Cairns Plastic Surgery’s hand surgery procedures target a range of conditions that occur in the hands, fingers, thumbs, wrists and nails.
The main benefit behind hand surgery is freedom from pain as well as improved or restored movement in the hand and finger joints. Many hand problems such as Carpel Tunnel Syndrome, can restrict the ease at which we can perform tasks we’d otherwise take for granted, like driving, playing sports, cooking, and working.
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Hand Surgery Procedures
Dr Hertess is prolific in Cairns Plastic Surgery’s diverse hand surgeries, and is a member of the distinguished Australian Hand Surgery Society. Read on to learn more about each of our specific procedures:
Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when pressure increases in the wrist, at the point where tendons and the median nerve pass from the arm to the hand. The median nerve supplies sensation to the thumb, index and middle fingers, and power to the thumb.
The main cause of carpal tunnel syndrome is injury and repetitive use of the hands and wrists, while symptoms include numbness, aching, and the loss of hand function.
Anti-inflammatory drugs, splinting at night, steroid injections, and carpal tunnel release surgery can provide relief. Carpal tunnel release surgery involves making an incision from the centre of the palm to the wrist, and cutting the fibrons tunnel roof to relieve pressure on the median nerve.
Recovery is generally about six weeks, and occupational therapy is required after surgery.
Trigger finger (or trigger thumb) is caused by inflammation of the flexor tendon sheath at the base of the finger. When the tendon becomes inflamed or swollen, bending the finger pulls the tendon though a narrow sheath, causing a snapping or popping sensation.
Trigger finger can cause stiffness, locking, clicking and general pain and discomfort in the affected finger. One or more fingers can be involved. Repeated or forceful movement of the fingers or thumbs can cause trigger finger.
To treat trigger finger, you may be prescribed anti-inflammatory medication, or may want to consider steroid injection or surgical release of the tendon sheath at the site of inflammation and narrowing.
Dupuytren’s contracture (named for surgeon Baron Guillaume Dupuytren) is the thickening and shortening on the layer of fibrous tissues under the skin of the palm. As the tissue thickens, it contracts and causes the finger to curl into the palm, restricting its movement. It can involve any finger, but affects the ring and little fingers most commonly.
Causes are unknown, but it is believed to have a heredity connection, and can also occur as a result of an injury.
As the tissue thickens, a lump or cord can appear in the palm, while the extension of the finger becomes restricted. Treatment exists, but recurrence after surgery is possible.
Surgery involves an excision of the Dupuytren’s tissue and Z Plasty to the incision to lengthen the scar and therefore increase the range of movement. A skin graft may be necessary in more severe cases.
Nail Injuries and Amputation Stumps
Injuries to the nail bed can cause a nail to grow deformed or cause troublesome nail spicules to grow into the skin next to the nail. A spicule is a small piece of a nail that is not removed when an ingrown nail is treated and continues to provide an undesired opportunity for infection. Spicules normally remain when an ingrown nail has been remove at home by the patient themselves, using non-sterile tools.
A nail bed repair will surgically correct the nail bed plate or remove troublesome nail growth plates.
Painful amputation stumps may not have adequate tip padding, causing unwanted pain and discomfort. Surgical revision involves addressing any sharp or excess bone or unwanted nail growth plates, and adding padded tissue to the tip of the amputated finger.
Mucous cysts are small, fluid-filled sacs that form on the fingers. They can appear over any joint of the fingers or thumbs. They are typically visible just under the skin’s surface, and may be painful.
As tension increases, the cyst gets bigger, resulting in pain and restriction of finger point flexion. Mucous cysts are typically found in patients with osteoarthritis, although it is not known why the cysts develop.
Surgically, mucous cysts can be treated. An incision is made over the cyst, and it is cut out down to the joint. The skin is sutured and there is a small chance of recurrence.
Ganglion cysts are benign protrusions of joint fluid that look like a ‘lump’ on the skin’s surface. Because they are caused by fluid leakage of a joint, they are typical around the dorsal (outer) or volar (inner) hands and wrists. They can increase and decrease in size, and may be relatively painful.
Surgery involves excision of the ganglion in its entirety to the joint space, and recurrence after surgery is not unusual.