Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other activities. To do these activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.
What do hand surgeons do?
Hand surgery is the field of medicine that deals with problems of the hand, wrist, and forearm. Hand surgeons care for these problems with and without surgery. They are specially trained to operate when necessary. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems.
Hand surgeons are orthopaedic, plastic, or general surgeons who have additional training in surgery of the hand. To become members of the Tunisia Society for Surgery of the Hand, hand surgeons must take a full year of additional training and must pass a rigorous certifying examination.
Why visit a hand surgeon?
When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.
Not every visit to a hand surgeon results in hand surgery.
Hand surgeons often recommend non-surgical treatment options to assist you. Sometimes, they may refer you to a hand therapist for more treatment.
Hand surgeons are specialists in hand care.
If you have pain in your fingers, hand, wrist or arm, or have other upper-extremity related concerns, you may want to consult a hand surgeon.
Examples of conditions treated by a hand surgeon are:
- Carpal tunnel syndrome
- Wrist pain
- Cuts on the fingers and hand
- Sports injuries to the hand and wrist
- Creating fingers from toes and other joints
- De Quervain's Tendinitis (De Quervain's Tendinosis)
- Arthritis of the Thumb
- Claw Toe
- Trigger Finger
- Tears and Instability
- Carpal tunnel syndrome
Carpal tunnel syndrome :
Carpal tunnel syndrome is a common source of hand numbness and pain. The tendons in the wrist swell and put pressure on the median nerve, one of three major nerves responsible for supplying feeling in the hand. It is more common in women than men and affects up to 10 percent of the entire population.
Diagnosis
Your doctor will make the diagnosis by discussing your symptoms and by performing a number of physical tests, such as the following:
- Ask you to straighten the thumb while it is being held to determine whether there is any weakness in the median nerve (thumb abduction strength test)
- Ask you to extend the arms and relax the wrists to see whether you experience any numbness or tingling in the wrists (Phalen maneuver)
- Press down on the median nerve in the wrist to determine whether there is any sign of numbness or tingling. (Durkan carpal tunnel compression test)
- Tap along the median nerve in the wrist to see whether tingling is produced in any of the fingers
- Tell you to close your eyes and ask you whether you feel the pressure of two light pin-point touch on the fingertip of the affected hand. If you have carpal tunnel syndrome, you may be unable to distinguish two pin-point touches that are closer than 5 mm as separate points
Your doctor may order X-rays of the wrist if you have limited wrist motion. If symptoms continue to bother you, electrical testing of the nerve function (electrophysiological tests) is often performed to help confirm the diagnosis and clarify the best treatment option in your case.
Treatment
If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery.
Nonsurgical Treatment
Treatment often begins with a brace or splint worn at night to keep the wrist in a natural position. Splints can also be worn during activities that aggravate symptoms.
Simple medications can help decrease pain. These medications include anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Changing patterns of hand use to avoid positions and activities that aggravate the symptoms may be helpful.
A corticosteroid injection will often provide temporary relief, but symptoms may come back.
Surgical Treatment
Surgery may be considered if carpal tunnel syndrome continues to bother you and you do not gain relief from nonsurgical treatments. The decision whether to have surgery is based mostly on the severity of the symptoms.
- If the symptoms are severe and won't go away, your doctor may consider surgery.
- In more-severe cases, surgery is considered sooner because other treatment options are less helpful.
- In very severe cases, surgery may be recommended to prevent irreversible damage.
Technique. Generally, carpal tunnel surgery is done on an outpatient basis under local anesthesia.
During surgery, a cut (incision) is made in the palm or wrist. The roof of the carpal tunnel is cut. This increases the size of the tunnel and decreases pressure on the nerve.
Some surgeons use a smaller incision and use a small camera (endoscope) to carry out the surgery.
Considerations. Risks from the surgery include bleeding, infection, and nerve injury. Some pain, swelling, and stiffness can be expected. Minor soreness in the palm is common for several months after surgery. Severe problems are rare. You may be instructed to elevate your hand and move your fingers after surgery. This helps minimize swelling and stiffness.
Recovery. Most patients see their symptoms improve after surgery, but recovery may be gradual. On average, grip and pinch strength generally return by about 2 months after surgery. Complete recovery may take up to a year. If significant pain and weakness continue for more than 2 months, your physician may instruct you to work with a hand therapist. If carpal tunnel syndrome has been present longer and the nerve is more severely affected before treatment is attempted, recovery is slower and less complete.
