HAND AND Forearm Procedures

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• WHAT IT IS: Carpal tunnel release is a type of surgery used to treat carpal tunnel syndrome. The goal of the carpal tunnel release surgery procedure is to make more room for the median nerve and flexor tendons. There are two different surgical techniques for this procedure: traditional or endoscopically. Endoscopically includes using a camera through a tiny incision. Both methods involve an incision at the palm of the hand near the wrist, which allows access for the surgeon to cut the transverse carpal ligament and open up the carpal tunnel reducing pressure on the median nerve.

  WHAT CAUSES IT: Carpal tunnel syndrome is a common condition that causes numbness, tingling and pain in the hand. These symptoms often affect the thumb, index and middle fingers. It occurs when the tissues surrounding the tendons in the wrist swell or thicken and put pressure on the median nerve. These tissues are called the synovium and they lubricate the tendons and make finger movement easier. This thickening of the synovium occupies more of the small space of the carpal tunnel, and over time, crowds the nerve. In addition, tightness of the transverse carpal ligament can constrict the carpal tunnel space. In many cases, there is no single cause for the development of carpal tunnel syndrome.

• WHAT IT IS: Incise finger tendon sheath, also known as incise trigger finger release, is a surgical procedure in which the tissue surrounding a tendon (tendon sheath or epitenon) is cut. Often, this is necessary to relieve pressure or constriction around a tendon. The tendon itself may be normal, but if the sheath around it is too tight, it can prevent the normal gliding function of the tendon. The trigger finger release surgery procedure helps to restore function by allowing the tendon to move more freely. This procedure can improve the tendons overall function as well as reduce swelling and relieve pain.

  WHAT CAUSES IT: Trigger finger is caused by certain inflammatory disorders, entrapment disorders, cumulative trauma disorders like lateral epicondylitis, changes resulting from fractures and dislocations, or other conditions that lead to formation of scar tissue along the tendon can be treated with a tendon sheath incision. Surgery may be indicated when conservative treatment has not led to improvement, or when decreased function and pain interfere with the activities of daily living.

• WHAT IS IT: A layer of specialized tissue, called tendon sheath surrounds and protects tendons that connect muscle to bone in the wrist. In some cases, tendon sheath can exert excessive pressure on the tendon causing pain and limiting movement. A surgical procedure to cut surrounding tendon sheath relieves constriction and pressure around the tendon.

  WHAT CAUSES IT: Entrapment or compression of the tendon from surrounding tendon sheath can be caused by or related to a variety of conditions and occurrences. Oftentimes this condition can result from repetitive motion activities, overuse, infection, or injury to surrounding muscle groups or bone.

• WHAT IS IT: A lesion is any abnormal change in structure to an organ or tissue due to an injury or disease. It is not uncommon for lesions such as tumors or growths in the hand to develop. In most cases these growths are benign, but still may require a surgical procedure to remove the lesion from the affected area. Giant cell tumors of the tendon sheath are one of the most common hand lesions found in young adults under the age of forty. A surgical procedure to remove hand or tendon sheath lesions is important for avoiding future recurrence of the tumor and other tendon, nerve and bone obstruction.

  WHAT CAUSES IT: Exact causes to benign tumors and growths in the hand are often unknown. Benign tumors typically develop when cells in the body divide and then grow at an excessive rate while damaged or dead cells remain, forming a growth.

• WHAT IS IT: A ganglion cyst is a non-cancerous, fluid-filled mass or lump that can develop in the hand. Ganglion cysts can develop in various locations in the hand and wrist. However, they most frequently develop on the back side of the wrist. Ganglion cysts are harmless in most cases unless the mass is painful or affects wrist functions. There are many treatment options available to remove the cyst.

  WHAT CAUSES IT: A ganglion cyst grows out of tissues surrounding joints. While it is not yet known what causes the formation of a ganglion cyst, it is most common in those between the ages of fifteen and forty years of age. Gymnasts, who repeatedly apply stress on the wrist, are also more susceptible to this condition.

• WHAT IS IT: There are three major classifications of treatments that can be performed to repair damage to the wrist: 1) Synovectomy, which is the removal of diseased tissue; 2) Joint replacements, in which painful joint surfaces are removed and replaced with an artificial joint, usually made of a soft synthetic material; and 3) Joint fusions, in which the joint is removed and the bones are stimulated to grow across the site of the joint surface to create a solid segment of bone. Joint fusions are usually done by adding bone graft tissue from another site of the body, such as the pelvis or wrist. Metal plates or pins are used to stabilize the bones as they fuse together over time.

