Hand Surgery

Hand surgery includes any procedure intended to restore form and function in the hands. In recent years, surgeons have made significant advances in treating defects of the hand. A wide variety of techniques are involved, from complex transplantations to non-surgical interventions. Dr. Morse performs a wide variety of hand surgery procedures, as well as non-surgical treatments for hand disorders.

Hand Surgery Indications and Procedures



Amputation

Amputation is a procedure that completely removes a deformed or injured body part. It may be necessary after a traumatic injury, to preserve health (such as when tumors are present) or for certain operations that require it.

During amputation, your hand surgeon removes the injured body part and prepares the remaining part for a prosthetic.

Arthroscopy

Arthroscopy is a technique that allows a hand surgeon to visualize the inside of a joint with minimal invasiveness. The wrist is one of the most common joints to undergo arthroscopy. The technique allows the doctor to treat disorders and problems through very small incisions.

During arthroscopy, Dr. Morse inserts a small camera attached to the end of a narrow fiber optic tube through a small incision at the wrist joint. On a television monitor, the doctor can see the small structures in the wrist, which allows for more accurate diagnosis.

Arthritis

Arthritis is a disease affecting the cartilage in the joints. The smooth cushioning lining in the cartilage deteriorates and causes structural changes in the wrist and hand, which can be seen on X-rays.

Sufferers often experience joint pain or swelling, limited joint motion, limited function, and weakness.

When other measures have failed to relieve arthritis symptoms, a hand surgeon can perform a reconstructive procedure to help restore function and relieve pain. Common procedures include joint fusion and joint replacement.

Burns, Chemical and Frostbite Injury

The hands are particularly prone to burns and other related injuries. If they come in contact with extreme heat, chemicals or frostbite, significant damage can result and death of cells in the skin.

These injuries will vary in depth and be more or less severe. Likewise, treatment will vary according to severity of the injury. If the burn is localized on the hand and pain can be controlled, an outpatient treatment may be suitable.

Skin grafts are often used to treat severe burns. Your hand surgeon would remove the dead skin, replace it with skin grafts and place the hand in a splint to allow healing. More than one operation may be necessary, since burn injuries on the hands can develop contractures over time.

Carpal Tunnel

Carpal tunnel release is a surgical procedure to treat carpal tunnel syndrome. The carpal tunnel is a passageway through the wrist that carries tendons and one of the hand’s crucial nerves. After repetitive motion, injury, or pregnancy, a condition called carpal tunnel syndrome can develop, causing aching, tingling, and hindered function in the hands and wrist. Options for surgical treatment include open carpal tunnel release in which the hand surgeon makes an incision from the palm to the wrist, or closed carpal tunnel release performed endoscopically. With either procedure, the carpal ligament is cut to release the pressure on the median nerve inside the carpal tunnel.

Congenital Hand Defects

Treatment for congenital hand defects has improved dramatically in recent years. After reconstructive surgery, many patients can achieve a full range of motion and a relatively normal appearance. One common defect is syndactyl, when two or more of the fingers are fused together. Using zig-zag incisions, the hand surgeon separates the fingers, creating triangular flaps of skin. Skin grafts are then used to fill in the uncovered areas at the base of the fingers.

Dupuytren’s contracture

Dupuytren’s contracture occurs when scar-like tissue restricts motion in the hands, pulling the fingers toward the palm. During surgery to treat Dupuytren’s contracture, Dr. Morse makes small incisions to separate the bands of thickened tissue, freeing the tendons for improved finger movement.

Hand Tumors

Hand tumors are abnormal lumps or bumps. Sometimes simply called a “mass,” a tumor isn’t necessarily malignant. Most hand tumors are actually benign (non-cancerous). Regardless of the cause, any lump or bump on your hand can be considered a tumor.

They can appear on the skin, such as a mole or a wart, or they can appear beneath the skin in the soft tissues or bone. There are many different tissue types in the hand (e.g. skin, tendon, fat, ligaments, bone, etc) so there are also many different types of tumors that can appear on the hands.

Tumors that appear on the hands include ganglion cysts, lipomas, neuromas, nerve sheath tumors, fibromas, glomus tumors, and others. The most effective treatment for hand tumors is surgical excision, combined with analysis of the tumor to determine its type.

Ingrown Nail

Ingrown nails are caused by an alteration in the proper fit of the nail plate within the nail groove. An ingrown nail can gradually drive into the skin, like a foreign object, causing undesirable effects like swelling, redness and pain.

