Hand surgery

If, in the case diseases or injuries of the hand, conservative therapies do not have sufficient effect, depending on the pattern of the disease, different operational methods are available which can be mostly performed on an outpatient basis. These operations are carried out under so-called ischaemia. This means that the blood supply is cut off to the surgical area through a sleeve in order to make the delicate nerves and blood vessels sufficiently visible.

The course of treatment
If for example, in the case of carpal tunnel syndrome, conservative treatment using injections and/or the nocturnal support rails are no longer sufficient and in the nerve pulses, changes show up in the nerve structure, the nerve must be removed through an operation. This is only way to avoid permanent injury. Pain and sensory disorders can be eliminated through the enlargement of the nerve canal (carpal tunnel partition) and the exposure of the nerve (neurolysis). In so doing, we cut the ligament which forms the carpal tunnel. In many cases, this minimally invasive procedure is carried out through a small incision in the wrist. Pain and sensory disorders disappear in many cases directly after the procedure. In the case of long-standing nerve disorders, it might take a little more time before a normal feeling sets in again. Even with the so-called trigger finger we cut the ligament which hinders the free sliding movement of the tendon into two under local anaesthetics.

As the distortions in the case of Dupuytren’s contracture are not painful, many patients wait a long time until they seek medical attention from the hand surgeon. It is often the case then there is already a stiffening of the finger joints. Before the operation it is always to check whether the joints have already been stiffened, as this reduces the chances of complete movement being restored. During the operation, we carefully remove all the unwanted strands of connective tissue, which often ‘wall in’ the nerves and blood vessels, of the finger. After the healing process – usually after about 10 days – the hand function can be restored again through own exercises supported by ergotherapy.

As a rule, we treat ganglions on the wrist and fingers using general surgery and under local anaesthetics. In so doing, we expose the thin capsule of the ganglion as far as the ‘root’ and remove it there. To prevent a recurrence, a so-called relapse, temporary immobilisation of the operated area with a splint is usually required.