Surgery for hand deformities

The Most Common Hand Diseases

Hands are very important for us – we use them to eat, dress, write, touch things, work, play, paint. To do all this, they have to be mobile and sensitive.  Various diseases, damage or congenital deformities can disturb the hand function. In these cases plastic surgeons can help by surgical procedures or nonsurgical methods. Some hand diseases are rather common. Timely treatment of such disorders can help prevent permanent damage to these areas.

 

Trigger Finger (Stenosing Tenosynovitis)

Tendons glide through the tunnel formed by various shaped ligaments (pulleys) as they bend the fingers. A trigger finger is caused by thickening of the flexor tendon. The tendon itself may develop a knot (nodule). When the tendon is too swollen to fit back into its tunnel, the tendon gets stuck and locks or clicks, with finger movement becoming increasingly painful and difficult. If trigger finger is severe, your finger may become locked in a bent position. Causes for this condition are not always clear.

A similar condition may occur in children. The goal of treatment in trigger finger is to eliminate the catching or locking and allow full movement of the finger without discomfort. The wearing of a splint or taking anti-inflammatory medications may sometimes help to reduce swelling of the tendon. If non-surgical forms of treatment do not relieve the symptoms, surgery may be recommended to open the pulley at the base of the finger so that the tendon can glide more freely.
Fig. 1. The tendon is too swollen to fit back into its tunnel.

 

Wrist Pain (de Quervain’s Tendonitis)

The mechanism of this disease is similar to that of trigger finger. It is the result of irritation and swelling of the tendons on the thumb side of the wrist. The swollen tendons rub against the narrow tunnel through which they pass. Pain is common in de Quervain’s. Thumb motion may be difficult and painful, particularly when pinching or grasping objects. The pain may travel up the forearm. Palliative treatments include a splint that immobilizes the wrist and the thumb, and anti-inflammatory medications. If de Quervain’s disease does not respond to conservative medical treatment, surgery may also be recommended. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, restoring the tendons’ smooth gliding capability.

 

Numbness in Fingers (Carpal Tunnel Syndrome)

The carpal tunnel is located at the base of the wrist. Nine flexor tendons and the median nerve pass through the carpal tunnel. Sometimes after traumas but most often for unknown reasons, the median nerve becomes pressed or squeezed at the wrist. Carpal tunnel syndrome is a condition brought on by increased pressure on the median nerve. Symptoms may include tingling or numbness, and complete insensibility in fingers, pain in the wrists radiating up the arm as the disease progresses.

The symptoms usually increase at night. If your symptoms occur all of the time, your hand muscles can become weak. Decreased grip strength can lead to frequent dropping of objects from the hand. Initial treatment usually includes immobilization of the wrist in a splint and anti-inflammatory drugs that may provide temporary relief to persons with mild or intermittent symptoms. When nonsurgical treatment has failed or for more advanced cases, surgical treatment of the carpal tunnel syndrome may be considered. The goal of surgery is to take pressure off the nerve at the wrist. The surgeon will cut the ligament that covers the carpal tunnel. By releasing the ligament, pressure is relieved on the nerve in the carpal tunnel. Some people experience immediate relief in their hand once the pressure on the nerve is eliminated with surgery. Other people do not experience immediate relief due to more long-standing and severe pressure on the nerve. It may take a few months to recover grip strength.

 

Fig. 2. The surgeon will cut the ligament that covers the carpal tunnel. By releasing the ligament, pressure is relieved on the nerve in the carpal tunnel.

 

Ganglion Cyst of the Hand

The ganglion cysts are generally found on the wrist or fingers. They usually come up from nearby joint linings or tendon sheaths. There is no known specific cause for ganglions. These cysts can be painful, especially when they first appear. Ganglions often change in size and may disappear completely. If the ganglion is painful, does limit motions of the wrist or fingers, or you dislike its appearance, then treatment may include removing fluid from the cyst (putting a needle into the cyst and aspirating) or surgery to remove the cyst.

 

Fig. 3. The ganglion cysts are generally found on the wrist or fingers.

 

Thumb Pain (Thumb Basal Joint Arthritis)

In a normal joint, cartilage covers the end of the two bones and allows smooth, pain-free movement. In thumb arthritis, also called basal joint arthritis, the cartilage layer wears out, resulting in direct contact between the bones and producing limited motion of the thumb, pain and deformity. An anti-inflammatory medication is often a good first step in the treatment process. A splint can rest the arthritic joint, and relieve the inflammation associated with thumb arthritis. If non surgical methods of treatment fail to cure thumb pain, then the damaged joint is repaired by surgical means.

 

Contracted Fingers (Dupuytren’s Contracture)

Dupuytren’s disease typically starts on the palm of the hand with a small nodule or several nodules. As it progresses, nodules can also appear in the digits. The scar that forms prevents full palm and finger straightening. Dupuytren’s contracture is a localized formation of scar tissue beneath the skin of the palm of the hand but it does not affect tendons. This disease is usually painless but it can complicate everyday activities such as shaking hands, washing, putting on gloves. The precise cause of Dupuytren’s contracture is not known. The incidence increases after the age of 40; at this age men are affected more often than women. Dupuytren’s contracture can be inherited. The inherited form is transferred in the family. Dupuytren’s contracture is treated with surgery. Surgery is usually recommended when the hand cannot be placed flat on a table and when it is impossible to straighten the fingers completely.

 

Fig.4. The scar that forms prevents full palm and finger straightening.

 

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For more information about D. Radzevičius, please see his personal website  www.dariusradzevicius.lt

 

 

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