Hand Surgery

Hand is the highest evolved functioning extremity/creation of nature in the entire living kingdom on this planet.

Hand surgery is one of the finest super specialty of orthopaedic surgery which requires a thorough knowledge of topographical function anatomy and extensive planning to correct the functional movements of human hands in order to restore their common functions after trauma. In a nutshell, Hand surgery involves reconstruction of anatomical structures and restoration of functions of human hand after extensive trauma and destruction.

Hand is attached to forearm through the wrist joint and has 20 muscles and more than 20 small bones with well organized functions. Hand functions are performed with the help of 8 carpal bones in wrist, 2 forearm bones and many extrinsic muscles and tendons (out side hand) in different compartments of forearm working together along with the intrinsic muscles (in the hand/palm) and tendons including 4 hypo-thenar, 4 lumbrical muscles, 4 dorsal and 4 palmer interossei muscles in the palm of human hand. The higher centers of the brain with the help of different nerves commands these structures to perform highly complex hand functions.

Our consultant orthopaedic surgeon at Ortho Medical Associates has over 30 years of experience in restoring human hand functions.

The common Hand problems are as follows:

Carpal Tunnel Syndrome
Patients with complaints of numbness and tingling radiating from the forearm into the fingers due to Carpal Tunnel Syndrome are being seen with increasing frequency. These symptoms may be secondary to repetitive activities and often reflect an individuals employment or recreational activities. The median nerve travels down the forearm and gains entry into the hand by passing under the transverse carpal ligament at the wrist. An impingement on the median nerve can occur at this location and result in numbness and tingling into the middle fingers of the hand.

Cramping, burning sensation sharp pains, and weakness of the hand can develop as the disease progresses. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

Carpal tunnel syndrome treatment usually begins conservatively, and moves to more aggressive and invasive techniques if the symptoms persist.

The initial carpal tunnel syndrome treatment steps include the resting of the wrist, some medications and splints.The wearing of a splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.

Putting ice on your wrist, massaging the area and doing stretching exercises may help too.

Cortisone injections provide temporary relief as is it injected directly into the affected area to decrease inflammation around the nerve.

Surgical treatments are available and effective in the treatment of carpal tunnel syndrome. The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve. Most of the surgery is performed as an outpatient under local or regional anesthesia. Rarely is a general anesthetic required. After two or three hours in the hospital the patient is usually discharged home with an ace bandage or removal splint in place. Physical therapy modalities are usually not necessary as long as the individual works on moving their fingers and wrist daily. Return to work is usually possible after two or three weeks with full strength and motion returning after six weeks.

Rehabilitation

The Carpal Tunnel Wrist Brace helps to stabilize the carpal tunnel in its neutral position. Exercise will help to strengthen the wrist and prevent the symptoms of carpal tunnel syndrome.

Tips on relieving carpal tunnel syndrome

*Prop up your arm with pillows when you lie down.
*Avoid using your hand too much.
*Find a new way to use your hand by using a different tool.
*Try to use the other hand more often.
*Avoid bending your wrists down for long periods.

Trigger Finger/Thumb/Tenosynovitis
Various movements of fingers and thumb are controlled by the tendons which pass through different channels/tunnels in the wrist and palm. most of the flexion portion of these tendons are covered by a sleeve called synovial sheath which carries synovial fluid (lubricant). On account of unknown deterioration of physiological balance of this joint lubricant and at times due to excessive movements especially in individuals involved in operation of computer keyboards and fine musical instructions, the excessive friction and eventually leads to disabling of functions, pain and click during movements of these tendons clinically termed as Trigger finger.

At Ortho Medical Associates, we successfully treat this condition with trigger point blocks under strict medical control and ultimately by surgical release of the contraction as an out-patient procedure.