Certain hand and finger conditions may require surgery – especially if conservative treatment options have not been successful.
For example, a trigger finger may need to be released if anti-inflammatory medications and cortisone injections are ineffective. Dupuytren’s Contractures may also require surgery to remove the scar tissue that prevents the fingers from straightening.
Hand and Wrist Surgery
Hand and finger surgeries like trigger finger or Dupuytren’s Contracture releases are outpatient procedures, which means you arrive at the facility about an hour before your actual surgery time, and you do not have to stay overnight in the hospital.
Our staff will check you in and conduct a brief health check, listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We then start an IV to give you fluids and medications.
The anesthesia staff will discuss your options for medications during surgery. Often times, a sedative is given which relaxes you but lets you be awake during the procedure; however, most patients do not recall any details of their time in the operating room. Your surgery time can vary depending on how much needs to be done, but can last anywhere from 30 minutes to an hour.
Once you are rolled into the operating room, you will be moved to the operating table with your arm outstretched. A sheet is placed between you and your hand to block your view, and your hand is placed in a holder to keep your fingers in place and out of the way of your surgeon. A tourniquet will be applied to your arm to prevent blood from flowing into the arm while the surgeon is operating. This may be slightly uncomfortable, but most patients say it feels like their arm is asleep. A local anesthetic is injected into the area so you will not feel anything during the procedure.
When the hand is fully numb, your surgeon makes an incision to allow access to the affected area. Your surgeon will usually fix any repairable damage they find, even if it was not expected before surgery. A Physician Assistant often helps your surgeon throughout surgery and understands everything that was done.
After surgery, your surgeon will explain what they found in the operating room and any limitations you will have. Your hand will have a bulky dressing that has to remain in place for the first few days. You will be told when and how to change the dressing after that time.
Usually, your surgeon asks you to just rest and recover for a few days after surgery. It can be difficult to care for yourself after a hand surgery, and you may find you need extra help. Your surgeon will detail any post-surgery restrictions.
In seven to 14 days, patients can expect to be seen by either their surgeon or a Physician Assistant. At that time, they will discuss what they found, what was done, and your recovery process.
It takes most patients a few weeks before they are back to their daily activities; however, it can take six months to a year before they no longer notice any hand pain.
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Dupuytren's Contracture and Surgical Release
The palm of your hand is covered with connective tissue, which helps flatten your palm. Sometimes people get scar tissue or nodules in the webbing between their fingers, which can cause the fingers to fold into the palm. Over time, it can become almost impossible to straighten the fingers. During corrective surgery, your surgeon creates an incision over the band of scar tissue, which is easily felt through the skin. Once this is open, your surgeon will carefully separate the tissue, identify the tendons of the finger and find the abnormal tissue. This is removed and full finger motion is restored. The incision is sewn closed and a bulky dressing placed on the hand. Until the stitches are removed, typically about 10 to 14 days after your procedure, you may shower but not soak the hand, take a bath or do dishes. Your surgeon will detail your post-surgery restrictions. The stitches may limit your activities initially, but once they are removed and your incision is healed, you are allowed to return to normal activities. There will be some mild tenderness over the incision for a few weeks, but this will completely resolve over a few months.
Trigger Finger and Surgical Release
Each finger has tendons that flex or bend your finger toward your palm. Each tendon is in its own individual sheath. Inflammation or nodules can develop in the sheath, causing a catching or triggering in the finger. This can be painful and limit the motion of your fingers. If oral anti-inflammatories and cortisone injections prove to be ineffective, surgical release is an option.
During the surgical procedure, your surgeon creates an incision over the band of scar tissue, which is easily felt through the skin. Once this is open, your surgeon will carefully separate the tissue, identify the tendon sheath and find the abnormal tissue. This is removed and full finger motion is restored. The incision is sewn closed and a bulky dressing placed on the finger or fingers. After surgery, you will not be able to soak your hand until the stitches are removed (typically 10-14 days after your procedure). You can take a shower, but should not take a bath or do dishes.
Your surgeon will detail your post-surgery restrictions. The stitches may limit your activities, but once they are removed and your incision is healed, you are allowed to return to normal activities. There will be some mild tenderness over the incision for a few weeks, but this completely resolves over a few months.