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Information for Patients About Hand & Elbow Surgery

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Information for Patients about Hand & Elbow Surgery Clinical Professor Allan Wang FRACS PhD FAOrthA Shoulder and Upper Limb Surgeon www.allanwangorthopaedics.com.au MURDOCH SUBIACO Murdoch Orthopaedic Clinic St John of God Subiaco Clinic St John of God Murdoch Clinic Suite 302, 25 McCourt St Suite 10, 100 Murdoch Drive Subiaco WA 6008 Murdoch WA 6150 Telephone: 08 6332 6390 Page | 2 Page | 3 Information for Patients about Hand and Elbow Surgery Introduction We have put this information booklet together to educate our patients about their Hand and Elbow condition, treatment options and post-surgical care. Please keep this booklet for future reference. It is not a detailed source of information and you may also wish to refer to our website www.allanwangorthopaedics.com.au for animated videos of surgical procedures. If you require further information or have concerns regarding your treatment please contact the office to discuss with Dr Wang or his staff. Contents Pages 1. Carpal Tunnel Syndrome 4 2. Cubital Tunnel Syndrome 6 3. Trigger Finger 7 4. De Quervain’s Tenodonitis 8 5. Ganglion Cysts 9 6. Arthritis at the Base of the Thumb 10 7. Wrist Arthroscopy 11 8. Dupuytren’s Disease 12 9. Lateral Epicondylitis 13 10. Elbow Arthroscopy 14 11. Post-Operative Instructions Hand & Elbow Surgery 15 Page | 4 Carpal Tunnel Syndrome What is it? Figure 1 Carpal tunnel syndroe is a condition aused by copression o te median nerve at te level o te wrist oint Here te edian nerve passes into te arpal tunnel along wit leor tendons and te tendon lining called tenosynoviu Carpal tunnel syndroe ocurs wen pressure builds up in te tunnel and tis an be due to swelling o te tenosynoviu ratures artritis luid retention during pregnany and certain conditions suc as diabetes and tyroid disease Symptoms en te pressure on te edian nerve becoes severe, you ay notice wrist pain tingling and nubness and lusiness in and oveents. Te tingling usually aects te tub index and iddle ingers and is worse at nigt or gripping ativities eg driving a ar. en carpal tunnel syndroe is severe, and longstanding, peranent nerve daage ay ocur, ausing peranent nubness in te ingers and te tub tenar usles ay waste away Diagnosis Carpal tunnel syndroe is usually diagnosed ro your syptos and eaination o your and Soeties electrial studies nerve condution veloity and electroyogra are perored. Tese studies are uncoortable but ay need to be done, as your syptos ay be due to nerve copression elsewere in your ar or in your neck. Page | 5 Treatment on operative treatent is oten successul in less severe ases splint ay rest te wrist and allow te swelling in te arpal tunnel to settle. nti-inlaatory tablets also elp or inections o cortiosteroid directly into te carpal tunnel Altering te worplae ay elp i you do a lot o repetitive wor wit your ands In ore severe ases surgery is reuired ressure on te edian nerve is released by surgially utting te transverse carpal ligaent Tis can be done via a direct inision over te ront o te pal (Fig 2); or by te endosopi etod were a telesope is passed via two ini inisions under te ligaent (Fig 3), and te ligaent is released ro it’s under surae. Figure 2 Figure 3 ollowing surgery te nigt tie tingling in your and usually settles uite uily. edution in grip strengt and soreness over the palm where the ligament has been divided (“pillar pain”) may last for wees or even soe onts especially i you do eavy work. Te endosopi etod as an advantage over te direct inision etod in tat te recovery o untion is quier. However it as te disadvantage tat coplications ay ocur. Tese are very unoon and inlude inection bruising o te nerve, or daage to te blood vessels or tendons in te pal Ater surgery, eep your and elevated and do gentle inger eercises eep te bandage clean and at two week, stites are reoved Heavy ativities are avoided or - wees Page | 6 Cubital Tunnel Release What is it? Cbital Tnnel yndrome ocrs when the lnar nerve is compressed at the bak of the elbow (“funny bone”). This cases tingling and nmbness in the small and ring fingers pain along the inner forearm and sometimes weaness in sing the hand ymptoms are sally worse when the elbow is held in a fleed position eg holding a phone, sleeping at night et. he nerve may be tingly when tohed and can be nstable, slipping forward and bawards when the elbow is fleed then straightened What investigations are needed? Usally an electrial test (G) is ordered to determine the severity of lnar nerve ompression and also to rle ot nerve ompression at the wrist (eg carpal tnnel syndrome) or a pinched nerve in the nek. rays maybe reired if there is an arthriti bone spr pressing on the nerve. n ltrasond san will show if the nerve is nstable, or if there is adaent tendon inflammation (medial epiondylitis). What are the treatment options? Minor cbital tnnel syndrome responds to rest, anti-inflammatories and a resting splint More severe lnar nerve ompression often needs srgery as permanent nerve damage an ocr withot treatment rgery involves an incision over the inner aspet of the elbow ometimes the ligament overlying the nerve is released to decompress the nerve (neurolysis) sally the nerve is released and shifted forwards, creating some “slack” in the nerve, so that it is nor stretched when the elbow is held fleed (transposition) After Surgery A sling is reired for wees and only light hosewor or offie ativities