Hand surgery

What symptoms to turn to a hand surgeon with?

The pain, swell and complications with motion after the injury of the wrist and the fingers.

Complaints as the later consequences of injuries (numbness, swelling, pain, decreased range of motion).

The tendonitis in various degrees of severity and localization can occur. Typical symptoms are the blockage of the fingers in flexed position, the so-called snapping fingers. Another frequent localization is the painful pressure sensitivity of the tendon sheath phren at the junction between the wrist and thumb, the pain occurring when moving the thumb, the M.De Quervain.

Tunnel syndromes: nerves running in a narrow canal get strangulated - the fingers of the hand are numb, the hand becomes clumsy, the gripping and clamping force decreases, muscle atrophy occurs in later stages. Timely treatments or a possible surgery prevent permanent damage.

Ganglion: The soft tissue swelling occurring in the wrist or possibly in the bases of fingers being tight and not sensitive to pressure, it may only be removed surgically once and for all. It is a benign lesion that starts out from the joint capsule or the tendon sheath.

Dupuytren contracture can be experienced with middle-aged and older men: a solid lump formed in the palm which eventually pulls the fingers into the palm and blocks the stretching of fingers. The surgery performed at an earlier stage provides better results.

 

The sports injuries of the wrist and hand mainly occur after the extreme load in case of bodybuilders, tennis players and the sportspeople of the martial arts. In this case, inflammation, edema and micro damage can occur in the adhesion of the tendons, at the tendon-muscle transition or at the section of tendon surrounded by a joint capsule. Loading the wrist is greatly influenced by the stability of the ligaments and the anatomy of the wrist.

Tennis elbow, golfer’s elbow

With the examination and surgical repair of the snapping finger, ganglion, tunnel syndrome; tendonitis, with the conservative, injection or surgical treatment of tennis elbow or golfer's elbow full function can be achieved.

 

Snapping finger (digitus saltans)

It can occur at any age. It is a ganglion occurring at the base of the fingers, which “snaps” when bending the fingers. In everyday language, finger snapping, which affects the tendons and their surrounding joint capsule rings.

 

The description of the illness:

The most characteristic symptom is the full difficulty in stretching the affected finger; when trying it, the patient feels a snap in their palm, accompanied by a strong, radiating pain from the palm towards the fingers. The phenomenon can be restricted to the feeling of the node without a snap or pain.

 

The snapping finger is the prolonged inflammation of the bending tendon of the finger, or develops due to the scarring of the belt rings pressing the tendon. Swelling or a lump develops on the tendon. At the base of the finger a snap can be experienced beside the pain during bending or stretching the finger, which is caused by the lump jumping over scar bundles.  In severe cases, the fingers get "caught" when in a bent or stretched position, they can only be replaced by snapping with the other hand, or sometimes they even cannot.

 

The course of the illness:

The flexor muscles are located on the palmar side of the forearm; they run down to the fingers with long tendons and stick. From the area of the wrist the tendons run in capsules, which provide protection from both external damage and injuries from being overloaded or abrasion. The lump, unknown so far, blocks the free motion of the tendon in the capsule, the motion (mostly stretching) gets blocked, and then by the increase of power it is possible to overcome the block initially, at the cost of considerable pain.

It is slightly more common in females.

Less often, but sometimes the finger bending difficulty also occurs. For concomitant diseases (rheumatoid arthritis, diabetes), simultaneous involvement of multiple fingers has been reported. The disease can deteriorate so much that stretching the whole finger becomes impossible.

During surgical repair, cutting the capsule of the tendon can provide permanent and long-term relief.

 

The treatment:

The purpose of the treatment is to eliminate the block and the snap and to restore the full range of motion of the fingers without pain. With the elimination of the inflammation and thickening around the tendons the easy sliding of the tendons should be allowed in the capsule. The anaesthesia may be local, general or regional (forearm) anaesthesia. In some cases, the sensitivity to pain, swelling after surgery – in an individually variable manner - can persist.  The active finger movement can be started immediately after the surgery. The everyday use of the hands becomes possible with the pain ceasing. Water must not reach the wound until removing the stitches; the drench of the bandage must be avoided.

 

Its MRI image:

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