Newcastle Hand Surgeon
Overuse, age, disease and injury can cause a variety of hand problems that interfere with your life. As a reconstructive surgeon with extensive experience in hand and microsurgery, I may have a solution.
I have extensive experience in treating a variety of hand problems. As a specialist plastic surgeon, I have particular expertise in microsurgery, soft tissue problems and small bone fractures.
Conditions treated include:
· Carpal Tunnel Syndrome and other nerve compression syndromes
· Dupuytren’s Disease
· Pain and deformities related to osteoarthritis and rheumatoid arthritis
· Trigger finger
· DeQuervain’s Tenosynovitis
· Ganglions and other cysts
· Hand tumours
· Raynaud’s Disease
· Ligament instabilities
· Fingernail deformities
· New and old hand injuries
The Procedure
The majority of hand procedures are performed as day only, in fully accredited private hospitals. Either a general anaesthetic or sedation and local anaesthetic may be offered. Some smaller procedures are performed in the office under local anaesthetic only. For larger procedures, such as multiple joint replacements or extensive reconstruction after injury, an overnight admission may be required.
The Recovery
Recovery after hand surgery relies on an appropriate balance of rest and use. In most cases an experienced therapist will provide exercises, scar massage, and if necessary splinting, to assist in your recovery. After most minor procedures it takes 2-4 weeks before you are able to return to driving and moderate activity. More invasive procedures, such as those on joints and tendons, have much longer recovery times. Having realistic expectations before surgery, adequate time off work and support at home is essential for a good recovery.
From sporting injuries to kitchen mishaps, workplace and DIY accidents to simple falls, hand injuries are unfortunately common. They are also very diverse, ranging from obvious fractures and lacerations, to subtle injuries that if not diagnosed and treated correctly can cause persistent pain and problems.
I am a hand surgery specialist with extensive experience treating a wide variety of injuries and emergencies.
These include:
· Hand fractures
· Finger tip wounds and nail repairs
· Tendon and ligament repair and reconstruction
· Muscle repairs
· Graft and flap repair for tissue loss, such as loss of finger tips or large wounds
· Hand burns
· Treatment or replacement of injured small joints of the hand
· Microsurgical repair of nerve and blood vessel injuries in the upper limb, hands and digits
· Treatment of sensory loss, pain or weakness after old nerve injuries
· Replantation of severed digits
· Contracted old scars impairing movement
If you have a new injury, or are experiencing ongoing pain or functional problems from an old injury, please obtain a referral to see me. If you have a medical emergency you should attend your local emergency department first.
Emergency consultations and out-of-hours operations are available. Referrals are accepted from emergency department doctors as well as general practitioners and other specialists. If your problem is urgent, please let us know and every effort will be made to accommodate you in a timely manner.
The Procedure
The majority of hand injuries can be treated as day-only surgery. Depending on the nature of the injury you may need only local anaesthetic, sedation, or a general anaesthetic. Smaller procedures can be performed in the office. Repair of tendon, nerve or bone injuries is performed in accredited operating theatres. Occasionally an overnight admission may be required.
The Recovery
Recovering from a hand injury can be incredibly frustrating. Despite not being sick or feeling unwell, you can be significantly limited in your ability to work, drive and participate in sport and hobbies for weeks or even months. When planning your treatment I will work with you to consider your occupational demands and your lifestyle. Hand therapy is a critical part of recovering after a hand injury. I work closely with several highly qualified hand therapists to help get you the best results. Injuries do require time to heal, but together we will get you back doing the things you love as quickly as possible.
Compression of the nerves in the upper limb may cause a combination of numbness, pain or weakness. These symptoms are often intermittent at first, but gradually become constant and more severe. Depending on which nerve is compressed and at what level, these symptoms may affect different parts of the hand and forearm.
By far the most common nerve compression is Carpal Tunnel Syndrome (CTS). This is caused by compression of the median nerve as it passes through the wrist. Symptoms of CTS include numbness of the thumb, index and middle finger, pain that is often worse at night and a weakened grip. Causes of CTS include certain repetitive movements, arthritis, diabetes, pregnancy or injury to the wrist.
