Hand and Wrist Surgery
Our hands serve many purposes. They help us eat, dress, type or text, drive, exercise, earn a living, create and are an essential part of our daily living. To accomplish these tasks, our hands require sensation and movement. We tend to take them for granted but when they are not operating properly, we are often challenged and frustrated. The hand may not function for a variety of reasons including trauma, arthritis, congenital issues or disease.
Hand surgery and hand therapy have been a part of the offerings at the Institute for Plastic Surgery since its creation in 1973. Our three board certified hand surgeons – Drs. Michael Neumeister, Reuben Bueno and Nada Berry – offer state of the art care in the treatment of hand problems. All three surgeons completed a full year of additional training in hand surgery and passed a rigorous certifying examination. Through therapy and possibly surgery, they seek to restore the function of fingers and hands injured by trauma or to correct abnormalities caused by disease or that were present at birth. Some of the issues we treat include:
Carpal tunnel syndrome
- Condition brought on my increased pressure on the median nerve at the wrist (pinched nerve at the wrist).
- Symptoms may include numbness, tingling and pain in the arm, hand and fingers.
- The cause is generally unknown, but pressure on the nerve can happen several ways: swelling of the lining of the flexor tendons, joint dislocations, fractures, arthritis and keeping the wrist bent for long periods of time.
- Treatment may often be relieved without surgery. Wearing wrist splints and/or steroid injections are some of the most common remedies.
- When symptoms are severe or don’t improve, surgery may be needed.
Congenital Hand Anomalies
A congenital condition is one that a child is born with. Congenital hand deformities occur in several different ways and have different causes. Some deformities can be inherited and others are caused by developmental abnormalities while the baby is still in the womb. The congenital hand deformities treated at SIU Institute for Plastic Surgery include extra fingers, webbed fingers, missing fingers, abnormal thumbs, trigger thumb
Congenital hand deformities are easily spotted at birth. Depending on the type and severity of the deformity the child may undergo additional testing to determine if the hand deformity is part of an underlying medical issue.
The goal of treatment at the Institute for Plastic Surgery is to maximize function and help children lead as normal a life as possible. Treatment will depend on the type of hand deformity and the severity of the condition. Treatments available include:
- Separation and reconstruction of attached digits.
- Removal of extra fingers.
- Surgery to optimize a limb for a prosthetic
- Custom prosthetic devices
- Physical and occupational therapy
Cubital Tunnel Syndrome
- Condition caused by increased pressure on the ulnar nerve at the elbow.
- Common symptoms are numbness, tingling and pain in the elbow, forearm, hand and/or fingers.
- Numbness or tingling most often occurs in the ring and middle fingers.
- Symptoms are usually felt when there is pressure on the nerve, such as sitting with the elbow on an arm rest, or with repetitive elbow bending and straightening.
- Symptoms may be relieved by changing patterns of elbow use; or in more severe cases, surgery to relieve pressure on the nerve.
- First dorsal compartment tendonitis caused by irritation or inflammation of the wrist tendons at the base of the thumb.
- Inflammation causes the compartment around the tendon to swell and enlarge, making thumb and wrist movement painful.
- Making a fist, grasping or holding objects are common painful movements.
- Main symptom is pain over the thumb-side of the wrist.
- Pain may appear gradually or suddenly.
- Common treatments include wearing a splint, oral anti-inflammatory medications or injection of a cortisone-type steroid.
Distal Radius Fractures
The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.
Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.
A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.
One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. A Colles fracture occurs when the broken end of the radius tilts upward.
Other ways the distal radius can break include:
- Intra-articular fracture. A fracture that extends into the wrist joint. ("Articular" means "joint.")
- Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture.
- Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.
- Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture.
It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.
- Abnormal thickening of the tissue just beneath the skin (known as fascia).
- Thickening occurs in the palm and can extend into the fingers.
- Firm cords and lumps may develop, causing the fingers to bend into the palm (Dupuytren’s Contracture).
- Cause of the condition is unknown.
- More common in men over age 40 and in people of European descent.
- Symptoms usually include lumps and pits within the palm.
- For mild cases, only observation needed; more severe cases may require surgery.
- Common lumps within the hand and wrist that occur adjacent to joints or tendons.
- Most common locations are top of the wrist, the palm side of wrist, the base of the finger on the palm side and the top of the end joint of the finger
- The ganglion cyst often resembles a water balloon on a stalk and is filled with clear fluid or gel.
- Cause is unknown, although they may form in the presence of joint irritation or mechanical changes.
- Occurring in patients of all ages, they may change in size or even disappear completely, and they may or may not be painful.
- They are not cancerous and will not spread to other areas.
- Cysts can simply be observed, especially if they are painless, as they frequently disappear spontaneously.
- If the cysts become painful or limit activity, treatments include: use of splints, anti-inflammatory medication, aspiration and surgical alternatives for more severe cases.
