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HAND SURGERY
The function of the hand is characterized by a diverse interaction of various anatomical structures in a very small space.
In addition to its function as a gripping organ, the hand is used for communication through gestures and motion and as a sensory organ for touching and gripping. Last but not least, it has a high aesthetic value: Just think of important works of art that are characterized by the elegance of the hands depicted.
Over thirty joints give the hand a range of motion that enables this organ to have such a high degree of dexterity.
In the millions of years of human evolution, the thumb has decisively expanded the function of the hand, since it enables differentiated gripping functions. Consequently, the thumb is the most important finger. The tendons act as filigree traction cables for the muscles to move or stabilize the joints. We can regulate our individual pulling power very precisely, from gentle caressing to gripping tug-of-war. Ligaments support stability and form stable hinge joints. On the one hand, nerves are responsible for the sensation of touch, pain and temperature, on the other hand they conduct impulses from the brain to the muscles and thus ensure movement. The nerves regulate the widening of the blood vessels and activate the sweat glands. Arteries and veins transport the blood and branch out into ever finer, thinner blood vessels in the periphery.
This anatomical marvel of the hand requires a thorough knowledge of its many individual structures. Consequently, hand surgery has its own place within surgical medicine.
As specialists in plastic and aesthetic surgery, both doctors have many years of expertise in hand surgery. Dr. Kricheldorff also has an additional board certification in hand surgery.
Carpal tunnel syndrome
Carpal tunnel syndrome corresponds to compression of the median nerve in the carpal tunnel. At this point the median nerve runs together with the flexor tendons from the forearm trough the hand to the fingers. The tunnel boundary is formed by the carpal bones on the sides and bottom. The carpal ligament (retinaculum flexorum) forms the roof of the carpal tunnel.
The carpal tunnel cannot expand. If there is an increase in volume of the structures in the tunnel, the sensitive median nerve is compressed and often damaged. All conditions that are associated with an increase in volume in the carpal tunnel can be considered as causes of carpal tunnel syndrome. Women are affected much more frequently than men, and hormonal differences probably play a role here.
Common causes are proliferation or inflammation of the tendon sheath tissue. But inflammation and swelling of the flexor tendon sheath, fractures in the hand area, swelling of the hand and forearm and poor posture can also cause carpal tunnel syndrome.
In many cases, the suspected diagnosis can already be made by the symptoms expressed. The nocturnal complaints of the patients are very typical. When examining the hand, special tests can help to substantiate or confirm the suspected diagnosis. Depending on the situation, an X-ray of the wrist may be necessary. A neurological examination can also determine the location of the nerve compression and objectify the degree of severity.
Nerves are made up of thousands of tiny fibers that transmit signals, both sensory information and motor control impulses. Nerve compression impairs signal transmission. On the one hand, the nerve conduction speed is regularly reduced, on the other hand, the so-called motor latency increases. Splitting the carpal ligament relieves the nerves by releasing the compression and allowing the nerve to regenerate.
The procedure is usually carried out under partial anesthesia of the arm or under light sedation. After the operation, all fingers can and should be moved at an early stage. The skin sutures are removed after 12-14 days. It can take 6-8 weeks for the hand to be fully resilient again. The duration of the inability to work is about 2-3 weeks. The scar itself can hurt a little for several weeks after the procedure.
Nerves are highly sensitive structures. Prolonged pressure leads to increasing dysfunction, which may not be able to "recover" anymore. In advanced stages, long-lasting pinching of the nerves can lead to increasing weakness of the thumb with partial atrophy of the thumb muscles, in addition to sensory disturbances. In many cases it is therefore advisable not to wait too long before having an operation.
Carpal tunnel surgery is one of the most commonly performed hand surgeries. It has a success rate of over 90%. A recurrence of the problems is very rare. In experienced hands, the procedure is not fraught with complications.
