My hand surgeryIf your hand is impaired in any way, surgery may improve your condition. This type of very specialized surgery can treat diseases that cause pain and impair the strength, function and flexibility of your wrist and fingers. Surgery seeks to restore to near normal the function of fingers and hands injured by trauma or to correct abnormalities that were present at birth. Specifically, hand surgery can treat:
The field of study dealing with hand surgery involves both surgical and non-surgical treatment of problems related to the heart. The different cases which lead to hand surgery are
Muscle Paralysis - it is the complete loss of muscle function and often affects a local area
Dupuytren's Disease - certain portions of the hand may become dimpled and curvy which is a result of formation of scar tissue beneath the skin which later accumulates in a tissue. Often a hand surgery rectifies such a condition.
Soft Tissue Injuries - damage of ligaments, tendons and muscles due to day-to-day activity results in sprains and other serious injuries. Surgical methods are used to cure such injuries.
Bone Joint Injuries - Joint injuries are very painful and depending on the condition of the patient the orthopedic suggests treatment. Apollo Hospitals offer exceptional faculty with regard to the treatment of bone joint injuries.
Nerve Compression - Nerve compression often leads to poor blood supply and swelling.
Brachial Plexus - Nerve fibres or plexus runs through the neck into the arm. Formation of lesions on the plexus leads to serious functional disorders.
Tetraplegia -It is a condition where the patient experiences paralysis. It is caused by damage to the brain or spinal cord.
Tumors - Swelling of a particular location is called tumors. Tumors are malignant and non-malignant.
Rheumatoid Arthritis - The condition makes the immune system attack the joints. This often requires surgery.
Type Of Hand Conditions1)Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through an opening from the wrist to the hand called the carpal tunnel. The carpal tunnel is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. Since the median nerve provides sensory and motor functions to the thumb and three middle fingers, many symptoms may result.
Facts About Carpal Tunnel Syndrome: - According to the National Institute of Neurological Disorders and Stroke (NINDS), carpal tunnel release is one of the most common surgical procedures performed in the US. Women develop carpal tunnel syndrome three times more frequently than men. It usually occurs only in adults.
What Causes Carpal Tunnel Syndrome?
Most cases of carpal tunnel syndrome have no specific cause, although any/all of the following may serve as a contributing factor: -
- frequent, repetitive, small movements with the hands (such as with typing or using a keyboard)
- frequent, repetitive, grasping movements with the hands (such as with sports and certain physical activities)
- joint or bone disease (i.e., arthritis, osteoarthritis, rheumatoid arthritis)
- hormonal or metabolic changes (i.e., menopause, pregnancy, thyroid imbalance)
- changes in blood-sugar levels (may be seen with type 2 diabetes)
- other conditions or injuries of the wrist (i.e., strain, sprain, dislocation, break, or swelling and inflammation)
What Are The Symptoms Of Carpal Tunnel Syndrome?
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include: -
- difficulty making a fist
- difficulty gripping objects with the hand(s)
- pain and/or numbness in the hand(s)
- "pins and needles" feeling in the fingers
- swollen feeling in the fingers
- burning or tingling in the fingers, especially the thumb and the index and middle fingers
- pain and/or numbness that is worse at night, interrupting sleep
The symptoms of carpal tunnel syndrome may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
How Is Carpal Tunnel Syndrome Diagnosed?
In addition to a complete medical history and physical examination, three medical associations agree that electrodiagnostic tests are the most accurate tool for diagnosing carpal tunnel syndrome. The American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine endorse a guideline that states that electrodiagnostic tests provide accurate diagnosis. Electrodiagnostic tests involve the stimulation of muscles and nerves in the hand.
Treatment Of Carpal Tunnel Syndrome
Specific treatment for carpal tunnel syndrome will be determined by your physician based on : -
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment May Include: -
- splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
- oral or injected (into the carpal tunnel space) anti-inflammatory medications (to reduce the swelling)
- surgery (to relieve compression on the nerves in the carpal tunnel)
- changing position of a computer keyboard, or other ergonomic changes
2)Congenital Hand Deformities
What Are Congenital Hand Deformities?
