Until you experience an injury or problem with the functioning of your hands, you probably don’t think about how essential they are to your everyday life. We depend on our hands to eat, type, dress, drive a car, and participate in countless activities for work, sports and leisure. When our hands aren’t working correctly, our lives are dramatically affected.
Fortunately, there are orthopedic surgeons who specialize in surgery for a variety of conditions of the hands. Alan Ertel, M.D., an orthopedic hand surgeon at Mount Auburn Hospital, a teaching hospital of Harvard Medical School, says, “With a cosmetic approach, a hand surgeon can achieve the goal of minimizing scarring while improving or maintaining the hand’s normal functioning.”
Hand surgery is a complicated discipline involving both orthopedics and plastic surgery. Hand surgeons treat a wide range of conditions, such as arthritis, vascular diseases, and overuse conditions such as carpal tunnel syndrome and other nerve problems. They also treat injuries, congenital problems, tumors and infections. Some hand surgeries are performed using minimally invasive procedures while others use more traditional surgical methods. Most hand injuries or conditions are diagnosed through physical examination, but diagnostic studies including x-rays, CT scans, bone scans and MRI may also be used. Dr. Ertel discusses some of the most common conditions he treats:
Carpal tunnel syndrome (CTS)
This is a very common condition that occurs when the median nerve in the wrist is pinched within the carpal tunnel, which is a passageway for the tendons along the bones and ligaments in the wrist. Patients may experience pain, aching, numbness, and tingling and find it difficult to perform normal activities with their hands. Their pain may extend to the forearm or shoulder. CTS is usually caused by repetitive hand motion, such as typing, knitting, using tools or playing the piano. People with conditions such as diabetes, thyroid conditions, and some forms of inflammatory arthritis are also more likely to develop CTS. Patients with CTS need to seek medical attention because doing nothing can lead to permanent damage to the muscles of the thumb and reduce the ability to feel with their fingers.
The first approach to treatment is usually conservative and may include physical therapy, anti-inflammatory drugs, splinting, or sometimes cortisone injections. If these approaches don’t relieve the problem, then surgery may be necessary to release the pinched nerve.
Dr. Ertel points out that CTS patients are usually treated with a minimally invasive surgical approach on an outpatient basis. Only a small incision is made in the hand and recovery is much quicker than it used to be. Most patients are able to go back to their normal activities, including the repetitive activity that caused the problem in the first place.
Hand surgery is frequently performed for osteoarthritis, which is a degenerative condition characterized by wear and tear on the joints and is usually associated with aging or trauma. Additional types of arthritis are related to inflammatory conditions such as rheumatoid arthritis, lupus, psoriatic arthritis, or gout. The hands are very vulnerable to arthritis because each hand has 27 bones and multiple joints where bones are joined and where arthritis can develop. Arthritis of the hand, which can be painful and disabling, frequently develops at the base of the thumb, at any of the joints of the fingers, or at the wrist.
Initial approaches to treatment may include medications, therapy, or splinting, but if these techniques fail, there are multiple surgical procedures that can be effective. Surgery can be performed to drain or remove cysts associated with arthritis or to remove bone spurs or loose particles caused by arthritis. Joint fusion may correct deformities that are affecting the functioning or appearance of the hand. The swollen tissue around the joints or tendons may be removed in order to reduce pain and prevent more damage
Sometimes a joint replacement is necessary. An arthroplasty involves placing an artificial joint in the hand. The devices implanted are very similar to those used in hip or knee replacements. These implanted devices are typically made of plastic, metal or silicone. A newer generation of materials available for hand surgery is made of carbon materials, similar to industrial diamonds, which are very hard and durable and should last indefinitely. In the hand, some arthroplasties are possible using a patient’s own tissues to compensate for the destruction of the bones and joints.
In some cases, the knuckles of the hand may become enlarged and inflamed and may be treated with an arthroplasty procedure where artificial knuckles are inserted. Surgical procedures performed on the rheumatoid hand and wrist are often complex and may require physical therapy during the recovery period. If the tendons have been damaged, then surgery may be performed to repair the damage. Surgeons also perform arthroscopic surgery for inflammatory or rheumatoid arthritis when medical treatment does not work.
Dr. Ertel points out that a significant portion of hand surgeries are the result of a traumatic incident, such as an accident or fall. In particular, when people are physically active, with work or sports in any season, there are many injuries from sprains, contusions (damage to tissue under the skin), and wrist fractures that may require surgery.
Wrist arthroscopy is a surgical procedure useful for ligament injuries about the wrist, during which an arthroscope (a small tube with lenses connected to a monitor for viewing) is inserted into the wrist. With this technique, the surgeon can look directly at the wrist joint to determine the exact injuries that have taken place and provide treatment. With these newer techniques, the need for a cast is usually minimal. Arthroscopy is not appropriate for all hand or wrist conditions so your surgeon will need to decide what approach is best.
There has been a revolution in hand surgery for fractures in recent years because there are many new devices and techniques available that can frequently help the surgeon return the hand to normal functioning. Newer devices for the treatment of wrist fractures are better able to restore the bone to the shape it was before injury and allows for faster rehabilitation, often without casting.
Dr. Ertel says, “New techniques and materials for treating hand injuries and conditions, along with better pain management, have provided the patient with significant advantages over previous surgical procedures. Most patients who undergo hand surgery may now feel less pain, have improved functioning, and recover much more quickly.”