Hand Surgery in Worcester, MA
Since our hands are so busy working for us, they often get hurt, overused, or injured. Just ask around and you will find “jammed” fingers, carpal tunnel syndrome, tennis elbow, and funky fungus in fingernails. The fact is, common hand problems are quite normal. At Salisbury Plastic Surgery, led by board-certified plastic surgeon Dr. Deborah K. Ekstrom, surgical treatment for common hand problems is available for residents of Worcester, Shrewsbury, and neighboring areas in Massachusetts.
What Types of Conditions Require Hand Surgery?
Our facility provides surgical treatment for a variety of common problems with the hands, including the following:
Carpal Tunnel Syndrome
This condition has become a household term because so many people suffer from it. Basically, the afflicted hand has the following classic symptoms:
- Numbness and tingling, usually in the three and a half digits on the thumb side of the hand
- “Clumsiness” of the hands with dropping things like pencils, cups and papers
- Nighttime waking
- Morning “sickness” of the hands and fingers (like trying to bend sausages)
- Pain in the hand/wrist, which travels up the arm
Some patients only experience pain in the hands, which may travel upward along the arms called “high pain component carpal tunnel syndrome.” Symptoms may continue for years before the patient is diagnosed and treated. Other symptoms, such as diabetes or arthritis in the neck may complicate the picture.
The ligament at the base of the palm where it meets the wrist, called the transverse carpal ligament, joins the tips of the horseshoe-shaped grouping of the wrist bones. The tunnel that results carries nine tendons that work like puppet strings to bend the fingers. Right on top of all the tendons and right under the ligament (which is a tough thick band of connective tissue) runs a nerve called the median nerve. This nerve may get pinched if the tendon tissues swell and cut off its blood supply.
In severe cases of carpal tunnel syndrome, the hands feel like they are on fire. Nothing except surgery or sometimes an injection will relieve the symptoms. This includes narcotics, such as morphine or Percocet.
How is Carpal Tunnel Syndrome Diagnosed?
A nerve test called electromyography and nerve conduction study (EMG/NCS) may be ordered to diagnose the condition and guide treatment plans.
Treatment of Carpal Tunnel Syndrome
When carpal tunnel syndrome is left untreated, pressure may cause a lack of blood supply to the nerve and may cause the muscles that move the hand to lack nerve connections and experience atrophy, or stop working. The tips of the fingers may become permanently numb, the thumb may lose its strength and permanently lose its ability to touch the tips of the fingers. If the pressure affects the area of the nerve carrying sensation, the tips of the fingers may become permanently numb.
Sometimes a steroid injection of the carpal tunnel space will temporarily shrink the swelling of the tendon tissue and relieve pressure on the nerve, but the symptoms almost always come back.
Women who get carpal tunnel syndrome when pregnant almost always need surgery to take care of symptoms later in life.
Carpal tunnel surgery usually takes about 30 minutes. Surgery can be done with general anesthesia. After the surgical procedure is completed the incision is sutured closed and the hand is wrapped in a bulky mitten-type dressing. The patient can usually take off the big mitten dressing after 48 hours and can begin using the hand again. Stitches usually are removed after about a week.
The hand stays achy and sore for a few weeks and gradually gets better. The incision heals quickly and the scar fades over about one year, until it is white and hardly noticeable in most patients. Weight lifting gloves pad the palm and are helpful for comfort for gripping objects against the palm. During the early recovery phase, the patient is allowed to do any physical activity that is comfortable for the hand. By six months, grip strength is almost completely returned and by one year very little reminder of the surgery remains.
Trigger Finger and De Quervain’s Disease
Both trigger finger and de Quervain’s disease are cousins of carpal tunnel syndrome and, like carpal tunnel syndrome, are caused by tendonitis (swelling and inflammation of the tendons). One or more fingers may “catch” when straightening the digits, especially first thing in the morning, causing pain. Gripping and grasping are difficult, and pressure at the base of the finger results in tenderness.