Loge-de-Guyon syndrome
Loge de Guyon's syndrome is also a compression syndrome of the ulnar nerve. The ulnar nerve runs at wrist level, just a few centimeters away from the median nerve, on the ulnar side. The ulnar nerve can also be compressed in its position between the wrist and the carpal / metacarpal (the so-called Guyon's loge).
Symptoms are tingling, numbness and pain in the little and ring fingers, often also weakness of the entire hand.
The diagnosis is made by taking anamnesis and a clinical examination. An additional neurological examination (electrophysiology, nerve conduction velocity measurement) by a neurologist is also necessary.
In the case of Loge de Guyon syndrome, it also makes sense to carry out imaging examinations such as X-rays / ultrasound / MRI, to rule out cystic formations such as ganglia etc.
If conservative treatment does not remedy the situation, surgical treatment is recommended with the aim of decompressing the ulnar nerve by means of an intervention.
Loge de Guyon syndrome surgery can be performed on an outpatient basis. During the procedure, the ulnar nerve in the hand area is exposed through an incision near the life line in the hand. The nerve is loosened and any causes of compression such as ganglia or similar are eliminated.
The follow-up treatments are carried out with a firm hand bandage, which is applied for a week. Depending on the activity, the inability to work lasts 2-3 weeks, but it can last longer in the case of heavy activity. As with carpal tunnel syndrome, prolonged nerve compression can lead to irreversible damage such as muscle weakness/atrophy and sensory disturbances.
Trigger finger
Trigger finger, abbreviated as TVS (Tenovaginitis stenosans), is a disease of the flexor tendon sheath. Recurring inflammation of this tendon sheath and the annular ligaments, which serve to guide the flexor tendons, can lead to a thickening of both the ligament and the flexor tendons. As a result, the tendon slides increasingly poorly and "jams" in the annular ligament. This promotes the occurrence of renewed inflammation, so that a kind of vicious circle is created, so to speak.
Typically, there is a snapping of the fingers after a complete fist closure. In some cases, the other hand is used to straighten the finger again.
There are several possible causes of this condition:
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Inflammation and swelling of the flexor tendons, eg due to overuse
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Swelling of the hand and forearm, eg after injuries
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Tendon tissue swelling in rheumatoid arthritis
A hand surgeon can make a quick and reliable diagnosis based on the typical symptoms. X-rays are not required for this.
During the surgical treatment, an approx. 1.5 - 2 cm long incision is made over the diseased annular ligament. After the connective tissue layer has been exposed, the small blood vessels and nerves are first identified using magnifying glasses. The annular ligament is then split lengthways. Additionally existing adhesions of the flexor tendons caused by the inflammatory process are released at the same time. The operation can be performed under local anesthesia. After the operation, the finger is immobilized in a tight bandage. In it, however, the finger is already being moved. When the bandage is changed for the first time on the first day after the procedure, the exercise treatment is started under medical supervision so that the tendons cannot stick together again. The sutures can be removed after 12 days. Possibly further exercises will be determined. The scar can be painfully hard for 3-4 months. To prevent this, it makes sense to massage the scar after the stitches are removed. The inability to work is usually 1-2 weeks.
The annular ligament release is one of the most common hand surgical operations and has a very high success rate. Problem recurrence is rare. In experienced hands, the procedure is not fraught with complications. However, adequate follow-up treatment and regular mobility exercises are crucial.
Dupuytren's contracture
This benign condition is characterized by the formation of nodular strands or thickenings in the area of the palm of the hand and fingers. Dupuytren's contracture usually occurs in middle age. In the course of the disease, which usually progresses slowly, there is an increasing flexion deformity or an extension deficit of the fingers. In the long term, this can lead to extensive hand dysfunction. The disease is basically painless, but occasionally the knots or strands can cause pain when subjected to mechanical stress. The strands are a change in the connective tissue of the palm of the hand (fascia of the palm of the hand or aponeurosis of the palm of the hand) and not a shortening of the flexor tendons. The cause has not been clearly clarified: the disease tends to run in families, and there is a hereditary component. The way of life in industrialized countries seems to favor the development of Dupuytren's contracture. Injuries can also trigger their development. Dupuytren's contracture affects men more often than women. The diagnosis can easily be made by a hand surgeon.