The term jammed finger refers to finger joint pain and swelling from an impact injury. Jammed fingers are extremely painful, and require immediate treatment to aid healing.
The first steps to treating such an injury is icing and elevating the finger. Ice the injury for 15 minutes and then remove the ice until the finger temperature returns to normal. Then repeat the process. After the swelling decreases and the pain subsides, try to move the finger very slightly. If the injury is mild, you will be able to move with little discomfort over a short time. If the finger doesn't move easily or the pain gets worse, see a physician and have an x-ray to determine if there is a bone fracture.
Most jammed fingers heal completely if there is no fracture or dislocation. If there is a fracture or dislocation, it can take months to heal. Pain may last months and the injured joint may be larger than those of uninjured fingers. Physical therapy exercises are helpful to get a full recovery.
A disabling disease that can cause severe inflammation in any joint of the body. In the hand, it can deform fingers and impair movement.
The scaphoid is one of the small bones in the wrist. It is the wrist bone that is most likely to break. The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends.
The scaphoid is located at the base of the thumb, just above the radius bone.
It can most easily be identified when the thumb is held in a "hitch-hiking" position. The scaphoid is at the base of the hollow made by the thumb tendons. Pain or tenderness in this area can be a sign that the scaphoid is injured.
A scaphoid fracture is usually caused by a fall on an outstretched hand, with the weight landing on the palm. The end of one of the forearm bones (the radius) may also break in this type of fall, depending on the position of the hand on landing.
Fractures of the scaphoid occur in people of all ages, including children. The injury often happens during sports activities or a motor vehicle accident. Men aged 20 to 30 years are most likely to experience this injury.
There are no specific risks or diseases that increase the chance of having a scaphoid fracture. Some studies have shown that use of wrist guards during activities like inline skating and snowboarding can decrease the chance of breaking a bone around the wrist.
Scaphoid fractures usually cause pain and swelling at the base of the thumb. The pain may be severe when you move your thumb or wrist, or when you try to grip something.
Unless your wrist is deformed, it might not be obvious that the scaphoid bone is broken. In some cases, the pain is not severe, and may be mistaken for a sprain.
Any pain in the wrist that does not go away within a day of an injury may be a sign of a fracture. A simple "sprained" wrist is very rare and it is important to see a doctor if pain persists.
Pain and swelling in the wrist will usually cause a person with a scaphoid fracture to see a doctor.
X-rays can show if a bone is broken and whether there is displacement (a gap between broken bones). Sometimes, a broken scaphoid does not show up on an x-ray right away. If this is the case, your doctor may put your wrist in a splint for a week or two. A new x-ray will be taken to see if the fracture will become visible. The splint should be worn during this waiting period, and heavy lifting should be avoided.
A magnetic resonance image (MRI) scan may be taken to visualize the bones and soft tissues. This sometimes shows a fracture of the scaphoid before it can be seen on an x-ray.
Treatment of scaphoid fractures depends on the location of the break in the bone.
Fracture Near the Thumb
Scaphoid fractures that are closer to the thumb usually heal in a matter of weeks with proper protection. This part of the scaphoid bone has a good supply of blood, which is necessary for healing.
Your doctor will place your arm and hand in a cast. The cast will usually be below the elbow. It may or may not include the thumb.
The time it takes for the fracture to heal varies from person to person. Your doctor will monitor the healing by taking periodic x-rays or other imaging studies, such as a computed tomography (CT) scan. These imaging studies are used to confirm that the bone has healed.
Fracture Near the Forearm
If the scaphoid is broken in the middle of the bone (waist) or closer to the forearm (proximal pole), healing is more difficult. These areas of the scaphoid do not have a very good blood supply.
If your doctor treats this type of fracture with a cast, the cast will probably include the thumb. It may extend above the elbow, as well.
If your scaphoid is broken at the waist or proximal pole, your doctor may recommend surgery. During surgery, metal implants—such as screws and wires—are used to hold the scaphoid in place until the bone is fully healed.
Where your doctor makes the surgical incision, and how large it is depends on what part of the scaphoid is broken. The incision may be on the front or the back of the wrist.
Sometimes, the screw or wire can be placed in bone fragments with a small incision. In other cases, a larger incision is needed to ensure that the fragments of the scaphoid line up properly.
In cases where the bone is in more than two pieces, a bone graft may be needed to aid in healing. A bone graft is new bone that is placed around the broken bone and is used to stimulate bone healing. It increases bone production and helps broken bones heal together into a solid bone.
This graft may be taken from your forearm bone in the same arm or, less frequently, from your hip.
Whether your scaphoid fracture requires surgery or not, you will need to wear a cast or splint while the fracture heals. This may be for as long as 6 months. During this period of healing, unless approved by your doctor:
- Avoid heavy lifting, carrying, pushing, pulling, or throwing with the injured arm
- Do not participate in contact sports
- Do not climb ladders or trees
- Avoid activities with a risk of falling onto hand (for example, inline skating, jumping on a trampoline)
Some people have wrist stiffness after scaphoid fractures. This is more common when a cast was needed for a long time or when the fracture required more extensive surgery.
