CARPAL TUNNEL SYNDROME
Symptoms of carpal tunnel syndrome can include pain, numbness, and/or tingling in the hand (particularly in the thumb, index, middle and ring fingers), weakened grip, inability to keep firm grasp on objects or even loss of sensation in the thumb and hand. CTS is the result of pressure on the nerve that passes through a tunnel with tendons from the forearm to the hand. The pressure is a result of swelling which can be caused by inflammation of the tendon lining, dislocations, fractures, arthritis, fluid retention, and sometimes diabetes. Inflammation can sometimes be caused by repetitive or strenuous use of the hand. Most often conservative treatment is attempted after a diagnosis is reached. This may mean changing the activity or motion made with the hand, keeping the wrist straight by splinting to reduce swelling within the tunnel and using oral or injectable anti-inflammatories.
If surgical intervention is indicated, the procedure is performed either in an open fashion or with a scope (creating a smaller incision) close to the palm. The tunnel is enlarged, pressure relieved, and the swelling decreases.
HANDS IN PLASTICS
A significant portion of some plastic and reconstructive surgery practices is dedicated to hand surgery. Hand surgery is common to correct contractures of the fingers (claw-hand ), release of trigger fingers, removal of ganglions and cysts and to treat birth defects of the hands. These include releasing fused fingers or removing extra digits. Plastic surgeons are also skilled in microsurgery. This enables them to rejoin severed nerves, veins, arteries and tendons with extreme magnification of the surgical microscope. Surgical replantation of amputated fingers can sometimes be successful with these techniques. Our thumbs, so valuable to everyday function, can be reconstructed by using a transplanted toe or by moving a finger and rotating it. Carpal tunnel syndrome and fractures are treated by many plastic surgeons. “Plastic Surgery” is derived from the Greek words for to mold or give form, this certainly applies in hand surgery as part of a reconstructive practice.
If you suffer an amputation of a finger, immediately stop bleeding by applying direct pressure to the “stump”area and wrap it in a clean cloth. Wrap the amputated part in a moist cloth sealed inside a plastic bag, place this inside a larger bag filled with ice. Go immediately to the Emergency Room of the nearest hospital.
GANGLION CYSTS
GANGLION CYSTS
Lumps that appear in the hand, fingers and wrists can be ganglion cysts. The hand surgeon makes the diagnosis based on location, size, shape and mobility of the mass. Often, an x-ray is necessary to establish any bony malformations or joint involvement. Ganglions usually are near joints or within the sheath surrounding tendons. There have been no specific causes established, like fractures or bruising of the area. The cysts may increase in size and then gradually disappear without ever causing any pain or problems. Only those that become painful, especially when using the hand or working the joint, warrant medical treatment. This can range from aspirating (removing) fluid from the cyst, injections of steroid into the cyst to surgical excision. Ganglions do sometimes return, even after they’ve disappeared following any of these methods.
If surgical intervention is indicated, after conservative therapy fails to relieve the symptoms of the ganglion, the surgery is performed on an outpatient basis. The patient’s hand is numbed and the cyst removed, including a portion of the lining of the joint or tendon from which it “ballooned”. Often a wrist splint is worn to protect the area for a period of time after the surgery.