A steroid injection into the sleeve of the tendon will help shrink the swelling and can relieve the problem. Anti-inflammatory medicines such as ibuprofen may help alleviate pain and swelling. Often surgery, which opens in the edge of the sleeve to prevent the catching, is the best solution.
Treatment of Trigger Finger and De Quervain’s Disease
De Quervain’s disease is a tendonitis at the thumb side of the wrist where ligaments hold tendons that run the supporting bone of the thumb, called metacarpal. Swelling of the tendons causes pressure, inflammation, and pain with motion of the thumb. Since the thumb accounts for about 45 percent of hand function, this causes significant disability. Ibuprofen-like drugs (Advil, Motrin, Naprosyn, naproxen, etc.) may help reduce pain and swelling but generally do not cure the problem. A simple injection of steroid suspension may be effective in shrinking the swelling and relieving the symptoms.
If no relief happens after a two-week trial of anti-inflammatory medication or two to three weeks after a steroid injection, surgery may be indicated. A simple operation opening the roof of the connective tissue holding the tendons is all that is needed. A wrap for about 48 hours is usually enough after surgery at which time the patient may be allowed to shower. Stitches come out at about seven to 10 days. A full return of function can be expected.
Ganglion cysts are “bubbles” that have their root or base in a joint or an inflamed tendon sheath. Common locations are on the backside of the wrist, on the front of the wrist near the pulse artery, at the base of the fingers near the connection with the palm and near the base of the fingernail.
Sometimes the cyst looks like a blister. Cysts should never be punctured at home since they connect to a joint or tendon sleeve, which may lead to joint infection and bacterial spread to the bone. Bone infections of the finger are usually cured only by amputation.
Treatment of Ganglion Cyst
Occasionally cysts may be drained in the doctor’s office, removing the thick slippery lubricant liquid from inside of the cyst through anesthetized skin under sterile conditions to relieve the discomfort. This is usually a temporary solution, however.
Ganglions never turn into something worse, like cancers, but they need to be removed if they are causing pain or if they are at the knuckle by the fingernail because they could get punctured or burst and get infected.
The “root” or base of the ganglion cyst must be removed to decrease the possibility of recurrence. Wrist ganglion excisions need to be splinted to hold the wrist still for one to two weeks to decrease the chance of ganglion reforming and allowing the root area to seal. Ganglions near the fingertip need to have the spurs on the joint removed (arthroplasty) to decrease chances of recurrence. To get the spurs, the tendon that straightens the tip of the finger may need to be cut and re-sewn. Splinting following the procedure will allow the tendon to heal and become strong, but the immobilization may make the arthritic joint stiff. The risk of recurrence of the ganglion cyst is about five percent.
Trauma to the Hands and Fingers
Fingertip injuries are some of the most common reasons to visit the emergency room, including everything from skin abrasions of the tip to amputations half way up to the knuckle to pulled-off fingernails. Many ways exist to successfully heal and reconstruct fingertips ranging from skin grafts to borrowing tissue from the finger next to it.
Sports injuries, especially jamming injuries from catching balls can result in drooping of the fingertip (“baseball finger” or “mallet finger”). This injury can cause swelling, pain, and loss of joint stability in the middle finger called the PIP joint. Jamming of the finger, sprains and dislocations may result in the ligament tearing off its bone, causing fractures.
Treating Traumatic Injury to the Hands
An X-ray is required before the doctor’s visit to determine the extent of injury and to see if a fracture might be involved. Most of these injuries can be healed by immobilization of the injured area. Occasionally surgery is required. Ligaments never heal quite as well as a fracture and may take longer to heal than a broken bone.
If you are experiencing problems with your hands, comprehensive testing and treatment for conditions of the hand are provided at Salisbury Plastic Surgery for residents of Worcester, Shrewsbury, and nearby communities in Massachusetts. Contact us to schedule a consultation.