Hand surgery

Surgical procedures on the hands are the domain of outpatient surgeries. They can almost always be performed under local or regional anesthesia (arm only). The operated patient is not bedridden and has little pain to fear after the procedure. The most common clinical pictures are:

  • Carpal tunnel syndrome (CTS = nerve entrapment)
  • Fasting fingers (tenosynovitis stenosans)
  • Finger retractions (DUPUYTREN’S disease)
  • Ganglion (ganglion)

We have been successfully performing these surgeries for over 15 years with an increasing tendency. The total number of surgeries now reaches about 250 surgeries per year. Small surgical interventions e.g. on the fingers or hand injuries were not counted.

CTS is caused by a “nerve entrapment” in the wrist area (narrow passage, pressure on the nerve). The carpal bones and a ligament stretched over these bones form a narrow channel there for the affected nerve, the median nerve. The exact cause of entrapment of this nerve is unknown. However, manual labor, injuries, especially fractures in the wrist area, and pregnancy are thought to be contributing factors.

CTS is initially most noticeable at night. One wakes up because of pain in the fingers that radiates to the wrist, sometimes to the elbow and shoulder. At the same time, there is tenderness of the thumb, index and middle fingers. The thumb-side half of the ring finger is also affected. In the advanced stage, patients have difficulty grasping and objects fall out of their hands. Finally, patients notice a marked reduction of strength in their hand and the disappearance of the thumb ball muscles.

Non-surgical treatment (night splints, cortisone injections, ointments, tablets) does not promise lasting success. Surgical treatment has very good results. This involves cutting the carpal ligament through a 3 – 4 cm skin incision between the ball of the thumb and the little finger (open surgical method). This gain of space results in a pressure relief of the nerve. In addition, with the open method, the nerve can be freed from tissue adhesions (neurolysis). In our opinion, endoscopic surgery (“closed” surgical method, “keyhole surgery”) offers no real advantages. On the contrary, it has the disadvantage that it is not possible to free the nerve from adhesions.

The open surgery we perform is a simple procedure that can be performed on an outpatient basis and even at an advanced age. The patient does not receive general anesthesia, but only regional (arm only) or local anesthesia. The complication rate is well below 1%. Mobility and resilience of the hand are fully regained after 3 – 4 weeks.

Dupuytren’s disease or Dupuytren’s disease is the benign proliferation of the palmar tendon plate (palmar aponeurosis). This tendon plate lies between the skin and the actual flexor tendons and nerves, which are not directly affected by the disease. However, tendons and nerves can be walled off by the cord-like growths over time and become indirectly involved in the disease process.

The exact cause of the disease is unknown. However, heredity plays an important role. In every 3rd patient a family member his affected by the same disease. The disease was named after the French physician “Dupuytren”, who made a special contribution to his research in the 19th century.

In Dupuytren’s disease, the palmar tendon plate begins to thicken in a strand-like pattern. It proliferates. Gradually, palpable and visible nodules develop, first in the palm and later in the fingers. The gradual shortening of these strands causes the fingers to become more and more curved. This can lead to the formation of a “hooked finger” with complete inability to function. The 4th and 5th rays of the hand are most frequently affected.

The effectiveness of ultrasound treatments, cortisone injections or laser applications has not been scientifically proven. There is also no drug treatment. The only promising treatment is surgery. However, it is only necessary if one or more fingers can no longer be fully extended (20° or more loss of extension). In the case of extensive nodular changes in the palm, which are accompanied by pain, or very severe skin retractions, surgery can be useful even without loss of extension of the fingers.

Sources: Own text