The hand is one of the most complex features of the human body. When one or more components of the hand do not function properly, or the hand looks abnormal in some way, the consequences can affect nearly every area of your life. Causes of hand issues can include congenital defects, injuries and trauma to the hand. Even daily use can take its toll. No matter what the reason for the problem, correction can improve both function and appearance.
Dr Damon Thomas of Melbourne is passionate about hand surgery and has made it a focus of his practice. He has undertaken additional fellowship training in this area and performs all types of reconstructive hand surgery to restore hand function and appearance. Offering the latest treatments and techniques, Dr Thomas is qualified to address a wide range of hand conditions and injuries for his Melbourne patients.
candidates for adult hand surgery
Dr Thomas offers a range of treatments, including surgical correction, for the following hand concerns:
While painless in most cases, Dupuytren’s contracture can be debilitating, rendering fingers and even the entire hand unable to perform even simple daily tasks. It is characterised by the permanent bending of one or more fingers into the palm with the inability to straighten the finger without medical intervention. This progressive condition occurs when fibrous tissue beneath the skin, called the palmar fascia, becomes thickened and tight, pulling the finger inward and creating a claw-like effect with the hand.
The typical fingers affected by Dupuytren’s contracture are the ring and little fingers. However, the condition can develop in any finger. A combination of external and internal concerns often leads individuals to seek treatment for the condition.
Treatment Options for Dupuytren’s Contracture
There are two options for reversing Dupuytren’s contracture today. The first is a nonsurgical option known as Dupuytren’s enzyme injection or a needle fasciotomy. The needle is placed directly into the fibrous bands, and a solution is injected to dissolve them to release the contracture. Two sessions are usually required, with the first consisting of the injections and the second involving manipulation of the bands so that they break into sections. Appointments are spaced one to two days apart so positive results are seen relatively quickly.
Surgical treatment of Dupuytren’s contracture is also an option and might be the approach recommended by Dr Thomas for certain patients. This procedure removes the fibrous bands from the finger to release the contracture. Skin flaps or grafts can also be used to extend the length of skin to improve finger position and create an aesthetically pleasing outcome.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition in which pressure is placed on the main nerve that leads to the hand. It is considered a repetitive motion injury because it is often caused by repeated functions like working on a keyboard or an assembly line. Common symptoms of carpal tunnel syndrome include finger numbness and pain in the hand and fingers that often worsens at night. When patients experience symptoms of this condition for three months or longer and the symptoms are not relieved by rest or pain medications, surgery may be the next logical step.
Surgical Treatment for Carpal Tunnel Syndrome
Carpal tunnel release surgery addresses the compression of the nerve, releasing it to stop the pain and numbness. The procedure involves one incision along the wrist, which is used to divide the ligament pressing on the nerve while keeping the nerve and its branches intact. This day surgery takes less than 30 minutes to complete in most cases and has a strong track record of success.
Both osteoarthritis and rheumatoid arthritis are debilitating conditions that can lead to severe pain and disfigurement. Osteoarthritis is commonly associated with the ageing process, as wear and tear on the joints can cause them to degenerate over time. It typically affects joints of the fingers but can also affect other joints of the body.
Rheumatoid arthritis is a type of autoimmune disorder that can affect many areas of the body in addition to the joints. This condition impacts the lining of the joints, which can lead to severe pain and reduced function of the hand. Over time, disfigurement of the fingers can also occur.
Treatment Options for Arthritis
Nonsurgical treatments are often used as the first course of action to address arthritis symptoms since they can offer temporary relief over an extended period. However, it is not unusual for patients to eventually seek out surgical procedures to ease progressive pain and discomfort while restoring the form and function of the hand. Arthritis surgery varies and may include joint replacement, fusion of the joint or ligament reconstruction.
This condition is characterised by clicking or popping in the finger joint when the finger is bent or straightened. In some cases, there is no pain involved, but some patients do experience a significant degree of discomfort with this condition. Trigger finger is caused by thickening tendons in the finger that begin to get “stuck” in the tunnel that runs between the hand and finger. There are different methods of treating trigger finger, depending on the severity of the condition.
Treatment Options for Trigger Finger
The nonsurgical treatment for trigger finger, which is often recommended as a first course of action, is the administration of pain relief injections into the tendon sheath. The purpose of the injection is to reduce inflammation of the tendon so that it can slide through the sheath easier. If this process does not provide the desired relief, surgery is usually the second step.
Surgical treatment for trigger finger usually involves a release of the sheath to allow the tendon to move through without catching. Dr Thomas makes a small incision at the base of the finger so that he can divide the pulley and release the tendon. Before closing the incision, he will make sure the tendon moves freely. The entire procedure takes under 30 minutes to complete and is usually performed under local anaesthesia with sedation.
These benign cysts typically form around the wrist or end joint of a finger. Although they are not a severe problem, they can become very painful if they start to compress a nerve in the hand. The condition can also be undesirable cosmetically if the ganglion grows exceptionally large. Surgery is recommended to remove the ganglion and relieve discomfort related to the cyst when it does not resolve on its own.
Surgical Treatment for Ganglion
Surgical excision of ganglion can be performed as a day procedure in most cases, often using just local anaesthetic. Dr Thomas will remove the cyst all the way down to its source, which is usually the joint. If there is weakening of the joint as a result of the ganglion, that can be strengthened using sutures as well. Other issues that frequently occur with a ganglion, such as a bone spur, can also be removed at the same time the ganglion is treated. Ganglion removal might take anywhere from 30 minutes to an hour, depending on the size of the cyst and the complexity of the procedure.
Injuries to the hand may require the skill of a plastic surgeon trained to prioritize both functional and aesthetic results. From stitching lacerations to reattaching amputated digits, Dr Thomas can treat your hand injuries to restore function while preserving the cosmetic appearance of the hand. Dr Thomas is available after hours through his paging service in the event an emergency case arises.Hand conditions and injuries require expert care to restore both the function and the appearance of the hand. Dr Thomas has been specially trained in this area and made it a focus of his plastic surgery practice. To learn more or to schedule your consultation with Dr Thomas, contact him at the Melbourne Institute of Plastic Surgery on 03 9508 9508.See Before and Afters