Arthritis of the Wrist
Arthritis affects millions of people in the United States. Often, arthritis strikes at the weightbearing joints of the body, such as the knees and the shoulders. A significant number of people suffer from arthritis in their wrists and hands, which makes it difficult for them to perform the activities of daily living.
Symptoms
OA of the wrist joint manifests with swelling, pain, limited motion, and weakness. These symptoms are usually limited to the wrist joint itself.
RA of the wrist joint usually manifests will swelling, tenderness, limited motion, and decreased grip strength. In addition, hand function may be impaired and there may be pain in the knuckle joints (metacarpophalangeal, or MP, joint).
Joint swelling may also put pressure on the nerves that travel through the wrist. This can cause a lesion to develop (compression neuropathy) or it can lead to carpal tunnel syndrome.
Diagnosis
The bones that make up the wrist joint include the two bones of the lower arm (the radius and the ulna) and four wrist bones (the carpals). Your physician will use a combination of physical examination, patient history, and tests to diagnose arthritis of the wrist. X-rays can help distinguish among various forms of arthritis. Some, but not all, forms of rheumatoid arthritis can be confirmed by a laboratory blood test.
Surgical Treatment
When nonsurgical methods are no longer effective, or if hand function decreases, surgery is an option. The goal of surgery is to relieve pain. Depending on the type of surgery, joint function may also be affected.
Surgical options include:
- Removing the arthritic bones
- Joint fusion (making the joint solid and preventing any movement at the wrist)
- Joint replacement
You and your physician should discuss the options and select the one that is best for you.
De Quervain's Tendinitis (De Quervain's Tendinosis)
De Quervain's tendinitis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinitis" refers to a swelling of the tendons. Thickening of the tendons can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping things, or when turning the wrist.
Surgical Treatment
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons. Normal use of the hand usually can be resumed once comfort and strength have returned. Your orthopaedic surgeon can advise you on the best treatment for your situation.
Kienböck's Disease
Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is known as osteonecrosis. In Kienböck's disease, the blood supply to one of the small bones of the hand near the wrist (the lunate) is interrupted
Surgical Treatment
There are several surgical options for treating the more-advanced stages of Kienböck's disease. The choice of procedure will depend on several factors, including disease progression, activity level, personal goals, and the surgeon's experience with the procedures.
In some cases, it may be possible to return the blood supply to the bone (revascularization). This procedure takes portion of bone (graft) from the inner bone of the lower arm. A metal device (an external fixator) may be used to relieve pressure on the lunate and preserve the spacing between bones.
If the bones of the lower arm are uneven in length, a joint leveling procedure may be recommended. Bones can be made longer using bone grafts or shortened by removing a section of the bone. This leveling procedure reduces the forces that bear down on (compress) the lunate and seems to halt progression of the disease.
If the lunate is severely collapsed or fragmented into pieces, it can be removed. In this procedure, the two bones on either side of the lunate are also removed. This procedure, called a proximal row carpectomy, will relieve pain while maintaining partial wrist motion.
Another procedure that eases pressure on the bone is fusion. In this procedure, several of the small bones of the hand are fused together. If the disease has progressed to severe arthritis of the wrist, fusing the bones will reduce pain and help maintain function. The range of wrist motion, however, will be limited.
Do not hesitate to discuss these options with your orthopaedic or hand surgeon.
Arthritis of the Thumb
Arthritis is a condition that irritates or destroys a joint. Although there are several types of arthritis, the one that most often affects the joint at the base of the thumb (the basal joint) is osteoarthritis (degenerative or "wear-and-tear" arthritis).
Surgical Treatment
When nonsurgical treatment is no longer effective, surgery is an option. The operation can be performed on an outpatient basis, and several different procedures can be used.
One option involves fusing the bones of the joint together. This, however, will limit movement.
Another option is to remove part of the joint and reconstruct it using either a tendon graft or an artificial substance.
You and your physician will discuss the options and select the one that is best for you.
Boutonniére Deformity
Boutonniére deformity is an injury to the tendons in your fingers that usually prevents the finger from fully straightening. The result is that the middle joint of the injured finger bends down, while the fingertip bends back. This is the characteristic shape of a boutonniére deformity. Unless this injury is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning.
