Hand and wrist surgery is broad ranging orthopaedic specialty. It is normally performed by an orthopaedic consultant with a special interest in hands and wrists to treat:
. Hand and wrist injuries.
. Arthritis treatment including osteoarthritis and rheumatoid arthritis that change and damage the structures in your hand and wrist.
. Degenerative changes to the structures in your hand and wrist.
. Hand and wrists problems or defects that are present at birth.
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Before Hand Surgery
Do I need hand and wrist surgery?
Not all patients need hand or wrist surgery. Most types of pain or discomfort can be treated using splints, taping, medications, injections, and hand physiotherapy. The decision to have hand or wrist surgery should be a cooperative one between you, your family, and your hand/orthopedic surgeon.
Most people with musculoskeletal and arthritis-related problems in their hands or wrists won't need surgery. The decision whether to operate will depend on:
. How bad your symptoms are (pain or loss of hand function)
. Your needs
. Your response to other treatments, including drugs, splinting and exercise.
Surgery is rarely carried out to improve the look of the hands, although an improvement in their appearance may be a welcome side-effect.
You may feel nervous, stressed or scared if you’ve been told you need surgery. Finding out as much as you can about the operation and understanding the process will help you feel calmer and more in control.
Preparing for surgery
Before the operation you’ll be asked to sign a consent form, which gives your surgeon permission to carry out the treatment. It’s important to ask any questions you may still have at this stage. Ask your doctor, nurse or therapist to explain anything you don’t understand. You should also discuss with your surgeon, anaesthetist or nurse at the pre-admission clinic whether you should stop taking any of your medications or make any changes to the dosage or timings before you have your surgery. Different units may have different advice.
You will typically have an anesthetic before your wrist or hand surgery.
A doctor or nurse will check your general health to make sure there won’t be problems with a general anaesthetic if this is being used.
You should have a dental check-up and get any problems dealt with well before your operation. There’s a risk of infection if bacteria from dental problems get into the bloodstream.
You may need to wear splints after the operation, which can make everyday tasks difficult. It’s a good idea to make preparations before the operation. Simple things like choosing clothes with wide arms, stocking up your freezer or arranging to have some help in your home will all make it easier to manage one-handed. It’s a good idea to arrange help with transport, as you’ll probably have to attend hospital regularly to see your doctor or therapist. Your occupational therapist will be able to advise you before your operation if you have any concerns about coping at home afterwards.
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What are the advantages of the hand and wrist surgery?
The main benefits of hand and wrist surgery include:
. Long-term pain relief
. Improved hand and wrist function
. Enhanced appearance of your hands and wrist.
Risks and Complications
What are the complications of hand and wrist surgery?
Most hand and wrist surgeries carry the risks of an unexpected reaction to the anesthetic and bleeding.
Additional risks will depend on the type of hand or wrist surgery being performed. They may include:
. Replacement joints, for example new knuckle joints, aren’t as hard-wearing or long-lasting as natural joints.
. Some operations reduce joint movement. (Loss of feeling or movement of the hand or fingers)
. Occasionally small nerves around the incision can be damaged, leading to patches of numbness.
. You'll have scars at the site of the cut (incision).
. Incomplete healing
. Blood clots.
. Increased pain
. The affected area feeling warmer than usual
. An unpleasant smell
Your consultant orthopaedic surgeon will talk through in detail the complications that might arise when you have your recommended hand and wrist surgery.
During Hand Surgery
Common types of hand surgery
A hand and wrist surgeon may perform many hand surgeries to help relieve pain and restore hand function. Here are some of the more common hand surgeries:
. Carpal tunnel release – the carpal ligament of your carpal tunnel at your wrist is cut so that the median nerve that passes through it is no longer compressed and your pain is relieved.
. Closed reduction and fixation – the realignment and immobilisation of broken or fractured bones in your hand and wrist. Wrist bones are regularly broken or fractured. The most common type of fractured wrist is called a distal radius fracture, when your radius bone breaks.
