If conservative therapies fail to produce results for conditions or injuries affecting the hand, there are a number of surgical options available, depending on the condition involved, which can usually be carried out as outpatient procedures.
These operations are carried out using a tourniquet. This means that the blood supply to the area being operated on is stopped using a cuff so that the fine nerves and blood vessels become adequately visible.
|Duration of treatment:||Carpal tunnel syndrome: approx. 20 minutes|
|Dupuytren's contracture: around 1 – 1.5 hours|
|Ganglion: approx. 0.5 hours|
|Trigger finger: approx. 15 minutes|
|In-patient stay:||these operations are generally carried out as outpatient procedures. Where there is a particular risk, patients may be advised to stay in for 1 to 2 days.|
If carpal tunnel syndrome fails to respond to conservative methods such as injections and/or night splints, for example, and changes start to occur in the nerve structures, the nerve must be released through an operation. This is the only way to avoid permanent damage to the nerve.
The widening of the nerve channel (carpal tunnel division) and extrication of the nerve (neurolysis) allows pain and sensation problems to be resolved. To do this, we divide the ligament that forms the carpal tunnel. In many cases, this procedure can be performed using minimally invasive techniques via a small incision in the skin in the area of the carpus.
In many cases, pain and sensation problems resolve immediately after the operation. Where the nerve problems have been present for a longer period of time, however, it may take a while until normal sensation is restored. With trigger finger too, we separate the ligament preventing the free movement of the tendons under local anaesthetics.
Since the contractures in Dupuytren's contracture are not painful, many patients wait a long time before they seek help from a hand surgeon. By this stage, it is not uncommon to see stiffening of the finger joints. Prior to the operation, therefore, it must always be checked whether the joints have already stiffened up since this can reduce the chances of restoring complete mobility.
During the operation, we carefully remove all the problematic strands of connective tissue, which often also "wall in" the nerves and blood vessels of the fingers. After the wound has healed - usually around 10 days - hand function can be restored using exercises that the patient can perform himself, supported by occupational therapy.
Ganglia on the wrist and fingers are generally treated surgically and under local anaesthetics. During this procedure, we expose the thin capsule of the ganglion down to the "root" and remove it from there. To avoid recurrence, a temporary splint may need to be worn in the area of the operation site to keep the area still.