Cubital Tunnel Syndrome is caused by compression of the Ulnar nerve at the elbow. This results in numbness of the little and ring finger and generalised weakness throughout the hand.
Radial Tunnel Syndrome is a much rarer condition that is frequently confused with tennis elbow. Tennis elbow is caused by inflammation of tendons at the elbow. Compression of the Radial nerve in the radial tunnel causes a dull ache at the top of the forearm, approximately 5cm past the elbow. Treatments for tennis elbow will not improve Radial Tunnel Syndrome.
Mild nerve compression may be treated by modifying your activities, wearing a splint at night or during certain tasks, and doing regular exercises and stretches.Injections around the nerve can reduce swelling and alleviate symptoms.
For more severe cases, the best treatment is surgery. The procedure varies depending on the location of nerve compression. In all cases tight bands overlying the nerve are released, reducing the pressure on the nerve. Symptoms then resolve over several days to weeks, depending on how long the compression has been present. Nerve compression that is allowed to continue too long can result in permanent nerve damage.
If you have pain and numbness in your hand or forearm, it is important to consider the possibility of a nerve compression syndrome. See your doctor for consideration of nerve conduction studies and ask for a referral to come for a consultation.
The Procedure
Most nerve release procedures are performed as day-only surgery. Carpal Tunnel Release requires only light sedation and local anaesthetic. Other longer procedures, such as Cubital Tunnel Release, are performed under general anaesthetic.
Carpal Tunnel Release is usually performed through a short incision on the palm. In some circumstances I will offer this as a keyhole procedure, through smaller incisions with the assistance of a camera.
The Recovery
Following carpal tunnel release you will have a bandage on your hand that may be removed after three days. After this you are able to gently use your hand. Most swelling and discomfort settles after 2-4 weeks. No heavy lifting is permitted for six weeks. Driving and office work may be resumed after two weeks, heavy manual labour after six weeks.
Dupuytren’s disease is a condition causing abnormal thickening of connective tissue in the palm of the hand. As this connective tissue tightens, it bends the fingers into the palm, interfering with normal hand function. As finger contractures worsen, common complaints include the inability to shake hands, put hands in pockets, perform work duties, grasp objects or keep hands clean.
The cause of Dupuytren’s disease is unknown, however there are a number of factors associated with an increased risk of it developing.
· Age – most commonly starts after 50
· Gender – men are more likely than women to develop the condition
· Family history
· Scandinavian ancestry
· Smoking and alcohol consumption
· Diabetes
The affected connective tissue is called the superficial palmar fascia. This is a fanlike layer of tissue beneath the skin, above the tendons that move the fingers. Treatment options include fasciotomy (cutting into the fascia) or fasciectomy (removal of the fascia). Fasciotomy is performed with a needle, making multiple small punctures to break up the fascia and allow the fingers to straighten. This is only effective in certain cases. Fasciectomy is a more invasive procedure involving surgical removal of the tightened bands. The recovery from this is longer, but is usually a more effective and long-lasting treatment. Dupuytren’s disease tends to slowly progress and cannot be completely cured. However many years of straighter and more functional fingers can usually be achieved through surgery. The best time to start treatment is once you are unable to place your palm flat on a table.
The Procedure
Needle fasciotomy is offered only for minor cases. This is done in the office under local anaesthetic. For more severe or extensive or cases, surgical fasciectomy is required. This is a day-only procedure, performed in hospital under general anaesthetic.
The Recovery
Following treatment of Dupuytren’s disease, dressings and plaster are kept on for two weeks and the hand is rested. If a needle fasciotomy only has been performed, you may begin using the hand after a few days. The majority of discomfort and swelling settles after 2-3 weeks, but depending on the extent of surgery this may take up to three months to completely resolve. To aid your recovery a specialist hand physiotherapist will provide stretches and exercises. A splint is worn at night for three months, to keep the fingers straight.