It is very important to maintain full finger motion throughout the recovery period. Your doctor will provide an exercise program, and may recommend hand therapy to help you regain motion and strength in your wrist.
Even with therapy, some people do not recover the same motion and strength in their wrists that they had before their injuries.
Intricate in design and function, the hand is an amazing work of anatomic engineering. Form follows function in the hand; therefore, any injury to the underlying structures of the hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries require proper medical evaluation.
The goal with injuries to the hand is a rapid and accurate initial evaluation and treatment. In other words, once an injury occurs, the doctor strives to begin medical treatment quickly so the short- and long-term effects on the hand can be minimized.
The hand consists of 27 bones (including the 8 bones of the wrist). When the other associated structures (nerves, arteries, veins, muscles, tendons, ligaments, joint cartilage, and fingernails) are considered, the potential for a variety of injuries exists when trauma involves the hand.
Hand injuries account for nearly 10% of hospital emergency department visits. A series of 1,000 consecutive hand injuries showed the following distribution: 42% lacerations (cuts), 27% contusions (bruises), 17% fractures (broken bones), and 5% infections. Hand injuries account for about 17% all workday loss injuries.
The most common cause of the injuries was blunt trauma (50%) followed by injury from a sharp object (25%).
Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight.
Trigger finger is a condition that affects the tendons in your fingers or thumb. The tendon sheath attaches to the finger bones and keeps the flexor tendon in place as it moves.
Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This is what causes some parts of the body to move.
The muscles that move the fingers and thumb are located in the forearm, above the wrist. Long tendons — called the flexor tendons — extend from the muscles through the wrist and attach to the small bones of the fingers and thumb.
These flexor tendons control the movements of the fingers and thumb. When you bend or straighten your finger, the flexor tendon slides through a snug tunnel, called the tendon sheath, that keeps the tendon in place next to the bones.
The flexor tendon can become irritated as it slides through the tendon sheath tunnel. As it becomes more and more irritated, the tendon may thicken and nodules may form, making its passage through the tunnel more difficult.
The tendon sheath may also thicken, causing the opening of the tunnel to become smaller.
If you have trigger finger, the tendon becomes momentarily stuck at the mouth of the tendon sheath tunnel when you try to straighten your finger. You might feel a pop as the tendon slips through the tight area and your finger will suddenly shoot straight out.
The thickened nodule on the flexor tendon strikes the sheath tunnel, making it difficult to straighten the finger.
The cause of trigger finger is usually unknown. There are factors that put people at greater risk for developing it.
- Trigger fingers are more common in women than men.
- They occur most frequently in people who are between the ages of 40 and 60 years of age.
- Trigger fingers are more common in people with certain medical problems, such as diabetes and rheumatoid arthritis.
- Trigger fingers may occur after activities that strain the hand.
Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use.
Symptoms may include:
- A tender lump in your palm
- Catching or popping sensation in your finger or thumb joints
- Pain when bending or straightening your finger
Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning. Your fingers will often loosen up as you move them.
Sometimes, when the tendon breaks free, it may feel like your finger joint is dislocating. In severe cases of trigger finger, the finger cannot be straightened, even with help. Sometimes, one or more fingers are affected.
Your doctor can diagnose the problem by talking with you and examining your hand. No other testing or x-rays are usually needed to diagnose trigger finger.
If symptoms are mild, resting the finger may be enough to resolve the problem. Your doctor may recommend a splint to keep your finger in a neutral, resting position.
Over-the-counter pain medications, such as non-steroidal anti-inflammatory medicines (NSAIDS) or acetaminophen can be used to relieve the pain.
Your doctor may choose to inject a corticosteroid — a powerful anti-inflammatory medication — into the tendon sheath. In some cases, this improves the problem only temporarily,and another injection is needed. If two injections fail to resolve the problem, surgery should be considered.
Injections are less likely to provide permanent relief if you have had the triggering for a long time, or if you have an associated medical problem, like diabetes.
Trigger finger is not a dangerous condition. The decision to have surgery is a personal one, based on how severe your symptoms are and whether nonsurgical options have failed. In addition, if your finger is stuck in a bent position, your doctor may recommend surgery to prevent permanent stiffness.
The goal of surgery is to widen the opening of the tunnel so that the tendon can slide through it more easily. This is usually done on an outpatient basis, meaning you will not need to stay overnight at the hospital.
Most people are given an injection of local anesthesia to numb the hand for the procedure.
The surgery is performed through a small incision in the palm or sometimes with the tip of a needle. The tendon sheath tunnel is cut. When it heals back together, the sheath is looser and the tendon has more room to move through it.
Surgical and Non-Surgical Treatment of Hand & Wrist Problems - click here