Surgery Hand and wrist surgery Hand and wrist surgery This booklet provides information and answers to your questions about these surgical procedures. Arthritis Research UK produce and print our booklets entirely from charitable donations. What is hand and wrist surgery? For most people with arthritis- related problems in the hands or wrists, surgery is unnecessary. But if you’re facing hand or wrist surgery you’ll probably have lots of questions on your mind. In this booklet we’ll explain when surgery might be needed and what you can expect from the process. We’ll also look at what happens before and after surgery and suggest where you can find out more. At the back of this booklet you’ll find a brief glossary of medical words – we’ve underlined these when they’re first used. www.arthritisresearchuk.org Page 2 of 24 Hand and wrist surgery information booklet What’s inside? 2 Hand and wrist surgery 13 How should I prepare at a glance for surgery? 4 How the do the hands and – Pre-admission clinic wrists work? 14 What will my recovery involve? 5 Do I need surgery? – After the operation – Getting back to normal 6 What are the possible advantages of hand and 14 What are the possible wrist surgery? complications of hand and wrist surgery? 6 What are the possible disadvantages of hand 15 Research and new and wrist surgery? developments 6 What are the common types 16 Glossary of hand and wrist surgery? 17 Where can I find out more? – Carpal tunnel release 20 We ’re here to help – Dupuytren’s contracture fasciectomy – Trigger finger release – Tendon repair – Ganglion removal – Knuckle (MCP joint) replacement – Thumb joint surgery – Wrist joint surgery Page 3 of 24 Hand and wrist surgery information booklet At a glance Hand and wrist surgery Surgery isn’t often needed for people with arthritis, but it can help ease pain and improve hand Do I need surgery? function. Most people with arthritis-related problems in their hands or wrists don’t need surgery. The decision whether to operate will be based on: • how bad your symptoms are (pain or loss of hand function) • your needs • your response to other treatments. What are the possible advantages? The advantages of having surgery can What are the common types include: of hand and wrist surgery? • less pain The following operations can help with hand or wrist problems: • improved hand function • carpal tunnel release • improved appearance of hands. • Dupuytren’s contracture fasciectomy • trigger finger release What are the possible disadvantages? • tendon repair • ganglion removal The disadvantages of having surgery can include: • knuckle (MCP joint) replacement • reduced joint movement, depending on • thumb joint surgery the operation • wrist joint surgery • replacement joints wearing down more • wrist fusion quickly than natural joints • wrist joint replacement. • possible complications. Page 4 of 24 Hand and wrist surgery information booklet What are the possible complications? Every possible care is taken to prevent complications, but in a few cases these do happen. They may include: • infections • stiffness • haematoma (bleeding) • reduced function. Page 5 of 24 Hand and wrist surgery information booklet How do the hands and The normal structure of the hand and wrists work? wrist is shown in Figure 1. Our hands play a very important part The movement and power are in everyday activities, and if we’re to lead controlled by muscles and tendons in the an active, independent life the joints in hand and forearm: our hands need to work properly. We also • The flexor group, on the inside or front care about how our hands look because of the arm, control bending of the they’re always on view and we use them fingers and wrist – these pass over the to help us communicate when we meet front of the wrist and are held in place by and talk to people. a strong fibrous band called the flexor retinaculum, or carpal tunnel ligament. This booklet describes how the hands and wrists work, the common musculoskeletal • The extensors on the outside or back of and arthritis-related problems that occur, the forearm allow the hand to open up. the type of surgery carried out to treat these conditions and what you should expect if you need an operation. Figure 1 The normal structure of the hand and wrist (palm view) Flexor Lumbricals tendons The normal Carpal structure of the tunnel hand and wrist, ligament showing the position of the Flexor Ulnar artery nerves, arteries tendons Ulnar nerve and tendons Radial Median nerve artery Page 6 of 24 Hand and wrist surgery information booklet • Small muscles in the hand itself Do I need surgery? (the lumbricals and interossei) allow For most people with musculoskeletal fine