, an extremely precise and delicate surgery performed under magnification
Some injuries may require several operations over an extended period of time. In many cases, surgery may restore a significant degree of feeling and function to injured hands, however, recovery may take months, and a period of hand therapy will most often be needed. Call Samra Plastic Surgery at 732-739-2100 and schedule your consultation with any of our board certified plastic surgeons to assess your condition and devise a plan to help you.
CARPAL TUNNEL SYNDROME
The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand’s major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as Carpal Tunnel Syndrome. In some cases, splinting of the hand, cortisone injection and anti-inflammatory medications will relieve the problem. If this doesn’t work, however, surgery may be required. During the operation, the surgeon makes an incision from the middle of the palm to the wrist. The tissue that’s pressing on the nerve will be loosened, in order to release the pressure. A large dressing and splint are used, after surgery, to restrict motion and promote healing. The surgical scar will gradually fade and may become barely visible.
ENDOSCOPIC CARPAL TUNNEL RELEASE
Carpal Tunnel Syndrome (CTS) is a medical condition that causes numbness, pain, and discomfort in the hand, afflicting an estimated 75 million people globally. Treatments for CTS are generally successful, but early diagnosis is important. Our team of plastic surgeons at Samra Plastic surgery use state-of-the art techniques to correct this issue, offering healing and relief to our patients
CUBITAL TUNNEL SYDROME
The cubital tunnel is a tunnel formed by bones and ligaments on the inside of the elbow. The ulnar nerve passes through this tunnel on its way from the upper arm into the forearm. This nerve is in the area of your “funny bone” and is the reason why you have a tingling sensation in your ring and little fingers when you accidentally hit it.
Cubital Tunnel Syndrome is caused by increased pressure on the ulnar nerve as it passes through this tunnel. The ulnar nerve normally stretches a few millimeters every time the elbow is flexed. When this is done repeatedly or for prolonged periods of time, the nerve can become irritated and inflamed. Direct pressure on the elbow and trauma are other causal factors. The nerve can also move from its original position in the tunnel to a place outside the tunnel, leading to continued irritation and inflammation.
At Samra Plastic Surgery, we offer surgical treatment for cubital tunnel syndrome. Surgery involves movement (or transposition) of the nerve to a new location where it is not compressed (submuscular transposition of the ulnar nerve). The surgery is a delicate operation, but recovery is typically quick and it may both provide relief of the symptoms of cubital tunnel syndrome and prevent further damage to the ulnar nerve.
Arthritis of the hand can manifest in many locations. Osteoarthritis, or degenerative joint disease, commonly occurs at the base of the thumb, resulting in debilitating pain. The trapezium (a bone in the wrist) and the thumb metacarpal (a bone in the hand) lose their normal relationship as cartilage wears down, and when the two bones make contact with each other a grinding, aching, pain can occur. This can prevent people from using their hands to perform basic daily activities, such as opening jars.
Other degenerative arthritic conditions of the wrist can occur from remote traumas and undiagnosed ligament or bone injuries. As normal joint relationships break down and the arthritic process progresses, pain worsens. Finally rheumatoid arthritis, a specific type of chronic progressive arthritis that affects the whole body, has specific manifestations in the hand that can disrupt normal joint and tendon relationships.
At Samra Plastic Surgery we offer patients both nonoperative and operative treatments for arthritis of the hand. For basilar joint arthritis in the thumb, we offer a procedure called a CMC arthroplasty using the Mini-tightrope. This technique is less invasive than traditional approaches and allows for quicker rehabilitation of the hand. Learn more about the mini-tightrope here: http://www.arthrex.com/hand-wrist/cmc-arthritis
Stenosing Tenosynovitis of the flexor tendons is also known as Trigger Finger, one of the most common problems of the hand. Tendons glide through a pulley system in each finger, similar to the way that a fishing wire glides through pulleys along a fishing pole. Just as this system keeps the fishing wire next to the pole, the tendons are held next to the bones of the finger, to prevent bowstringing of the tendon. Sometimes the tendons can become inflamed in areas, making it difficult for the tendon to easily glide past the pulleys, as in straightening or bending the fingers. When the swollen part of the tendon is forced through the pulley, the patient experiences a characteristic triggering sensation. Trigger finger can occur in any finger, however it is most common in the thumb or ring fingers.