. Dupuytren’s contracture fasciotomy – the connective tissue in your palm or fingers is divided to release the tightness in your hand that is causing Dupuytren’s contracture.
. Dupuytren’s contracture fasciectomy – the connective tissue in your palm or fingers is removed to treat more severe Dupuytren’s contracture.
. Ganglion removal – the cutting away of a harmless fluid filled swelling called a ganglion for pain relief, better joint function and improved cosmetic appearance.
. Joint fusion (arthrodesis) - to treat arthritis in many hand and wrist joints. Fusing the joint straightens and adds stability to it.
. Joint replacement (arthroplasty) – hand or wrist joints can be replaced with artificial ones to relieve pain and increase function. It is often used to treat severe wear and tear osteoarthritis of the hand and, rheumatoid arthritis of the knuckles that causes damage and deformity.
. Tendon repair – the repair of ruptured tendons caused by infection, trauma, or arthritis to improve hand control.
. Trigger finger release – the cutting through of an affected section of your tendon sheath to stop your tendon getting caught in it when you unbend your finger.
. Trapeziectomy – the removal of your trapezium bone (a bone in your wrist at the base of your thumb) to treat arthritis that is causing you pain and, to improve your hand function.
. Surgical drainage or debridement – the removal of cartilage and pus and, wound cleaning, to treat and prevent hand infections and promote healing.
What is usually involved in a wrist or hand surgery procedure?
You will typically have an anaesthetic before your wrist or hand surgery.
Surgery usually involves cutting, repairing, removing, and replacing damaged or swollen tissue. It can be performed by open or keyhole surgery. Your hand and wrist surgeon will advise you on what is involved in the procedure recommended for your individual needs.
After Hand Surgery
After the operation
You may need to wear a bulky bandage on your wrist and hand for a week or two after the operation. Your stitches will be removed within 10–14 days. During this time you’ll be able to use your fingers and thumb, although you should avoid heavy tasks.
It’s important to move your fingers to prevent the nerve and tendons becoming caught up in the scar tissue which may form after your operation. You should recover from the effects of surgery in less than a month, although it may take longer to get all the feeling back, especially if you’ve had carpal tunnel syndrome for a long time. In a small number of people, the scar may ache and be sensitive for some months, but this usually settles without more treatment.
Besides, after surgery, patients will be given specific instructions on how to care for their hand or wrist. Patients will also receive medications and directions on how to address their bandages.
Exercise therapy is an important part of recovery. Patients will have a hand specialist and specialized therapists called occupational therapists demonstrate exercises that will aid in restoring strength, flexibility, and movement. Do not attempt to return to normal function too soon, as it will increase the risk of re-injury.
It will take time to fully regain the use of the hand or wrist after surgery. Recovery times differ based on the type of operation, but regular hand therapy exercises and routine check-ups with your surgeon will greatly increase hand and wrist restoration.
Recovery time after hand and wrist surgery will vary depending upon on the cause of your condition and the type of operation and your general health. Ask your surgeon what you should expect after the operation. Planning ahead can make it easier to manage when you return home.
Different surgeons have different ideas about the treatment required after an operation. This is affected by the type of operation and your health. You may need to wear splints to protect the healing tissues and bone, but you should discuss with your surgeon what to expect after the operation. Your nurse, occupational therapist, physiotherapist or hand therapist will be able to offer support.
You could expect to initially have mild to severe pain after your hand or wrist surgery.
Your hand and wrist surgeon will discuss with you the expected recovery timings for your individual situation and surgery requirements.
After you’ve been discharged from hospital an appointment will be made for you to come in as an outpatient to check your progress. Sometimes your GP will help with this aftercare. A district nurse or practice nurse may be asked to remove stitches and change dressings.
If you stopped taking any of your regular drugs or had to alter the dose before the operation, it’s very important to talk to your rheumatologist for advice on when you should restart your medication.