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Hand Surgery

Hand Surgery includes many conditions. Listed are but a few:

  1. Carpal Tunnel Syndrome
  2. Trigger Finger
  3. Ganglions

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome occurs when the median nerve which runs through the wrist to the hand becomes compressed. In the wrist, the median nerve (the major "communication line" between the brain and the hand) is routed through a small passage bounded by the wrist bones (the carpals) and the tough ligament tissue connecting them. Nine tendons also pass through this crowded "carpal tunnel". Because this structure is rigid, any influence that causes tissue swelling within the tunnel or reduces its size tends to compress and pinch the median nerve. If conservative efforts fail to control symptoms, an operation called a carpal tunnel release is indicated. In this relatively simple outpatient procedure, the surgeon carefully cuts the wrist ligament, releasing the pressure inside the carpal tunnel, usually providing almost instantaneous relief from arm and hand pain and tingling.

As the wound heals, new tissue will bridge the severed ligament in about six weeks, making the ligament long enough to create additional space inside the tunnel and prevent recurrence of symptoms in most cases.

The hand surgeon is specifically trained and experienced in diagnosing, treating and, when possible, preventing disorders of the hand and upper extremity. A hand surgeon will generally have available all effective methods of carpal tunnel evaluation and treatment.

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Trigger Finger

Usually, snapping and clicking in the fingers relates to a condition we call trigger fingers or trigger thumbs. These clicks occur when one bends or straightens the fingers (or thumb). Occasionally, a digit will lock either fully bent or straightened. Why does this occur? Normally the tendons that bend the fingers pass through a tunnel that holds them attached to the finger bones. For some reason, the tendons form lumps that catch as they pass through the narrow passages of the tendon tunnel.

This condition usually occurs near the crease in the middle of the palm of the hand, and the patient feels pain in this area as well as over the top of the finger. Frequently, the clicking and locking becomes worse overnight, but as the patient uses the finger more and more during the day, the symptoms improve.

Treatment of these clicking fingers involves either cortisone injections or surgery. When cortisone is injected around the tendon, it can cause the lump in the tendon to become smaller, at least temporarily, which alleviates the symptoms.

Should this treatment fail, trigger finger release surgery, which enlarges the narrow part of the tunnel, is indicated. This allows the lump to pass freely back and forth through the narrow area, resulting in normal motion. Trigger finger release is highly successful in terms of "curing" this condition; in fact, many patients and hand surgeons prefer to proceed directly to surgery, since it is simple, safe, and more effective than cortisone injections. Once again, however, cortisone injections can be performed as an office procedure, while trigger finger release requires an operating room.

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Ganglion is a Greek word meaning "a knot of tissue." Ganglions were first described by Hippocrates and can be found emanating from any joint but are mostly seen in and around the wrist.

These lumps and bumps are not cancerous tumors at all and, in fact, have never been linked to cancer in any way. Rather, they are balloon-like sacs, which are filled with a jelly-like material. They are more frequently seen in women, and the reason for their occurrence is unknown.

One explanation is that they occur where there is a weak place in a joint capsule that develops a "blowout." This area forms a balloon-like extension of a joint with a one-way valve from the joint. Joint fluid can then flow into the balloon through the one-way flap valve but cannot return to the joint. Therefore, the ganglion generally becomes larger and larger.

The relationship between ganglion formation and occupation and injury is not totally understood. Ganglions can also be seen in and around tendons. A common place where this occurs is the palm of the hand at the base of the finger.

Most hand surgeons allow patients to choose the treatment of their ganglion. Since we know that these are not cancerous lumps, one can feel comfortable leaving the ganglion alone as long as it is not bothersome. In olden times doctors recommended hitting a ganglion with a large book (usually the Bible as it was the largest book available) and thus rupturing the sac.

Nowadays, if the patient is bothered by pain or unsightly appearance, the hand surgeon can either aspirate (take the fluid out with a needle) or surgically remove the ganglion. Though surgery offers a better prognosis of a "cure", it requires an operating room, while needle aspirations can be easily accomplished in the office. Regardless of the type of treatment, ganglions can recur even with satisfactory surgery. (Hitting a ganglion with a large book is not recommended, since serious damage to bones and ligaments can occur.

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