  WHAT CAUSES IT: There are several conditions which may benefit from hand and wrist surgery, including flexor tendon injuries, extensor tendon injuries, DeQuervain’s tendinitis, osteoarthritis, ligament tears, rheumatoid arthritis and cartilage damage.

• WHAT IS IT: A wrist arthroscopy utilizes a small fiber-optic camera and tiny surgical instruments inserted through an incision in the skin to examine and repair tissues inside and around the wrist joint. Orthopedic surgeons commonly use this minimally invasive surgical procedure to evaluate and treat a variety of different wrist conditions.

  WHAT CAUSES IT: A wrist arthroscopy is used to diagnose and treat a variety of different conditions in and around the wrist joint. There are multiple causes, conditions and symptoms that may warrant a wrist arthroscopy in order to more accurately diagnose and treat an injury or condition to the wrist joint. Arthritis, fractures, instability, infection, or any other unexplained wrist symptom are common conditions that may require a wrist arthroscopy in order to accurately determine appropriate action for treatment and care.

• WHAT IS IT: A palm contracture, also referred to as Dupuytren’s contracture, is the thickening and tightening of fibrous tissue layers in the palm. While painless, this condition can cause the fingers to curl. A surgical procedure for Dupuytren’s contracture is performed in order to remove the thickened layer of fibrous tissue effectively restoring proper finger motion.

  WHAT CAUSES IT: The causes for Dupuytren’s contracture are largely unknown. It is believed that this condition can be hereditary and is often associated with other existing medical conditions such as diabetes and epilepsy. Drinking alcohol can also increase the likelihood of developing Dupuytren’s contracture.

• WHAT IS IT: The ulnar nerve runs down the inner aspect of the arm, passing behind the medial epicondyle to supply sensation to muscles throughout the forearm and hand. Ulnar nerve transposition is a surgical procedure that effectively moves or transports the ulnar nerve from behind the bony medial epicondyle to a more suitable location in order to alleviate irritation or pinching.

  WHAT CAUSES IT: Ulnar nerve transposition is a common surgery performed in individuals whose ulnar nerve has become compressed against the medial epicondyle. This compression commonly occurs from excessive and prolonged pressure against the elbow. Such activities can include leaning the elbow against a desk or car window for prolonged hours. Other conditions such as rheumatoid arthritis and cubital tunnel syndrome can cause compression to the ulnar nerve.

• WHAT IS IT: The radius is one of two bones located in the forearm connecting to the thumb side of the wrist. Radial fractures can occur near the wrist (distal end of the bone), the middle of the forearm or near the elbow (proximal end of the bone). A radial break can occur in a variety of different ways, some of which require a surgical procedure to promote proper healing. An open radial fracture repair is a surgical procedure that requires an incision to the skin in order to properly align and repair an injury to the radius bone in the forearm. Fractures are commonly repaired with pins, screws, plates, or a combination of these materials.

  WHAT CAUSES IT: In most cases, a fracture to the radius is caused by high force or impact events. A fall onto an outstretched hand or a direct blow to the forearm can effectively fracture the radius. In adults, most forearm fractures will occur in both the radius and ulna, though fracture to just the radius is not uncommon.

• WHAT IS IT: The ulna is one of two bones located in the forearm that runs parallel to the radius. It connects to the pinky-side of the wrist. Ulnar fractures can occur near the wrist (distal end of the bone), the middle of the forearm or near the elbow (proximal end of the bone). An ulnar break can occur in a variety of different ways, some of which require a surgical procedure to promote proper healing. An open ulnar fracture repair is a surgical procedure that requires an incision to the skin in order to properly align and repair an injury to the ulna bone in the forearm. Fractures are commonly repaired with pins, screws, plates, or a combination of these materials.

  WHAT CAUSES IT: In most cases, a fracture to the ulna is caused by high force or impact events. A fall onto an outstretched hand or direct trauma to the forearm can effectively fracture the radius. In adults, most forearm fractures will occur in both the ulna and radius. A fracture to just the ulna uncommon.