Hand Surgery has always been an important part of plastic surgery. We treat patients with traumatic injuries, arthritis, tendonitis, nerve compression, congenital abnormalities, cancers of the hand.
Carpal tunnel syndrome
Carpal tunnel syndrome is a condition in which the median nerve is compressed where it passes through the wrist. The median nerve controls muscles that move the thumb; it also carries information back to the brain about sensations in your thumb and fingers.
When the nerve is squeezed it can cause pain, tingling or numbness in the affected hand.
Women and people with Diabetes are more likely to develop carpal tunnel syndrome and although the condition affects people of all ages, it's more common in middle aged people.
The symptoms are usually worse in the thumb, index and middle fingers, but sometimes it may feel like your whole hand is affected. You may also have an ache extending up the arm to your shoulder or neck.
The symptoms tend to be worse at night. Hanging your hand out of bed or shaking it around will often relieve the pain and tingling.
However, if the nerve is badly squeezed you may have symptoms throughout the day. Your hand may feel weak, or your fingers numb, or both. You may find that you drop things more often and that activities which require fine finger movements, like writing or fastening buttons, become more difficult.
A nerve conduction test may help if there’s any doubt about the diagnosis or to see how severe the compression of the nerve is. These tests can be done in several ways but one common measurement is made by stimulating a finger with a small electric current while recording the response of the median nerve at the wrist with a pair of electrodes attached to the skin. When the nerve is impaired, the speed of conduction between the finger and the wrist is slower.
Carpal tunnel release surgery relieves pain by reducing the pressure on the median nerve. Surgery under local anesthesia takes place as a day-case and you can expect to recover in less than a month.
If you’ve had carpal tunnel syndrome for a long time – especially if you have muscle-wasting or loss of sensation – the operation may not bring a complete recovery, but the pain should be greatly reduced. For most people, the surgery is very successful.
Hand tumors of the skin and soft tissue are frequently encountered by plastic surgeons. Including epidermal inclusion cysts, ganglion cysts, and glomus tumors—in addition to malign tumors that are rare but nonetheless require differential diagnosis and expedient treatment.
Often a detailed history and clinical examination can direct towards the diagnosis. Sometimes additional investigations such as ultrasound, x-ray or MRI are needed.
The treatment relies on complete surgical removal of the tumor and if needed plastic surgical reconstruction.
Dupuytren's contracture is a hand deformity that usually develops slowly, over years. It affects the fascia, or connective tissue, under the skin of your palm where it forms nodules. These are pulling the fingers toward the palm and restrict motion. The condition usually develops in mid-life and has no precise cause (though it has a tendency to run in families). It is known that it occurs more frequently in patients with diabetes mellitus, seizure disorders (epilepsy), and high alcohol consumption.
For patients with significant fixed flexed posture (contracture) of the fingers a surgical procedures can remove the scarred tissue to free the fingers and release the tendons. These procedures can return function to a disabled hand. Minor nodule formation of the palm is not a reason to operate. Sometimes the surgeon can release the scarred tissue by carefully cutting it with a needle. This procedure is referred to as a needle aponeurotomy. In more advanced cases a palmar fasciectomy is needed.
Trigger finger is caused by a tendon whose bulge becomes too big to easily traverse within its tunnel. This might trap the finger in a flexed position and cause irritation or damage to the tendons. Trigger finger is curable with an operation under local anesthesia to release the tunnel and allow smooth tendon gliding.
Correction of traumatic tendon, nerve or bone injuries
The minor hand problems are managed by the Emergency Room physicians. The more complex hand problems are generally referred to plastic surgeons.
Some fractures will require surgery to better align the broken fragments especially if the break occurs into a joint where arthritis is more likely to occur.
When tendons are cut they have to be repaired with surgery in order to regain normal finger function. Tendon injuries usually result in 6-8 weeks of absence from work. Intensive physiotherapy is always necessary to obtain optimal results.
When nerves in the hand are cut, fingers or thumbs become numb. If a successful nerve repair operation by plastic surgeons is possible, some of the feeling does return to the involved finger or thumb tip several weeks after the operation.
Sometimes injuries of the hand can be overlooked or the first treatment could not achieve satisfying results. With careful planning, a corrective operation can align bones in the proper position, free tendons and release scar contractures of the skin. Nerves can be sutured or transplanted and destroyed joints be replaced.
Dr. Reuter, after taking a detailed history of your condition, will perform a functional examination of the hand. This will help to choose additional investigations such as x-ray or MRI if needed. With all information at hand the treatment options, expected results, complications and aftercare with physiotherapy will be discussed.