Wrist & Hand
Hand Surgery
Carpal Tunnel Release Surgery
Why is hand surgery performed?
Hand surgery is performed to restore the structure and functionality of the fingers, wrist and hand secondary to a traumatic injury, medical condition, severe infection, or birth defect causing pain and/or deformity of the hand. It is performed by trained and certified plastic surgeons. The surgery is done either as an emergency procedure or as an elective procedure depending on the condition and its severity.
Conditions for which elective hand surgery is done include:
- Burn reconstruction- Congenital deformities such as fused digits, extra digits and missing digits- Tendinitis, an inflammation of the tendons, including De Quervain's tendinitis of the thumb, flexor and extensor tendonitis of the wrist- Tumours of the skin, soft tissue or bone- Dupuytren's contractures- Ganglion cysts- Trigger finger- Compression syndromes e.g. carpal tunnel syndrome, cubital tunnel syndrome, distal ulnar tunnel syndrome and pronator syndrome Conditions that may require emergency hand surgery include:
- Fractures- Tendon injuries- Nerve or artery injuries- Fingertip injuries- Other accidental injuries What are the common hand surgery procedures? Some of the most common procedures used for the treatment of these conditions and injuries include:
- Skin grafts: This involves the use of healthy skin from an area of the patient's body to cover or resurface the injured area. This is most commonly used for burn reconstruction and amputation of fingers.- Tendon repair: This is used for the management of ruptured tendons caused by trauma or sports injury by special sutures. Preferably the surgery is performed within 24 hours of the injury, as early surgery is associated with better outcomes.- Nerve repair: This is a complex surgery done immediately after a nerve injury, as damage to any of the three main nerves of the hand may lead to limited use or hampered range of motion of the hand including the fingers and the wrist. It may also result in permanent disability.- Closed reduction and fixation: It involves the realignment of the bones of the hand with the help of rods, wires, splints and casts. It is used for fractures with completely displaced and/or crushed bones.- Joint replacement: This involves the replacement of the joints in the fingers and the wrist with a new joint made of silicone rubber, a portion of the patient's tendon or a plastic or metal implant. This is usually done in patients with osteoarthritis or traumatic arthritis of the hand to relieve pain and restore function in the affected hand.
Conditions for which elective hand surgery is done include:
- Burn reconstruction- Congenital deformities such as fused digits, extra digits and missing digits- Tendinitis, an inflammation of the tendons, including De Quervain's tendinitis of the thumb, flexor and extensor tendonitis of the wrist- Tumours of the skin, soft tissue or bone- Dupuytren's contractures- Ganglion cysts- Trigger finger- Compression syndromes e.g. carpal tunnel syndrome, cubital tunnel syndrome, distal ulnar tunnel syndrome and pronator syndrome Conditions that may require emergency hand surgery include:
- Fractures- Tendon injuries- Nerve or artery injuries- Fingertip injuries- Other accidental injuries What are the common hand surgery procedures? Some of the most common procedures used for the treatment of these conditions and injuries include:
- Skin grafts: This involves the use of healthy skin from an area of the patient's body to cover or resurface the injured area. This is most commonly used for burn reconstruction and amputation of fingers.- Tendon repair: This is used for the management of ruptured tendons caused by trauma or sports injury by special sutures. Preferably the surgery is performed within 24 hours of the injury, as early surgery is associated with better outcomes.- Nerve repair: This is a complex surgery done immediately after a nerve injury, as damage to any of the three main nerves of the hand may lead to limited use or hampered range of motion of the hand including the fingers and the wrist. It may also result in permanent disability.- Closed reduction and fixation: It involves the realignment of the bones of the hand with the help of rods, wires, splints and casts. It is used for fractures with completely displaced and/or crushed bones.- Joint replacement: This involves the replacement of the joints in the fingers and the wrist with a new joint made of silicone rubber, a portion of the patient's tendon or a plastic or metal implant. This is usually done in patients with osteoarthritis or traumatic arthritis of the hand to relieve pain and restore function in the affected hand.
What is carpal tunnel syndrome?
Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.
Symptoms of carpal tunnel syndrome Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.
Causes/Risk factors of carpal tunnel syndrome Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumour in the canal.
Treatment of carpal tunnel syndrome Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:
- Treating underlying medical conditions- Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks- Rest the hand for 2 weeks or more- Ice packs to avoid swelling- Avoid activities that tend to worsen the symptoms- Medications such as nonsteroidal anti-inflammatory drugs, diuretics, and steroid injections- Strengthening and stretching exercises once symptoms diminish If conservative treatment options fail to resolve the condition your surgeon may recommend a surgical procedure
Carpal Tunnel Release Surgery Carpal tunnel syndrome can be treated with carpal tunnel release Surgery Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.
Postoperative Care following Carpal Tunnel Release Surgery Your surgeon may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.
- Elevate the hand above heart level to reduce swelling- A splint may be worn- Ice packs to the surgical area to reduce swelling- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering- Physical therapy may be ordered to restore wrist strength- Eating a healthy diet and not smoking will promote healing Risks and complications associated with carpal tunnel release surgery The majority of patients suffer no complications following carpal tunnel release surgery. However, some patients may suffer from:
- Pain- Infections- Scarring- Nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area
Symptoms of carpal tunnel syndrome Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.
Causes/Risk factors of carpal tunnel syndrome Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumour in the canal.
Treatment of carpal tunnel syndrome Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:
- Treating underlying medical conditions- Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks- Rest the hand for 2 weeks or more- Ice packs to avoid swelling- Avoid activities that tend to worsen the symptoms- Medications such as nonsteroidal anti-inflammatory drugs, diuretics, and steroid injections- Strengthening and stretching exercises once symptoms diminish If conservative treatment options fail to resolve the condition your surgeon may recommend a surgical procedure
Carpal Tunnel Release Surgery Carpal tunnel syndrome can be treated with carpal tunnel release Surgery Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.
Postoperative Care following Carpal Tunnel Release Surgery Your surgeon may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.
- Elevate the hand above heart level to reduce swelling- A splint may be worn- Ice packs to the surgical area to reduce swelling- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering- Physical therapy may be ordered to restore wrist strength- Eating a healthy diet and not smoking will promote healing Risks and complications associated with carpal tunnel release surgery The majority of patients suffer no complications following carpal tunnel release surgery. However, some patients may suffer from:
- Pain- Infections- Scarring- Nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area