Hand Injuries

Carpal Tunnel Syndrome Congenital Defects Dupuytren's Contracture Trigger Finger Rheumatoid Arthritis

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 can 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. 

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 become barely visible.

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CONGENITAL DEFECTS

Congenital deformities of the hand - that is, deformities a child is born with - can interfere with proper hand growth and cause significant problems in the use of the hand.  Fortunately, with modern surgical techniques, most defects can be corrected at a very early age - in some cases during infancy, in others, at two or three years - allowing normal development and functioning of the hand.

One of the most common congenital defects is Syndactyly, in which two or more fingers are fused together.  Surgical correction involves cutting the tissue that connects the fingers, then grafting skin from another part of the body. (The procedure is more complicated if bones are also fused.)  Surgery can usually provide a full range of motion and a fairly normal appearance, although the color of the grafted skin may be slightly different from the rest of the hand.

Other common congenital defects include short, missing or deformed fingers, immobile tendons, and abnormal nerves or blood vessels.  In most cases, these defects can be treated surgically and a significant improvement can be expected.

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DUPUYTREN'S CONTRACTURE

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 the only 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.

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Trigger Finger

Trigger finger is a common disorder of the hand which causes a painful snapping or locking of the fingers or thumb.  The medical name for this condition is Stenosing Tenosynovitis.  Stenosing refers to the narrowing of an opening or passageway in the body.  Tenosynovitis refers to inflammation of the outer covering of the tendons that bend and extend the fingers and thumb. The tendons are tough, fibrous cords that connect the muscles of the forearm to the bones of the fingers and thumb.  This muscle and tendon system enables one to bend the fingers inward when making a fist, or extend them  straight.

Conservative (non-surgical) treatment is an appropriate first step, unless the finger or thumb is in an unmovable, locked position.  Initial treatment involves a cortisone injection as well as avoiding or modifying those activities that have caused the inflammation.

In cases that do not respond to conservative treatment, or if the finger or thumb remain in a locked position, surgery may be recommended.

Surgery is performed on an out-patient basis under a local anesthetic.  A longitudinal or zigzag incision is made in the palm of the hand at the base of the affected finger, or a transverse incision for the thumb.  In most cases the surgeon will simply release (cut) the first annular band, relieving the constriction of the tendon as it passes through the sheath.  The patient may be asked to actively move the tendon during surgery to confirm whether the triggering has been relieved.

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RHEUMATOID ARTHRITIS

Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body.  It often deforms finger joints and forces the fingers into a bent position that hampers movement.

Disabilities caused by rheumatoid arthritis can often be managed without surgery - for example, by wearing special splints or using hand therapy to strengthen weakened areas.  For some patients, however, surgery offers the best solution.  Whether or not to have surgery is a decision you should make in consultation with your surgeon and your rheumatologist.

Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, or implanting artificial joints.  While your hand may not regain its full use, you can generally expect a significant improvement in function and appearance.  Still, it's important to remember that surgical repair doesn't eliminate the underlying disease.  Rheumatoid arthritis can continue to cause damage to your hand, sometimes requiring further surgery, and you'll still need to see your rheumatologist for continuing care.

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