Congenital anomalies are deformities that are present at birth. Any type of deformity in a newborn infant can become a challenge for the child as he/she grows. Hand deformities can be particularly disabling as the child learns to interact with the environment through the use of his/her hands. The degree of deformity varies from a minor deformity, such as a digital disproportion, to a severe deformity, such as total absence of a bone.
Early consultation with a hand surgeon is an important part of the treatment process for the child born with a hand deformity. Even if reconstructive surgery is not a possibility, there are many different types of prosthetic devices that can be used to increase function.
What Are The Different Classifications Of Congenital Hand Deformities?
The classifications for hand deformities can vary. The classifications listed below have been accepted by the American Society for Surgery of the Hand (ASSH). Classifications may change as more knowledge is obtained regarding each of the conditions.
There are seven groups of deformities of the hand that will be discussed, including the following: -
- problems in development of the parts
This occurs when parts of the body stop developing while the baby is in the womb, causing either a complete absence of a part of the body, such as the hand, or a missing structure, such as part of the arm bone. In the case of the complete missing part, surgery is not indicated. These children may be introduced to prosthetic devices early in their childhood.
Types of this classification include, but are not limited to : -
- radial clubhand : - A radial clubhand is a deformity that involves all of the tissues on the radial side (thumb side) of the forearm and hand. There may be shortening of the bone, a small thumb, or absence of the thumb. Deformities of the wrist are usually operated on around 6 months of age.
- ulnar clubhand : - An ulnar clubhand is less common than a radial clubhand. This deformity may involve underdevelopment of the ulnar bone (the bone in the forearm on the side of the little finger), or complete absence of the bone.
- failure of parts of the hand to separate
With this type of deformity, the parts of the hand, either the bones and/or the tissues, fail to separate in the womb. The most common type of this classification is syndactyly. Syndactyly is the most common congenital hand deformity, in which two or more fingers are fused together. According to some sources, this condition occurs in seven out of every 10,000 live births. There is a familial tendency to develop this deformity. This deformity usually involves both hands, and males are more often affected than females. If the fingers are completely fused together, it is considered complete.
There are two types of syndactyly, including the following: -
- simple syndactyly - involves fusion between only the tissues of the fingers.
- complex syndactyly - involves fusion between the bones.
Another example of failure of the hand to separate is seen in contractures of the hand. Contractures of the hand may also develop as a result of failure of the cells to differentiate in utero. A contracture is an abnormal pulling forward of the digits of the hand, usually caused by problems with the muscles or skin. One of the common types of this classification includes congenital triggering.
Congenital triggering occurs when one of the digits is unable to extend. It is usually seen in the thumb. It may take some time in the child's development before it is noted that the child can not extend the thumb. About 33 percent of these cases improve on their own. Surgery is usually not performed until the second year of life, but preferably before the age of 3.
- duplications of digits
Duplication of digits is also known as polydactyly. The little finger is the finger that is most often affected. There are three degrees of polydactyly, including the following: -
- type 1 polydactyly - an extra digit is attached by skin and nerves.
- type 2 polydactyly - an extra digit with normal parts is attached to the bone or joint.
- type 3 polydactyly - an extra digit with normal parts is connected to an extra normal metacarpal bone in the hand.
- undergrowth of digits
Underdeveloped fingers or thumbs are associated with many congenital hand deformities. Surgical treatment is not always required to correct these deformities. Underdeveloped fingers may include the following: -
- the digit is small
- muscles are missing
- bones are underdeveloped or missing
- there is complete absence of a digit
What Is Dupuytren's Contracture?
Dupuytren's contracture, also called Dupuytren's disease, usually begins with a thickening of the skin in the palm of the hand, which may develop into a hard lump or thick band that eventually could cause the fingers to contract, or pull into the palm.
What Causes Dupuytren's Contracture?