movement. and arthritis-related problems in their The tendons in the hand are covered by hands or wrists, surgery is unnecessary. a layer of synovium, the same tissue that The decision whether to operate will lines the joints. The tendon and synovium depend on a number of factors: are covered by a tendon sheath, which is • how bad your symptoms are (pain or a bit like the protective covering on the loss of hand function) brake cable of a bicycle. • your needs The sense of touch in the hand is supplied by two main nerves, the median or carpal • your response to other treatments, tunnel nerve and the ulnar or ‘funny including drugs, splinting and exercise. bone’ nerve. The median nerve passes Surgery is rarely carried out to improve under the carpal tunnel ligament and the look of the hands, although an gives feeling to most of the hand (from improvement in their appearance may the thumb to half of the ring finger). It be a welcome side-effect. also provides power to muscles at the base of the thumb. The ulnar nerve gives You may feel nervous, stressed feeling to the little finger and half the ring or scared if you’ve been told you finger, and it powers all of the other small need surgery. Finding out as much muscles in the hand. as you can about the operation and understanding the process There are also two arteries (radial and will help you feel calmer and more ulnar) that supply blood to the hand. You in control. can feel these on the palm-side of your wrist. The radial artery (nearer the thumb) is often felt to take your pulse. The ulnar artery on the opposite side of the wrist is much more difficult to feel. Understanding what’s involved in your operation will help you feel more relaxed and in control of your treatments. Page 7 of 24 Hand and wrist surgery information booklet What are the possible What are the common advantages of hand types of hand and wrist and wrist surgery? surgery? The main advantages of hand and Surgery can help with a number of hand wrist surgery can be: and wrist conditions: • long-lasting pain relief Carpal tunnel release • better hand function Carpal tunnel syndrome happens when • better-looking hands (although pressure is put on the median nerve as it this isn’t always the case, depending passes through the wrist under the carpal on the procedure). tunnel ligament (see Figure 1). This causes pins and needles and numbness in the fingers. Surgery is sometimes needed to What are the possible ease pressure on the nerve. disadvantages of hand and wrist surgery? There can be some disadvantages to hand and wrist surgery: • Replacement joints, for example new knuckle joints, aren’t as hard-wearing or long-lasting as natural joints. • Scars are unavoidable at the site of the cut (incision). • Some operations reduce joint movement. • There are possible complications of surgery, for example swelling, stiffness or infection. • Occasionally small nerves around the incision can be damaged, leading to patches of numbness. Page 8 of 24 Hand and wrist surgery information booklet In the operation, the surgeon is able to of the hand. You may need surgery to ease the pressure by splitting the carpal remove the tissue and release the fingers, tunnel ligament. This is often done under although it’s not always possible to make local anaesthetic, where only your arm this completely better. is made numb, which means that you The operation is generally performed probably won’t need to stay in hospital as a day case, so you won’t need to stay overnight. Following the operation you in hospital. It’ll take two to three weeks may need to wear a bulky bandage on for the skin to heal and up to 12 weeks your wrist and hand for a week or two. before you have full use of your hand. Stitches are removed after 10–14 days. You’ll be seen by a hand therapist who During this time you’ll be able to use your will start you on exercises and monitor fingers and thumb, although you should your movement and function. A night avoid heavy tasks. extension splint may be made for you, It’s important that you move your fingers although this won’t always be needed. to reduce swelling and to prevent the nerve and tendons becoming caught up Trigger finger release in the scar tissue which may form after the If you have trigger finger, the affected operation. You should recover from the finger can often bend normally but effects of surgery in less than a month, becomes stuck in a curled position. This although it may take longer to get all the is caused by the tendon which allows the feeling back in your hand, especially if finger to bend becoming thickened, so it you’ve had carpal tunnel syndrome for a becomes stuck in the tunnel where the long time.