Our hands play a critical role in our everyday lives. Without them, even the simplest tasks become much more complicated.
At Orthopedic Specialists of San Diego, Dr. Mark Jacobson and Dr. Brooke Ballard are fellowship trained in hand surgery and can treat a full range of conditions affecting the hands.
Hand surgery often involves more than just the hands. It can also include the wrists, forearms, and elbows, which also contribute to proper hand function. Below are some of the most common hand and forearm procedures offered at our practice.
Carpal Tunnel Surgery
Carpal tunnel is one of the most common conditions that affects the hand and forearm. Carpal tunnel syndrome happens when the median nerve becomes compressed in the carpal tunnel, where it travels through the wrist. The median nerve is one of the main nerves that supplies the hand, and the carpal tunnel is a small, narrow space in the wrist through which the median nerve travels to the hand.
Because the carpal tunnel is so narrow, swelling or inflammation in the area can crowd the median nerve, causing pain, numbness, and tingling in the affected hand and forearm. Without treatment, symptoms often get worse over time. If symptoms do not improve with nonsurgical treatment, carpal tunnel release surgery may be recommended to relieve pressure on the nerve.
Trigger finger is a condition in which the flexor tendon in the finger becomes irritated and begins to thicken and develop nodules, causing it to become temporarily “stuck” in the tendon sheath tunnel when trying to straighten the finger. The finger may shoot straight out when the tendon is able to pass through the tunnel.
If nonsurgical treatment does not relieve symptoms, you may wish to undergo surgery to relieve the problem. Trigger finger surgery involves widening the tunnel so that the flexor tendon has more room to pass through. This is typically an outpatient procedure and can be often be done under local anesthesia.
Like the hips, knees, and shoulders, the wrists can also be affected by arthritis. If arthritis has caused severe damage to the wrist, wrist arthroplasty may be recommended. Wrist arthroplasty may allow for better function of the wrist, making it easier to accomplish daily tasks.
During a wrist arthroplasty procedure, the joint surfaces of the wrist are replaced with metal prosthetics, and a plastic spacer is inserted between them. Unlike a hip or knee replacement, wrist arthroplasty may be done as an outpatient procedure.
In some cases, when a patient has severe arthritis affecting the wrist or one of the finger joints, the joint may be fused together, rather than replaced. During this procedure, the articular cartilage is removed from the joint surface, and metal fixation devices are used to connect the two bones in the joint so that they fuse together. This eliminates movement in the joint, relieving pain.
ORIF (Open Reduction Internal Fixation)
Severe or complex wrist fractures may require more than just a cast to have the bones heal properly. Sometimes, surgery is needed to realign the bones and fix them in place. First, an incision is made over the area so that the surgeon can realign the bones. This is called an open reduction. Then, internal fixation devices, such as pins, plates, and screws are used to hold the bones in place. This process, called an open reduction internal fixation (ORIF), ensures that complex wrist fractures heal properly.
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is a condition in which the tendons at the base of the thumb become irritated and constricted. The tendons in the thumb pass through a fibrous tunnel called the tendon sheath. If the tendon or tendon sheath becomes irritated or swollen, it creates friction, resulting in this condition. It is often caused by overuse and is also common during pregnancy and in those with rheumatoid arthritis.
If symptoms are severe and do not improve with nonsurgical treatment, surgery may be an option. Surgery involves opening the tendon sheath to reduce friction by creating more space for the tendon. This procedure is called a Dorsal Compartment Release.
Dorsal Compartment Releases
Dorsal compartment release is an outpatient procedure. The affected tendon passes through a tunnel called the dorsal compartment. During the procedure, the dorsal compartment is opened up to make space for the tendon so that it can glide more easily when moving the thumb.
If arthritis occurs at the base of the thumb, suspension arthroplasty may be an option. During this procedure, a tendon graft is used to reconstruct the ligaments that support the base of the thumb. This procedure can relieve pain and improve grip strength by strengthening the ligaments that support the thumb.
An allograft is a tendon graft taken from donated tissue and implanted into another patient. An allograft may be used to repair a tendon in the hand or wrist. In some cases, an allograft may provide a more stable result than a graft taken from the patient’s own body.
Ganglion Cyst Removal
Ganglion cysts are fluid-filled noncancerous masses that commonly occur on the back of the wrist. It is not known what causes ganglion cysts, but they are generally harmless. Many ganglion cysts do not produce any symptoms, but can cause pain, tingling, and muscle weakness if it puts pressure on the nerves passing through the hand and wrist.
Nonsurgical treatments like immobilization and aspiration are generally recommended first, but if the cyst returns, surgery may be recommended. During a ganglion cyst removal procedure, the cyst is removed along with a small portion of the joint capsule or tendon sheath to remove the root of the cyst.
Hand Surgery in San Diego
At Orthopedic Specialists of San Diego, we offer hand surgery services for patients in San Diego and surrounding communities, including La Mesa, Coronado, and Sorrento Valley. If you would like to learn more about hand surgery options or schedule an appointment with Dr. Jacobson please call our office at 619-286-9480.