The time to treat Dupuytren's contracture is when the extension deficit causes problems in everyday life or at work. Since, due to a certain frequency of recurrence (occurrence again after surgery) or progression (occurrence on other fingers that have not yet been operated), further interventions are possible in the long term, one tries to wait for the most favorable point in time.
This operation is called an aponeurectomy, and the diseased tissue is removed. In the hand, the important structures such as nerves, blood vessels and tendons are close together. The Dupuytren's tissue wraps around these nerve structures, which makes their removal considerably more difficult and makes the procedure challenging.
The preparation is carried out with special instruments in order to reliably represent the individual structures. The surgeon should have microsurgical training, especially in advanced stages. In addition to removing the diseased tissue, contracted joints must also be regularly loosened and made flexible again through separate surgical measures. Skin defects often occur after finger extension because the skin has shrunk (as a result of the finger being in the flexed position for a long time). In this case, plastic surgical measures such as so-called local skin flaps (see also "Thenar flap") are often necessary. Sometimes skin grafts from other regions of the hand are also necessary.
We perform all stages of aponeurectomy on an outpatient basis. Conscientious follow-up treatment is very important, especially after operations on the hand, and is carried out independently by the patient under our guidance. In addition, regular physiotherapy or occupational therapy is necessary.
A splint is placed postoperatively for 4-8 days. After the wound has healed (approx. 14 days), regular training of the affected hand regions begins. The duration of the follow-up treatment is several weeks, sometimes longer. Accordingly, depending on the activity, different lasting, longer periods of incapacity to work can be expected.
Ganglion
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A ganglion cyst is a bulge in the joint capsule. It typically occurs in the wrist area and usually shows up in the form of swelling. At first it is barely visible but painful. The causes of a ganglion can be:
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Repeated strain or injury to the wrist
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Irritable conditions, rheumatoid arthritis, diabetes and arthrosis
A ganglion is more common in women than in men.
The diagnosis can be made by a simple examination. An x-ray should usually be taken to rule out other causes.
Longer existing ganglia should be surgically removed as they often press on surrounding structures and cause pain.
After the appropriate preparations, the operation is performed on an outpatient basis under local or general anesthesia. Through a small incision in the skin over the swelling, the surgeon gets to the fibrous strand and can trace it to its origin in the tendon or joint and remove it in such a way that it is less likely to recur. The wound is then closed with a fine suture and a bandage is applied. After a short recovery phase in our recovery room, you can return home.
In some cases, it may be useful to wear a cast for a few days after surgery, especially if the ganglion arises from larger joints. However, longer periods of rest are not required.
Hand rejuvenation
It is often said that it is the hands that reveal a person's true age. As plastic and hand surgeons, we have something to counter this assessment: Hand rejuvenation with hyaluronic acid or biostimulators such as polylactic acid or calcium hydroxyapatite. A targeted injection of these substances can pad and tighten the skin and subcutaneous tissue on the hands. The procedure is performed under local anesthesia and is therefore not painful. After the treatment, slight redness, burning and swelling may occur temporarily. Sometimes there is also a small bruise. After the treatment, you should cool and massaged regularly.
INFORMATION
OVERVIEW
Duration
About 30min
Post-treatment
After the treatment, local cooling, no sport for a week, no strong handshake, no extreme temperatures
Wissenswertes
Immediate effect, but full development after 10-14 days, duration of action 12-24 months, depending on the metabolic situation, natural degradation, vegan product without animal testing
Technique
Approx. 3-5 injections on the back of the hand
Presentability
Immediately
Pain level
Local anesthetic, no pain. In addition, the filler itself also contains a local anesthetic (lidocaine), so that there is no pain afterwards
Risks
More rarely bruises, asymmetries, tendency to swell
Procedure
Outpatient
Costs
Starting from 350 Euros