Since the first recording of this disease in the 1600s, great advances have been made in understanding this disease, although, there are still some unanswered questions. It is thought to be a hereditary disease, which means it is inherited from the family, but the exact cause is unknown. Dupuytren's contracture may be associated with cigarette smoking, epilepsy, diabetes, and alcoholism, and usually presents in middle age.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic disease that causes inflammation of the joints. The inflammation can become so severe that the function and appearance of the hands, as well as other parts of the body, can become affected. In the hand, rheumatoid arthritis may cause deformities in the joints of the fingers, making it difficult to move the fingers. Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrist. Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow juvenile rheumatoid arthritis. However, the disease can affect bone development in the growing child.
What Causes Rheumatoid Arthritis?
The exact cause of rheumatoid arthritis is not known. Rheumatoid arthritis is an autoimmune disorder, which means the body's immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis also may have devastating effects to other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, may contribute to the onset of the disease.
Rheumatoid arthritis affects more women than men (70 percent of persons with rheumatoid arthritis are women). The disease most often occurs between the ages of 30 and 50.
Diagnosing Hand ConditionsHow Are Hand Conditions Diagnosed?
Diagnosing many hand conditions may require surgery, depending on the underlying cause of the condition. In general, diagnostic procedures for hand conditions may include the following: -
- complete history and physical examination
Your physician will need to know your age, hand preference, occupation, and any history of other problems with the affected extremity. For injuries, your physician may also need to know the following : -
- type of trauma that occurred
- when and where the trauma occurred
- other circumstances about the trauma (i.e., was it work related, with a contaminated piece of machinery or chemical)
- position of the thumb during the injury or fall
- your past medical history (including tetanus immunization status and current medications)
In some cases, a diagnosis can be made simply based on a physical examination. However, the following tests may also be used to help confirm the diagnosis, or the extent of the problem: -
- arthrography - a contrast dye is injected into the hand to allow for better visualization of the joints on x-ray.
- bone scintigraphy - a dye is injected into a vein and images are obtained to show the distribution of activity of the dye in various tissues and structures. The study is usually conducted in phases, with images of the hand taken at different times after the injection of the dye.
- computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- electromyogram (EMG) - a test that measures the electrical activity of a muscle or a group of muscles. An EMG can detect abnormal electrical muscle activity due to diseases and neuromuscular conditions.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; allows for visualization of the tendons, ligaments, vessels, and nerves in the hand.
- ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In the hand, ultrasound is useful for locating fluid collections, such as cysts.
- video fluoroscopy - a diagnostic test that allows visual examination of the movement of the hand that can be recorded on a video for repeated viewing. A fluoroscope is a device that takes an x-ray and allows for immediate projection of the image on a screen for examination.
- x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Is It Right For Me?
Hand surgery is a highly individualized procedure which can be performed on people of any age and is a good option for you if: -
- You do not have additional medical conditions or other illnesses that may impair healing
- You are a non-smoker
- You have a positive outlook and realistic goals for your hand surgery
- You are committed to following your plastic surgeon’s prescribed course of treatment
- In some conditions, hand surgery is necessary to treat wounds and to help painful conditions
RisksAccording to the American Society of Plastic Surgeons, the most common complications associated with hand surgery are the following: -
- poor healing
- loss of sensation or range of motion in the hand
- formation of blood clots
- allergic reactions to the anesthesia
Complications are relatively infrequent with hand surgery, however, and most can be successfully treated.
AftercareAftercare following hand surgery may include one or more of the following, depending on the specific procedure: oral painkilling medications; anti-inflammatory medications; antibiotics ; splinting; traction ; special dressings to reduce swelling; and heat or massage therapy. Because the hand is a very sensitive part of the body, the patient may experience severe pain for several days after surgery. The surgeon may prescribe injections of painkilling drugs to manage the patient's discomfort.
Exercise therapy is an important part of aftercare for most patients who are recovering from hand surgery. A rehabilitation hand specialist will demonstrate exercises for the hand, instruct the patient in proper wound care , massage the hand and wrist, and perform an ongoing assessment of the patient's recovery of strength and range of motion in the hand.
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