When Hands Need Helping
By Paul Leahy, MD
We often take some of the wonderful properties of our bodies for granted. Consider our hands and what they do for us each day. From feeding and cleaning, to driving and typing our hands are busy most hours of the day and they are unique appendages of bone, joints, ligaments, tendons, muscles, nerves, skin and blood vessels. All these features, many of them delicate, must be in good working order for the hand to function well.
Disease, injury and congenital problems (birth defects) can lead to pain and loss of function. Our goal as hand surgeons is to restore, as close to normal as possible, the function, strength and flexibility of fingers, hands and wrists that have been damaged.
Modern hand surgery began as a military planning decision around World War II, because of the poor outcomes of hand surgery during World War I. Military surgeons were trained in new techniques being developed by orthopedic and plastic surgeons and hand surgery soon became a sub-specialty.
Apart from wounds and fractures, there are a number of problems where surgery may be a good option for the patient.
Carpal tunnel syndrome (CTS) is a condition caused by pressure to the median nerve within the wrist, or carpal tunnel, which is the passageway that connects the forearm to the plane of the palm. This tunnel, or canal as it is referred to, is narrow. If any of the nine tendons that pass through it become swollen or damaged, the median nerve can become entrapped or compressed causing pain, a tingling sensation, numbness in the fingers and weakness. The exact cause of carpal tunnel syndrome is not known, but is associated with many conditions such as repetitive motion or overuse, fluid retention during pregnancy, sleeping habits and rheumatoid arthritis. Genetics may also play a role. Left untreated, CTS can lead to permanent nerve damage and muscle atrophy.
Dupuytren's contracture is a shortening or thickening of the palm where the fingers bend towards the palm and cannot be fully straightened. It does have a tendency to run in families, especially among Scandinavian populations. It is a connective tissue disorder that progresses slowly and is usually painless. In its early stages, the disease can often be treated non-surgically.
Rheumatoid arthritis is a disabling disease that can cause severe inflammation in any joint of the body. In the hand, it can deform fingers and impair movement.
Trigger finger has nothing to do with shooting a gun. It is a common disorder of later adulthood characterized by catching or locking of the finger flexor tendon, associated with loss of function and pain. The name came about because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun. For many patients, injections of the tendon sheath with a corticosteroid over a number of weeks are effective. If injections fail, the problem can be resolved by a relatively simple surgical procedure in which the surgeon alters the sheath that is restricting the tendon.
Is hand surgery an option for me?
Hand surgery is a highly individualized procedure which can be performed on people of all ages. Hand surgery may be a good option for you if:
- You do not have medical conditions or illnesses that may impair healing
- You are a non-smoker
- You have a positive outlook and realistic goals for your hand surgery
- You are committed to following your prescribed course of treatment
Why post-op is as important as the surgery
The success of hand surgery is directly related to following your therapist’s and surgeon’s instructions. The best hand surgeon in the world cannot overcome a patient's lack of willingness to follow all postoperative instructions involving cleansing, prescribed medications and hand therapy exercises. Therapy is the key to restoring strength and flexibility. If you attempt to return to normal function too soon, the risk of re-injury is possible. It’s important that patients continue their hand therapy regimen and attend follow-up visits as scheduled. This is essential to a successful outcome.
Dr. Leahy is in practice with Monarch Plastic Surgery and is a member of the American Society of Plastic Surgeons. He can be reached at 913-663-3838.