are permitted for the following si wees ring this time, gentle finger and wrist eercises are enoraged to prevent pain and stiffness (dystrophy) ifting the arm overhead several times daily will prevent frozen sholder. The srgial scar maybe swollen brised and tender early after srgery ecovery following lnar nerve decompression srgery may tae plae over many months f nerve compression was severe, recovery may be in-complete and therapy may be presribed by Dr ang if progress is slow Page | 7 Trigger Finger What is it? Trigger inger or Trigger Thumb are conditions caused by swelling of the fleor tendons (tenosynovitis) which bend the fingers into the alm. The tendons glide through a series of tunnels, and when the tendons swell they cause a ainful clunk or trigger when they sueeze through the oening of the tunnel (fleor sheath). The triggering is usually felt at the base of the digit. lum may also be felt at the base of the thumb. ccasionally the finger becomes stuck (locked) and will not straighten or bend on its own accord. What causes it? Trigger inger may arise with overuse of the hand or an inury, which cause the fleor tendon to swell. Certain medical conditions including diabetes, gout or rheumatoid arthritis may also cause triggering at the digits. How is it treated? Treatment includes anti-inflammatory tablets and a eriod of rest, to reduce the swelling of the fleor tendons. n inection of cortisone at the base of the finger may also hel. hen triggering is more severe, with regular and ainful catching when the finger is bent, surgery is usually reuired. Under a A, a small incision is made in the alm at the base of the affected finger. The fleor tendon is located and the tunnel surgically oened. This allows smooth gliding of the swollen tendon. The tendon swelling (tenosynovitis) may need to be surgically removed. The digital nerves are carefully rotected during surgery. ecause they are immediately adacent to both the fleor tendons and tunnel, there is a very small ossibility of the nerve being damaged during surgery, causing some numbness at the fingerti. What can I expect after surgery? Mr ang alies a sterile dressing which should remain intact, clean and dry until he reviews you at 10-14 days after surgery. ou should kee your hand elevated in a sling to minimie swelling. entle finger, wrist, elbow and shoulder eercises are encouraged to minimie stiffness. ou can resume light work or activity at - days after surgery but any heavy work should be avoided for at least weeks. Page | 8 De Quervain’s Tendonitis What is it? De Quervains yndroe is a condition caused y inlaation and swelling o the thu tendons at the wrist level. hen you gri or twist the wrist these tendons glide in a tunnel and when the tendons ecoe very swollen they cannot glide reely. Symptoms ain over the thu side o the wrist. ytos are worse on reetitive or heavy activity. Treatment Oten resting the thu and wrist in a sot slint or even a hard lastic Surgery opens the compartment slint will relieve sytos. nti-inlaatory talets, cortisone over the inflamed tendon inections and odiying wor activities also hel. hen sytos are severe, surgery is reuired. A general anaesthetic is reuired ut surgery is done as a “daystay”. The tunnel enclosing the swollen tendons is oened. This relieves the ressure and as the inlaation settles down the ain and wrist otion will gradually irove. The swollen lining o the tendon tenosynoviu is also ecised. andage is worn or one week, then the stitches are reoved. ight activity can start at -2 wees ater surgery and heavier activity can egin at - weeks ater surgery. Page | 9 Ganglions and Cysts What are they? Ganglions are swellings which grow on the hand and wrist. They are coon and usually arise ro a nearby oint or tendon sheath. Ganglions are illed with luid and ay eel hard and e ainul when they are under ressure, or with constant use o the hand or wrist.
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    STENOSING TENOSYNOVITIS RMA ID Reference List for RMA436-1 as at February 2019 Number Abate M, Schiavone C, Salini V, et al (2013). Occurrence of tendon 75098 pathologies in metabolic disorders. Rheumatology, 52(4): 599-608. Acar MA, Kutahya H, Gulec A, et al (2015). Triggering of the digits after 88082 carpal tunnel surgery. Annals of Plastic Surgery, 75(4): 393-7. Adams JE, Habbu R (2016). [Erratum] Tendinopathies of the hand and 88081 wrist. J Am Acad Orthop Surg, 24(2): 123. ID: 88080. Adams JE, Habbu R (2015). Tendinopathies of the hand and wrist 88080 [Erratum ID: 88081]. J Am Acad Orthop Surg, 23(12): 741-50. Aggarwal R, Ring D (2017). de Quervain tendinopathy. Retrieved 9 August 89632 2018, from https://www.uptodate.com/contents/de-quervain-tendinopathy Amirfeyz R, McNinch R, Watts A, et al (2017). Evidence-based 88083 management of adult trigger digits. J Hand Surg, 42(5): 473-80. Andreu JL, Oton T, Silva-Fernandez L, et al (2011). Hand pain other than 88084 carpal tunnel syndrome (CTS): The role of occupational factors. Best Pract Res Clin Rheumatol, 25(1): 31-42. Anon (2010). Tendon trouble in the hands: de Quervain's tenosynovitis 88085 and trigger finger. Harvard Women's Health Watch, 17(8): 4-5. Ashurst JV, Turco DA, Lieb BE (2010). Tenosynovitis caused by texting: 88086 an emerging disease. J Am Osteopath Assoc, 110(5): 294-6. Avci S, Yilmaz C, Sayli U (2002). Comparison of nonsurgical treatment 89633 measures for de Quervain's disease of pregnancy and lactation. J Hand Surg, 27A: 322-4.
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