Hand & Upper Extremity Surgery

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area. Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength. Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

• Treating underlying medical conditions 
• Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks 
• Rest the hand for 2 weeks or more
• Ice packs to avoid swelling
• Avoid activities that tend to worsen the symptoms
• Medications such as nonsteroidal anti-inflammatory drugs, diuretics, and steroid injections.
• Strengthening and stretching exercises once symptoms diminish

If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release surgery. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Your surgeon may suggest you to practice certain post-operative procedures for better recovery and to avoid further complications. 

• Elevate the hand above heart level to reduce swelling
• A splint may be worn 
• Ice packs to the surgical area to reduce swelling
• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
• Physical therapy may be ordered to restore wrist strength
• Eating a healthy diet and not smoking will promote healing

The majority of patients suffer no complications following carpal tunnel release surgery. However some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

What is Cubital Tunnel Syndrome?

Cubital Tunnel Syndrome is a condition that is caused by compression of the ulnar nerve in an area of the elbow called the cubital tunnel.

The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed leading to a variety of symptoms.

Signs and Symptoms

Signs and symptoms of Cubital Tunnel Syndrome usually occur gradually, progressing to the point where the patient seeks medical attention. Left untreated, Cubital Tunnel Syndrome can lead to permanent nerve damage in the hand. Commonly reported symptoms associated with Cubital Tunnel Syndrome include the following:

• Intermittent numbness, tingling, and pain to the little finger, ring finger, and the inside of
  the hand. These symptoms occur more frequently at night, and with elbow bending or
  prolonged resting on the elbow.
• Aching pain to the inside of the elbow
• Weakness in hand with diminished grip strength
• Diminished sensation and fine motor control in the hand causing the person to drop
  objects or have difficulty handling small objects.
• Muscle wasting in the hand and permanent nerve damage if left untreated. 

Trauma

Injury to the elbow such as fractures, dislocations, or a direct blow can cause tissue swelling which can compress the ulnar nerve within the cubital tunnel.

Joint fusion is a surgical procedure that involves removal of the damaged ends of the joint and fusing them together. Fusion prevents the movement of the joint and allows it to realign by itself.

Arthritis of the finger and wrist damages the articular cartilage which results in pain and inflammation.

Finger Fusion

It is a common surgical procedure done if the cartilage or bone in the finger is completely damaged due to arthritis. In the arthroscopic fusion surgery incisions are made at the dorsal surface (back) of the joint which are to be fused. The tendons are separated so that the two ends of the bone are brought closer for fusion. Surgeon removes the articular cartilage from both the joint surfaces and inserts metal pins and screws at the centre of both the bones. Metal pins and screws help to connect the two bones together and prevent the movement of these bones allowing them to fuse. Later, the soft tissues are stitched.

Cast or splint is placed over the finger joint until the bone completely fuses together.

Wrist Fusion

There are two types of fusion. In the first type, a contoured plate is fixed at the back of the wrist joint using metal screws. The entire articular cartilage is removed from the wrist, allowing the bone to fuse with the metal plate. In the second type, a metal pin is passed into the wrist through the middle knuckle joint. The second type is usually performed on patients suffering from rheumatoid arthritis.

Cast or splints are not required in the first type of surgery. Patients are allowed to move their finger soon after the surgery. Swelling is observed which can be treated by elevation above the heart level for few weeks after surgery. In case of splints or pins, cast or splints are placed until the bone is completely healed.

Rehabilitation is generally suggested after the surgery which helps to control pain and swelling. Gentle massages and strengthening exercises will help to improve the grip strength and movement.

Reconstruction surgery is a surgical procedure to restore the functioning of the deformed limb or joint. The deformities may be congenital or acquired. Traumatic injury is the most common cause for deformities and may also be caused due to infections or fractures that do not heal properly.

Limb reconstruction or restoration procedures include joint fluid therapy, cartilage transplantation, and prosthetic replacement surgeries. Use of external fixators is more common where the fixators are attached to deformed limb or joint using screws and wires. Fixators are used to lengthen or shorten the limb, realigning the non union fractures, correct the deformity and replacement of the missing bone.

Apart from these surgical procedures, bone stimulation techniques using electromagnetic or ultrasound devices such as pulsed electromagnetic field device and low frequency ultrasound device are also employed for limb reconstruction. Used for external fractures, these methods may avoid the need for surgery.

Some of the common conditions treated with limb restoration procedures include:

• Club foot
• Leg length differences
• Deformities of limbs
• Contractures of knee
• Congenital bone dysplasias

To learn more, please click this link to be directed to our Shoulder Education section inside Patient Education.