Trigger finger is first treated with direct injection of steroids into the tendon sheath. This is successful in a large number of patients. However, if this treatment is ineffective or if the patient has multiple fingers that trigger, surgical release of the pulleys is warranted. Long-term prognosis for cure is excellent.
DE QUERVAIN’S TENOSYNOVITIS
Also known as DeQuervain’s Stenosing Tenosynovitis, tendonitis of the wrist is an irritation and swelling of the wrist tunnel that the tendons of the thumb pass through on the way into the hand. The most common symptoms of DeQuervain’s are a pain over the tunnel in the wrist when pinching, grasping or stretching the wrist towards the small finger. Sometimes a swelling can be felt over this inflamed tunnel. More common in women, aged 30-50, this condition may be associated with repetitive stress, pregnancy or rheumatoid arthritis.
We offer both nonoperative and operative treatment for this common problem. Nonoperative therapy includes splinting and steroid injection. When indicated, surgical release of the inflamed tendons can be a definitive cure for the pain.
Dupuytren’s contracture is a disorder of the skin and underlying tissue on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families). Surgery is one treatment for Dupuytren’s contracture. The surgeon will cut and separate the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. In some cases, skin grafts are also needed to replace tightened and puckered skin. The results of the surgery will depend on the severity of the condition. You can usually expect a thin, fairly inconspicuous scar and significant improvement in function, particularly after hand therapy.
POLYDACTYLY / THUMB DUPLICATION
Polydactyly refers to having excess digits (more than 8 fingers and 2 thumbs). Many newborns are born with an extra digit or remnant of a digit which can be quite distressing to parents. The extra digit can be on the pinky-side or the baby may have an extra thumb.
Sometimes the extra digit can be a problem for function, sometimes it is just a cosmetic problem, but in either case, parents usually want the deformity addressed. Removing a supernumerary digit or digit remnant can involve a combination of excisional and reconstructive surgery and is best addressed by a hand surgeon with experience in dealing with congenital deformities of the hand.
Our surgeons are experienced in handling this particular congenital deformity of the hand and have done clinical research investigating the best treatment approaches. We offer surgical removal of the supernumerary digit and reconstruction of the hand.
Ganglion cysts are the most common soft tissue swellings of the hand and wrist. They can occur at any age, in either sex, or from any joint or tendon sheath. They are non-cancerous cysts that are filled with fluid. Some will disappear and others may cause problems due to large growth. It is unclear what causes the formation of ganglion cysts, but there is some evidence that they may be related to prior trauma or arthritis.
Not all ganglion cysts need to be removed surgically; some resolve spontaneously while others remain small and asymptomatic. This type of ganglion can be observed without surgery. The larger ganglia that do not disappear or are painful, symptomatic or cosmetically undesirable should be treated. Fluid may be drawn off the cyst but the cyst may still return. The ganglion may also be removed surgically with a lower rate of recurrence. This is performed as an outpatient procedure.
It is important to see a hand surgeon for removal of a ganglion cyst. In addition to having the most familiarity with the anatomy of the hand, hand surgeons are best equipped to ensure that the cyst is excised completely. A ganglion cyst that is incompletely excised is at high risk of recurrence. Our surgeons are very experienced in the surgical removal of these cysts, ensuring they are eradicated from their origin points from deep within joint spaces.
Syndactyly is the most common congenital hand deformity. Most commonly affecting the third and fourth web spaces of the hand, it involves the fusion of the skin or bones of the fingers. If the fusion of the fingers involves only the skin and soft tissues, the syndactyly is considered to be simple. If there is any bony fusion, the syndactyly is defined as complex. If the entire length of the fingers is fused, it is regarded as a complete syndactyly while a partial fusion is considered to be incomplete. A detailed physical examination as well as X-rays helps to classify the syndactyly.
Our surgeons are experienced in the management of children with syndactyly. Releasing the fused fingers is a delicate operation and often involves skin grafting. Our surgeons operate in local children’s hospitals to help ensure a safe and successful surgery. We care for both child and parent through the healing process.