Treatment varies depending on the stage of the condition. If surgery is necessary, the hand surgeon may stretch the tissue away from the nail or remove the nail margin.

Injuries

Injuries are the most common reason for seeking out a hand surgeon. If you have experienced a debilitating hand injury, a reconstructive procedure may be recommended. Dr. Morse can help repair fractures, burns, cuts, or injured tendons, nerves and blood vessels. Techniques used may include microsurgery, grafting, flaps and replantation / transplantation.

Infections

Hand infections have the potential to cause severe problems such as stiffness, loss of strength, and loss of tissues. Infections should be addressed by a doctor as early as possible.

In early stages, infections can often be treated with antibiotics, local rest, elevation and other no-surgical measures. After the early stages (sometimes just a few days) the treatment may involve a combination of antibiotics, surgical drainage, and removal of infected or dead tissues. Drainage from the infection will need to be sent for laboratory testing to determine the type of bacteria causing the infection and the appropriate antibiotic for treatment.

Nail Bed Injuries

Nail bed injuries are typically associated with damage to other surrounding structures, such as fractures of the bone, or cuts of the nailbed, fingertip skin, tendons, and nerve endings. These injuries can occur when a fingertip gets crushed, cut or pinched.

To restore a normal appearance to the nail and surrounding tissues, a hand surgeon can perform simple treatments or surgical reconstruction.

Nerve Injuries

Nerves act like wires in your body, carrying information to and from your brain. Motor nerves transmit messages from your brain to your muscles, telling your body to move. Sensory nerves transmit messages about pain, pressure, and temperature to your brain from different parts of your body.

Pressure, stretching, or cutting can damage fragile nerves. After nerve injury, the nerves can stop working and carrying information to the brain. As a result, the muscles may stop working and loss of feeling can occur in the area.

To repair a severed nerve, Dr. Morse sews together the insulation surrounding both ends of the nerve. The stitches used for this surgery are very tiny and thin. After the operation, a splint is typically needed for a few weeks to protect the delicate nerve.

Tendon Injury and Repair

Injuries to both the extensor and flexor tendons are a relatively common occurrence. Lacerations of these tendons can be simple or complex, depending on what surrounding structures are affected.

Surgical treatment (tendon laceration repair) involves treatment of the wound, suturing of the lacerated tendon and postoperative rehabilitation.

Tennis Elbow

Tennis elbow, also know as lateral epicondylitis, is a bothersome condition caused by overuse or trauma. Most sufferers experience pain when lifting, gripping, or grasping.

Lateral epicondylitis involves the tendons that attach to the bone on the outside part of the elbow. Tendons anchor the muscle to bone, while the muscles help to extend and stabilize the wrist. Tennis elbow can result when the tendon’s attachment degenerates, which weakens the anchor site and places more stress on the area.

A variety of treatments can be recommended to address tennis elbow. In cases of severe pain, surgery can remove the degenerated tendon tissue.

Trigger Finger

Trigger finger, or stenosing tenosynovitis, affects the pulleys and tendons in the hand that bend the fingers. Like long ropes, the tendons connect the forearm muscles with the finger bones. Inside the finger, there are the pulleys – a series of rings that form a tunnel where the tendons glide through. The pulleys work to hold the tendons close against the bone. With a slick lining, the tendons and the tunnel allow the tendons to easily glide through the pulleys.

Trigger finger results when the pulley at the base of the finger gets too thick and constricts the tendon, making it hard for the tendon to glide through the pulley. In some cases, the lining becomes swollen or the tendon develops a knot. With the resistance on the tendon, the patient feels pain, popping or a constricted feeling in the fingers.

Dr. Morse performs surgical and non-surgical procedures to treat trigger finger. You may need an anti inflammatory medication or a steroid injection around the tendon. If surgery is recommended, the doctor would open the pulley at the finger base.

Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the increased resistance to the gliding of the tendon through the pulley, one may feel pain, popping, or a catching feeling in the finger or thumb.

Wrist and Hand Fractures, Dislocations

Your hand and wrist are composed of many bones that form a complex framework. When fractures occur in these bones, it may cause pain, stiffness, and loss of hand movement. Some fractures can cause deformities like a crooked finger, but many do not.

Hand surgeons often treat fractures using procedures such as internal fixation, external fixation and bone grafts. These techniques use plates, screws, pins and bone fragments to join the fractures and allow healing.