Other Hand and Wrist Surgery

De Quervain’s Tenosynovitis Surgery

What is De Quervain’s Tenosynovitis Surgery?

De Quervain’s tenosynovitis is inflammation of the tendons to the thumbs where they pass through the ‘first compartment’ of the wrist. These tendons travel through separate tunnels at the level of the wrist joint and the tunnels ensure that the tendons do not bowstring when the wrist is extended.

Usually the space inside the tunnel is lubricated by fluid, but if inflammation occurs within the tunnel, the tendons can become inflamed and swollen. This causes pain and irritation at the site.

How does De Quervain’s tenosynovitis surgery work?

Surgery is usually performed under a local anaesthetic as a day procedure. It usually takes about 10 minutes to complete. A tourniquet is placed above the elbow to ensure a bloodless field. Then a 2–3cm incision is made over the thumb side of the wrist and the underlying fat is retracted. Nerves and blood vessels are identified and protected, and the extensor compartment sheath is then opened. The affected tendons are released and allowed to glide more freely. Occasionally, multiple compartments need to be released. The skin is sutured closed and dressings are applied.

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Possible complications

Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Specific complications related to De Quervain’s tenosynovitis surgery include failure to completely resolve the symptoms. This is rare, occurring in less than 1% of patients. The nerves under the skin at this site are very close to where the incision is made and may be damaged during surgery. This can cause ongoing pain and possibly numbness just beyond the incision site.

What to expect after De Quervain’s tenosynovitis surgery

You will be able to go home soon after the operation. The anaesthetic will wear off after approximately 6–8 hours, and any discomfort will usually be controlled with simple analgesia.

You should keep your hand should elevated, but there are no limitations on finger movements. These are actively encouraged.

The bandage dressings are usually removed after 48 hours. The sticky dressing over the wound is usually left on. It, and the sutures, are usually removed 10–14 daysafter surgery. You need to keep the wound dry until the sutures are removed.

Most people notice an improvement in their symptoms within the first few days but some have ongoing symptoms for up to 3 months following surgery.

You can return to driving once the sutures have been removed. You will need at least 2 weeks off work if your job involves heavy manual work or frequent hand-washing. Some peopleneed longer period off work and this should be discussed with your surgeon prior to the procedure.

Ganglion surgery

What is ganglion excision surgery?

Ganglion excision surgery is a treatment option for large or painful ganglions.

A ganglion is a smooth fluid-filled lump that occurs under the skin near joints or tendons. These cysts most frequently develop on the back of the wrist, but they appear at multiple sites over the hand. A ganglion is not a cancer and is usually harmless. They can change in size (becoming larger or smaller) and may spontaneously disappear completely.

Many ganglion do not require treatment, however if the ganglion is painful, interferes with function or limits the ability to use the hand then there are treatment options available including immobilising with cast or splint, draining the cysts and surgical removal.

How does ganglion excision surgery work?

Ganglion excision surgery is done under local or general anaesthetic. It is usually a day procedure, meaning you can go home on the same day as the surgery.

During the surgery, your surgeon cuts over the ganglion, then removes it completely, including its stalk that goes down to the joint capsule.

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Possible complications

Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Complications specific to ganglion removal surgery include recurrence of the ganglion. Recurrence is more common with ganglions on the palm side of the wrist than on the back side of the wrist.

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Trigger Finger Surgery

What is trigger finger surgery?

Trigger finger surgery is a treatment for trigger finger. Surgery involves releasing the first annular pulley ligament in your hand, which allows the affected ligament to move freely.Trigger finger is also called stenosing flexor tenosynovitis.

Trigger finger is a painful condition that causes the finger or thumb to catch or lock when flexed. When it affects the thumb, it is called trigger thumb. The condition occurs when tendons in the finger or thumb become inflamed.

Surgery is suggested if non-surgical therapy (including steroid injections into the tendon sheath) fails.

How does trigger finger surgery work?

Surgery is usually performed under local anaesthetic as a day procedure. The procedure usually takes about 10 minutes to complete.

A tourniquet is placed above the elbow to ensure a bloodless field.  A transverse or oblique incision is made over the palm in line with the affected digit. The pulley ligament is divided, allowing the tendon to move freely within the palm. The skin is sutured closed and dressings are applied.

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Possible complications

Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1–2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Outcomes of surgery may not be as successful in people with diabetes, who also have higher rates of complications like infections and surgical revisions.

What to expect after trigger finger surgery

You will be able to go home soon after the operation. The anaesthetic will wear off after approximately 6–8 hours, and any discomfort will usually be controlled with simple analgesia.

You should keep your hand should elevated, but there are no limitations on finger movements. These are actively encouraged.

The bandage dressings are usually removed after 48 hours. The sticky dressing over the wound is usually left on. It, and the sutures, are usually removed 10–14 daysafter surgery. You need to keep the wound dry until the sutures are removed.

Most people notice an improvement in their symptoms within the first few days but some have ongoing symptoms for up to 3 months following surgery.

You can return to driving once the sutures have been removed. You will need at least 2 weeks off work if your job involves heavy manual work or gripping. Some peopleneed longer period off work and this should be discussed with your surgeon prior to the procedure.