HAND SURGERY (CARPAL TUNNEL, TRIGGER FINGER, GANGLION CYST & MORE)
Surgery performed by Dr. Sarah Elswick
Our hands are vital to our everyday life and these two diseases can be debilitating. Luckily there are non-surgical and surgical approaches that can restore your hands functionality. As a plastic surgeon Dr. Elswick is highly trained in non-surgical treatments and advanced reconstructive techniques, including hand surgery, and focuses on suturing techniques that minimize scarring.
CARPAL TUNNEL SYNDROME
The carpal tunnel is a space in the wrist that multiple tendons and the median nerve pass through in order to reach the hand. The median nerve has several functions, including providing sensation or feeling to the thumb, index, middle, and half of the ring finger as well as providing supply to the muscles at the base of the thumb. Sometimes swelling can occur in this space, which compresses the nerve and can cause symptoms of numbness and weakness in the hand. These symptoms can be permanent if not treated early.
There are various treatments for carpal tunnel syndrome depending on your symptoms and their duration. The simplest treatment is to wear nighttime splints to help prevent compression on the nerve. Another potential treatment option is to inject a steroid into the carpal tunnel, which can be done by Dr. Elswick or a Radiologist. The final option for treatment is surgery, called a carpal tunnel release.
The medical term for trigger finger is stenosing tenosynovitis, which describes the underlying disease which causes trigger finger. Our hands use tendons to help us flex our fingers. The tendons pass through a series of tight bands called pulleys, which help hold the tendons in place. When swelling occurs in these tendons, they are unable to pass through this tight pulley system and can “trigger”, or get stuck. Sometimes patients have to manually pry open or straighten the finger. Some patients even wake in the morning with their fingers in a flexed position. Understandably, this can cause some discomfort.
Depending on your symptoms and preferences, Dr. Elswick will start with the non-surgical approach of a steroid injection into the palm at the base of the finger. Cure rates with a steroid injection are approximately 70%. If there is a recurrence or persistent symptoms, a second steroid injection can be performed. If symptoms persist then generally surgery is required. This procedure is called a trigger finger release or A1 pulley release.
GENERAL INFORMATION: OTHER TYPES OF HAND SURGERY
Dr. Elswick forms a variety of hand surgeries. Some of the more common procedures she performs include hand reconstruction, excision of tumors of the hand, and removal of mucous cysts or ganglion cysts.
THE BEST CANDIDATES FOR SURGERY
The best candidates for surgery are those individuals who do not get relief from the non-surgical treatments or who have advanced disease.
PLANNING YOUR SURGERY
During the consultation your symptoms and previous treatments will be discussed. A thorough physical examination will be performed. If you have carpal tunnel syndrome, a test called an EMG (electromyography) may be required to further evaluate your symptoms. This test is usually performed by a neurologist at the hospital. Any major medical problems will be evaluated and should be optimized prior to surgery to minimize complications. Patients who smoke or use other nicotine products need to stop doing so at least four weeks before and after surgery.
PREPARING FOR YOUR SURGERY
It is important to maintain a healthy diet prior to your surgery to optimize the healing capabilities of your body. Dr. Elswick will give you specific instructions to prepare for the procedure, including guidelines on diet and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.
WHERE YOUR SURGERY WILL BE PERFORMED
Surgery for carpal tunnel syndrome and trigger finger is performed as an outpatient surgery at the hospital. Dr. Elswick has privileges at William Beaumont Hospital of Troy, William Beaumont Hospital of Royal Oak, and McLaren Macomb Hospital.
TYPES OF ANESTHESIA
Depending on your preferences, carpal tunnel release or trigger finger release can be performed with local anesthesia only (which numbs the hand) or with IV sedation.
CARPAL TUNNEL RELEASE
Carpal tunnel release involves making an incision approximately 3 cm long in the palm near the wrist and dividing the ligament of the carpal tunnel, which relieves the pressure on the nerve. Surgery takes approximately 15 minutes. If you have carpal tunnel syndrome on both hands, Dr. Elswick recommends waiting 2-6 weeks between surgeries on each hand.
TRIGGER FINGER RELEASE
Trigger finger release involves making an approximately 1 cm incision over the base of each effected finger in the palm, to release one of the pulleys. The tendons are then able to pass freely through the remainder of the pulley system. Surgery takes approximately 10 minutes per finger. If you have more than one finger that is effected, they can all be treated at the same time as long as they are on the same hand. If you have trigger fingers on both hands, Dr. Elswick recommends waiting 2-6 weeks between surgeries on each hand.
AFTER THE SURGERY
The incisions are closed with sutures above the skin that are removed 10-14 days after surgery. You will have a soft bulky dressing in place for 5 days. After the 5 days you can transition to a small bandage over the incision.
Mild to moderate discomfort and pain is to be expected after surgery, which will usually subside in the first few days to weeks after your surgery. Most of your discomfort can be controlled by over-the-counter pain medication, including Tylenol and NSAIDs although your doctor will provide you with prescription pain medication.
Bruising and swelling is expected after surgery. Generally the major bruising and swelling subsides 2-3 weeks after surgery.
You should not participate in any strenuous exercise, heavy lifting, or pushing/pulling on the side of your operation for 4 weeks after surgery. Strenuous exercise includes any activities where your heart rate exceeds 100 beats per minute. We highly encourage our patients to remain active post-operatively, doing activities such as walking. You should not lift anything heavier than 10 pounds (about a gallon of milk) on the side of your operation. After a few days, it is ok to type and work at a computer. You can slowly work back into your normal activities at 4 weeks post-operatively and should be back to your normal self at 6-8 weeks post-operatively.
When you can return to work depends on how you are healing post-operatively and what you do for work. Patients with sedentary jobs can return to work as early as one week post-operatively. If you do a lot of lifting, you will require four weeks off or modified duties at work.
GANGLION AND MUCOUS CYST REMOVAL
An additional hand procedure is the removal of a ganglion or mucous cyst, which is typically covered by insurance. These are cysts that develop in association with a joint or tendon and are filled with fluid. They presents as a firm bump on the wrist, fingers, or hand. They are noncancerous and can be round or oval. Sometimes these can cause pain or difficulty moving a joint. If they are symptomatic, they can be removed with localized numbing of the area. As a plastic surgery I am able to remove these with minimal scarring.
RISKS ASSOCIATED WITH SURGERY
Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.
Complications after carpal tunnel release and trigger finger release are very rare. Most patients heal well and experience relief from their symptoms. Potential complications after surgery include bleeding, infection, wound healing problems, and damage to surrounding structures (for example, nerves, blood vessels, and tendons that are near the surgical site). Other potential complications include incomplete relief of your symptoms or recurrence of your symptoms. Sometimes you may require additional surgeries to address these complications.
INTERESTED IN SETTING UP A CONSULTATION?
Most surgeries involving the hand are covered by insurance. Dr. Elswick enjoys helping people restore the use of their hands and will work with you to develop a treatment plan that is right for you. Call today to schedule your consultation with Dr. Elswick at our office located in Troy, Michigan. 248-524-0620.