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FRACTURES
The hand is comprised of many different bones, not only those bones in the fingers, but also bones in the body of the hand itself. When trauma leads to fractures of any of these bones, it is important to seek consultation immediately as surgical treatment may be required. Prompt appropriate treatment may prevent infection and may lead to an overall better result of the bone healing properly.
We often see crushed fingertips from the many laborers that we treat. It is important that we treat these patients urgently, again to help prevent infection and provide the best possible care to maintain the maximum length of the finger. Sometimes there are surgical procedures that can be done, that when one is completely healed they suffer no loss to the length of the fingertip.
Different treatment remedies for fractures range from simple splinting or casting to closed reduction of the fracture to open “surgical” treatment sometimes requires pins or plates and screws. If one is diagnosed with a fracture of the hand they definitely need to obtain a formal consultation and x-rays need to be reviewed to select the appropriate treatment.
AMPUTATION
Complete amputation (and even partial amputation) is a surgical emergency that needs to be addressed immediately. The surgical repair of this condition may involve reattachment of the tendons, nerves, arteries, and veins, as well as the bones involved.
It is not uncommon that following amputation the patient requires several staged surgeries, and in the future may require a surgery known as tenolysis; which involves surgically lysing all the scar tissue that is limiting motion. [TOP OF PAGE]
FINGER CUT? TENDON OR NERVE DAMAGE
Many times someone has a “simple” laceration involving the hand and they don’t realize that they’ve partially cut one of the tendons responsible for moving the finger. This is often because the patient, in their evaluation, may seem to have normal range of motion. However, the tendons in the fingers are directly under the skin, and often with a laceration thru the skin one may have partially cut their tendon. Often, it is necessary to explore these lacerations and repair these partial tendon cuts to prevent further more serious damage. If a partial tendon cut were left unrepaired, when one returns to normal vigorous activity or lifting, the tendon could rupture necessitating a more complicated surgery possibly with a less favorable outcome.
When one causes significant damage to the tendons and the hands or fingers, they may require a second surgery known as a tenolysis. This surgery is performed to increase the range of motion of damaged fingers. During the healing process, and relative inactive use of damaged fingers, one can develop scar tissue or adhesions between the tendons and the skin or bones. These adhesions are scar tissue that can cause limited range of motion of the fingers. A tenolysis can be performed often through the same old scars and provide dramatic improvement in the range of motion. Unlike the original surgery for the main trauma, on the first post op day the patients usually have dramatic improvement in their range of motion. [TOP OF PAGE]
DUPUYTREN’S DISEASE
People who develop Dupuytren’s Disease, or proliferation of abnormal fibrous tissue in the palm and fingers, can experience both “hardening” of the skin as well as a contraction of their fingers. When appropriate, surgical treatment of this disease is directed at surgically removing or lysing these adhesions with the goal of improving the range of motion and flexibility of the fingers. Patients who think they may have this disease should obtain a consult with an experienced hand surgeon. [TOP OF PAGE]
WRIST PAIN
Wrist pain can be caused by a myriad of symptoms, from arthritis to inflammation of the tendons. It is necessary to obtain a consultation to accurately diagnose the underlying problem.
There is a particular pain, which is quite common, experienced at the wrist in line with the thumb know as De Quervain’s Tenosynovitisis. These symptoms can be caused by a constriction in the tunnel that the tendons to the thumb run thru. Sometimes splinting or non use and anti-inflammatory medication can help, but often surgery is required to provide complete relief. Luckily, there is an outpatient procedure which often provides dramatic relief to the patient instantaneously. [TOP OF PAGE]
DE QUERVAIN’S TENOSYNOVITISIS
 VIEW A VIDEO ABOUT TREATMENT FOR DE QUERVAIN'S TENOSYNOVITISIS
De Quervain’s Tenosynovitisis is a specific entity involving two of the tendons that control extension and abduction of the thumb. Specifically, these tendons run through a canal, which can be associated with significant pain at this location. The pain is produced from a relative compression on the tendons as they pass through this canal, and that is why extension or abduction of the thumb or motion of the wrist can produce this pain. If you are experiencing pain in your wrist, in line with your thumb, you may be experiencing this condition. De Quervain’s Tenosynovitisis can be corrected with an outpatient procedure.
GANGLION CYST
VIEW A VIDEO ABOUT TREATMENT FOR A GANGLION CYST
Ganglion Cysts are the most common cysts associated with the hand, and can range in size from a few millimeters to a few centimeters. These cysts are usually excised during a relatively simple outpatient procedure, which provides symptomatic relief to the patient. Complete surgical excisions of the cysts is usually more obtainable when the cyst is smaller in size as the operation is less complicated.
A consultation can help determine if the cyst should be excised and would be necessary to fully accurately diagnose the condition. One can not assume that a mass or cyst is a benign entity and does not require any treatment, as often a pathologic determination is necessary to rule out a tumor. [TOP OF PAGE]
TRIGGER FINGER
VIEW A VIDEO ABOUT TREATMENT FOR TRIGGER FINGER
Trigger finger is a relatively common problem that people experience in their hand, and is associated often with a “locking” of one of their fingers in the flex position. Sometimes one can palpate a nodule or bump at the base of one of the finger which is locking. This condition usually requires an outpatient procedure which involves opening the constricting tunnel that the tendons are having difficulty gliding through. Symptoms in this condition range from mild to severe, and with the appropriate consultation, you and the surgeon can discern whether surgical innervation is in your best interest. [TOP OF PAGE]
TUMORS
Just like in any part of the human body, one can also develop a tumor in the bones or soft tissue of the hand. These tumors can be either benign or malignant, and often only a pathologic diagnosis can discern between the two. Fortunately, most soft compressible cysts of the hand are ganglion cysts, a benign condition which is easily operable. Tumors of the hand can involve the skin, soft tissue or bones. If one thinks they may have a tumor of the hand, a full consultation is required and appropriate studies along the path of obtaining an accurate diagnosis and treatment plan. [TOP OF PAGE]
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