1. CARPAL TUNNEL SYNDROME & ULNAR NERVE PALSY

These conditions are peripheral nerve compressions in which the medianor ulnar nerve is irritated. External pressure on these nerves can produce symptoms of tingling, numbness and loss of strength in the hand, fingers or arm. If untreated these symptoms become more severe and may result in permanent damage. Surgery is the treatment for both of these conditions although splinting may provide some temporary relief. For Carpal tunnel syndrome the operation is performed by making an incision in the palm. The tissue pressing on the nerve is cut to relieve the external pressure it is placing on the median nerve. The wound is then sutured and a bandage applied to the hand. Early healing takes about 3 weeks and the resultant scar is barely visible.

For ulnar nerve palsy, a long skin incision is made ate the elbow. The ulnar nerve is then dissected free from the surrounding scar tissue. On occasion, the nerve is shifted to a slightly different position to relieve it from external compression. Again the wound is sutured and a bandage applied to the elbow. The results of surgery for both of these problems is influenced by how long the condition existed and the extent of damage to the nerve. Therefore, it is advisable to have these conditions evaluated early so that prompt therapy may lead to the best outcome.

2. DUPUYTREN'S CONTRACTURE

Dupuytren's contracture is a disease affecting the skin of the palm of the hand or fingers. Rarely, it may also involve the skin of the soles of the feet. Thickened, scar-like tissue develops beneath the skin and this causes a pulling down of the finger(s). This is called a contracture and it limits the movement of the fingers and it tends to become more severe over time. Surgery is the only successful treatment for this condition. The operation is done by making zig-zag skin incisions on the palmar skin and then removing the scar-like tissue. This is outpatient surgery and it is done under general or regional anesthesia. Recovery takes 3 weeks and occasionally post-operative physical or occupational therapy is necessary. The success of the surgery is dependent upon the severity and extent of the disease at the time of surgery. Again it is wise to seek early consultation in order to obtain the best result.

3. GANGLION CYST / MUCOUS CYSTS

Soft tissue swellings of the hand or fingers are most commonly benign tumors call ganglion cysts. These soft tissue tumors grow slowly and cause pain or discomfort because they exert pressure on adjacent structures such as tendons and nerves. The best treatment for these benign tumors is surgical removal. A skin incision is made over the soft tissue mass and the cyst is removed.

The incision is then closed with sutures and a supportive bandage is applied. Recovery and healing varies between 2 and 4 weeks in most instances.

4. TRIGGER FINGER (STENOSING TENOSYNOVITIS)

In this condition there is a "locking" or "catching" of the involved finger when it bends. The easy flexion/extension motion of the finger or thumb is prevented because the tendon becomes stuck and doesn't glide easily. If untreated, the locking tends to become more severe and persistent over time. If treated early this problem can often be successfully treated with 1 or 2 cortisone injections (office procedure). If surgery is necessary then a short outpatient procedure is done to relieve the tissue binding the tendon. Recovery and healing general occurs in 2 to 4 weeks time.

The above conditions are some of the more common hand problems performed by plastic surgeons. Many times the results of surgery are improved with a post-operative program of physical/occupational therapy. This may include strength training, range of motion exercises, scar massage, nerve stimulation or desensitization, splinting and wrapping to reduce swelling. The outcome of hand surgery is generally dependent on both of these treatment modalities.