Hand and wrist surgery

 

The hand and wrist represent some of the most complex areas of anatomy in the human body. For such a small area, there is a disproportionate number of bones, joints, ligaments, tendons, muscles, nerves, and blood vessels that must all work together for the hand to function well. These structures are covered with specialised skin that allow you to feel the finest of textures and grip the heaviest of power tools; is durable enough to use a spade to turn compost all day long, yet pliable enough to allow a pianist to play a complex piece of music.

An injury or disease process can affect these structures and have an adverse effect on hand function. In general, I operate with the intention to repair and reconstruct an injury or positively change the course of a disease process to improve pain and hand function.

See a hand surgeon

 

I cannot emphasise enough how important it is to see a specialist hand surgeon regarding your hand or wrist problem. Hand specialists can come from an orthopaedic surgery or plastic surgery background, but undergo additional advanced specialist training in management of hand problems and hand surgery, over and above that of a general plastic or orthopaedic surgeon.

I have a strong background in plastic surgery, but also spent a year in a busy orthopaedic hand surgery unit in Auckland, New Zealand, so bring the best of both specialties when treating my patients.

Common problems that I see and treat

 

  • Carpal tunnel syndrome

  • Trigger finger

  • Dupuytren’s contracture

  • Nerve damage

  • Basal thumb arthritis

  • Cubital tunnel syndrome

  • Ganglion cyst

  • Wrist pain

  • Tennis elbow

  • Fractures

  • Tendon injuries

  • Finger amputation

Hand surgery

 

Hand surgery is typically day-case surgery (without the need to stay overnight in hospital). Many operations can be done either under local anaesthetic (where the area of the surgery is numbed with an injection) or under regional anaesthetic (where the whole arm is numbed by placing precise injections around the nerves in the neck or armpit).

For surgery I wear special magnifying glasses (called loupes) that enlarge what I see by 5 times. They allow me to operate on the tiny structures of the hand and wrist with great precision and detail.

Treatment without surgery

 

Not all hand and wrist problems need surgery. Paradoxically, it takes greater expertise and experience to decide when not to operate. It is important to remember that any surgery, no matter how carefully and precisely it is carried out, is still a sort of ‘injury’ to the delicate balance of anatomical structures in the hand and wrist.

“I may recommend non-surgical treatments such as a splint, injection, or a course of hand therapy prior to considering surgery.”

If we agree that surgery is required, you will be given hand and wrist exercises to perform in order to maximise the benefit of the operation and minimise the unwanted side-effects, such as internal scarring and stiffness.

Hand therapy

 

A hand therapist is an occupational therapist (OT) or physiotherapist (PT) who has undertaken advanced specialist training in non-surgical management of hand, wrist and upper limb problems.

“From a surgeon’s point of view, having a good hand therapist looking after my patients is essential; they bridge the gap between my surgery and the eventual result the patient achieves.”

Without post-surgical rehabilitation, and commitment from the patient to follow the exercises and advice of a hand therapist, even the most technically advanced and cutting-edge surgery will fail. Getting the best results from complex hand surgery requires close 3-way co-operation between patient, surgeon and hand therapist.

Risks and complications

 

Complications following routine hand surgery are thankfully rare. A large American study showed that complications affect between 2 and 3 people in 100 (2 – 3%). General risks of any operation on the hand and wrist include:

  • Infection (usually treatable with antibiotics)

  • Bleeding (usually showing as bruising)

  • More significant bleeding may form a haematoma – this is a collection of blood that occasionally has to be surgically drained

  • Delayed healing or wound breakdown

  • Injury to a small skin nerve, causing numbness around the scar

  • Injury to a small skin nerve, causing severe chronic pain or CRPS

  • Stiffness, swelling and reduced function, which can be improved by following the advice and exercises of a hand therapist

  • Scars, which can become stretched, itchy or lumpy

  • Cold intolerance, which can occur after injury as well as surgery.

There are other specific risks and complications for certain operations, and these will be discussed with you as required.

Serious complications that pose a major risk to your health are very rare (less than 1 person in 1000 (<0.1%)), particularly if your surgery can be performed without a general anaesthetic and you are in good health. I have never had a patient who has suffered any of these serious complications, but we know from national large-scale research that they can happen. It is therefore important that you should know about them so you could alert us (or dial 999 if you were unwell at home) and get emergency treatment as soon as possible.

“We take special precautions around the time of your surgery to minimise the risk, for example by monitoring your heart and using special pumps on your calves to prevent a deep vein thrombosis.”

More serious complications include:

  • Heart attack

  • Deep vein thrombosis (DVT – a clot in a vein in your leg)

  • Pulmonary embolus (PE – when a DVT gets lodged in the lungs)

  • Sepsis

  • Stroke

  • Pneumonia.

“I recently had carpal tunnel surgery carried out by Mr Hywel Dafydd. My surgery and recovery were very straightforward and my scar is barely noticeable!”

— Rebecca, 49. Carpal tunnel decompression patient, iWantGreatCare