Surgical Options
While nonsurgical treatment of boutonniére deformity is preferred, surgery is an option in certain cases, such as when:
- The deformity results from rheumatoid arthritis.
- The tendon is severed.
- A large bone fragment is displaced from its normal position.
- The condition does not improve with splinting.
Surgery can reduce pain and improve functioning, but it may not be able to fully correct the condition and make the finger look normal. If the boutonniere deformity remains untreated for more than 3 weeks, it becomes much more difficult to treat.
Trigger Finger
A trigger finger occurs when the motion of the tendon that opens and closes the finger is limited, causing the finger to lock or catch as the finger is extended.
Surgical Treatment
Trigger finger is not a dangerous condition. The decision whether to proceed with surgery is a personal one, based on how severe the symptoms are. If the finger is stuck in a bent position, surgery may be recommended 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. The surgery is performed through a small incision in the palm or sometimes with the tip of a needle. Usually, the fingers can be moved immediately after surgery.
Some soreness in the palm is common, but elevating the hand after surgery can help reduce swelling and pain. Recovery is usually complete within a few weeks. If the finger was quite stiff before surgery, therapy may help loosen up the finger.
Wrist Arthroscopy
Arthroscopy is a surgical procedure used by orthopaedic surgeons to diagnose and treat problems inside a joint. The wrist is a complex joint with eight small bones and many connecting ligaments.
Arthroscopy enables the surgeon to see the anatomic parts and their movements without making large incisions into the muscle and tissue.
An arthroscope is used for two reasons: to make more accurate diagnoses (diagnostic arthroscopy) and to correct any problems with the joint.
Arthroscopic surgery is a valuable diagnostic and treatment tool. Because it needs fewer and smaller incisions (ie, it is minimally invasive), patients generally have fewer problems and a more rapid recovery than with regular surgery. Because it is usually an outpatient procedure, most patients return home several hours after surgery.
Arthroscopic Surgical Treatment
Arthroscopic surgery can be used to treat a number of conditions of the wrist. These include chronic (long-term) wrist pain, wrist fractures, ganglion cysts, and ligament tears, and tears of the triangular fibrocartilage complex (TFCC). Wrist arthroscopy may also be used to smooth bone surfaces and remove inflamed tissue.
- Chronic wrist pain: Arthroscopic exploratory surgery may be used to diagnose the cause of chronic wrist pain when the results of other tests do not provide a clear diagnosis. Often, there may be areas of inflammation, cartilage damage, or other findings after a wrist injury. In some cases, after the diagnosis is made, the condition can be treated arthroscopically as well.
- Wrist fractures: Small fragments of bone may stay within the joint after a bone breaks (fractures). Wrist arthroscopy can remove these fragments, align the broken pieces of bone, and stabilize them by using pins, wires, or screws.
- Ganglion cysts: Ganglion cysts commonly grow from a stalk between two of the wrist bones. During an arthroscopic procedure, the surgeon can remove the stalk, which may reduce the change that these cysts will return.
- Ligament/TFCC tears: Ligaments are fibrous bands of connective tissue that link or hinge bones. They provide stability and support to the joints. The TFCC is a cushioning structure within the wrist. A fall on an outstretched hand can tear ligaments, the TFCC, or both. The result is pain with movement or a clicking sensation. During arthroscopic surgery, the surgeon can repair the tears.
- Carpal tunnel release: Carpal tunnel syndrome is characterized by numbness or tingling in the hand, and sometimes with pain up the arm. It is caused by pressure on a nerve that passes through the carpal tunnel. (The carpal tunnel is formed by the wrist bones and a thick tissue roof.) Pressure can build up within the tunnel for many reasons, including irritation and swelling of the tissue (synovium) that covers the tendons. If the carpal tunnel syndrome does not respond to nonsurgical treatment, one option is to repair the area surgically. The surgeon would cut the ligament roof and enlarge the tunnel. This would reduce pressure on the nerve and relieve symptoms. This can sometimes be done using an arthroscope.
Examples :
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The Surgical Procedure
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Stay in Clinic (without limit of time)
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5 to 7 days in nice Hotel
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Complete Hematology Tests Analysis
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Anesthetist fees
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Implants or Prothesis (if any)
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Compression Garments
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Pre and ost-operative Consultations
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Clinical Professional Insurance
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Professional insurance of surgeon
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Transportation
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Personal Assistant
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