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 prove 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 do not have to stay overnight in the hospital. For these procedures, you will arrive at the facility about an hour before your actual surgery time. Our staff will check you in and conduct a brief health check by listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We will 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 medication will be given which relaxes you but allows you to 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 get moved to the operating table with your arm outstretched. A sheet will be placed between you and your hand to block your view. Your hand will be 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 will be injected into the area so you will not feel anything during the procedure. When the hand is fully numb your surgeon will make an incision in the skin 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 (PA) often helps your surgeon throughout surgery and understands everything that was done during your surgery.
After surgery, your surgeon will explain what they found in the operating room to your family and discuss any limitations you will have in using your hand. Your hand will have a bulky dressing on it that will need to remain in place for the first few days. After that time, you will be instructed on when and how to change the dressing. Usually, your surgeon will ask you to just rest and recover for a few days after surgery. As you can imagine, it can be difficult to care for yourself after a hand surgery, and you may find you need extra help. Your surgeon will be sure to tell your family if you have any specific restrictions after surgery.
After these procedures, patients can expect to be seen by either their surgeon or a Physician Assistant in 7-14 days. At that time, they will discuss with you what they found during your surgery, what was done, and your recovery process. On average, it takes most patients a few weeks before they are back to their daily activities, however, it can take up to six months to a year before they no longer notice any pain in their hand.
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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 web space between their fingers, which can cause the fingers to fold into the palm. Overtime, it can become almost impossible to straighten the fingers. During the corrective 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 tendons of the finger and find the abnormal tissue. This is removed and full finger motion is restored. The incision is then sewn closed and a bulky dressing is placed on the hand. You are unable to soak the hand until the stitches are removed which is typically about 10-14 days after your procedure. You may shower during that time, but not soak the hand. This includes taking a bath or doing dishes. Your surgeon will tell your family exactly what your restrictions are after surgery. 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 then sewn closed and a bulky dressing is 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 soak the hand before that 10-14 day period is up. This includes taking a bath or doing dishes.
Your surgeon will tell your family exactly what your restrictions are after surgery. 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.