Do I Need Hand or Wrist Surgery?

From petting the dog to preparing meals, your hands are the most valuable tool you have. They’re also among the most anatomically intricate parts of your body, consisting of 27 bones, 27 joints, 34 muscles, over 100 ligaments, tendons, blood vessels, nerves, and soft tissue. 

Given the complexity and constant work of your hands, it’s easy to see why they’re prone to injury and disabling conditions caused by overuse, such as arthritis, carpal tunnel syndrome, and trigger finger

Anyone experiencing pain or lack of mobility in a hand, finger, or wrist should consult an orthopaedic surgeon who specializes in hand surgery. Those suffering from arthritis symptoms should seek treatment before their condition worsens. Likewise, a hand specialist should immediately examine any fractures.

Fellowship-trained in orthopaedic hand and upper extremity surgery,  Matthew C. Shillito, MD of San Diego Sports Medicine & Orthopaedic Center, is such an expert.

Dr. Shillito always considers non-surgical treatments first, including physical therapy, occupational therapy, splinting, and medication. If these are unsuccessful, he may recommend surgery. 

Symptoms that signal a potentially serious problem 

Some symptoms go away with rest; others may indicate an issue that requires medical evaluation and possibly surgery. These include:

Common causes of these symptoms are:

Types of hand surgery 

Dr. Shillito is an expert in hand, wrist, and elbow pathology. Among the surgeries he performs most often are:

Carpal tunnel release

The carpal tunnel is a narrow opening in the wrist through which the median nerve and other tendons pass. When these tendons become inflamed, they place pressure on the median nerve, causing pain, numbness, and tingling sensations that radiate to the hand.

This surgery entails cutting the band of tissue around the wrist to create more space in the carpal tunnel and alleviate pressure on the median nerve. 

Tendon repair surgery

Tendons are strong connective tissues that connect muscles to adjacent bones. If injured or damaged from overuse, tendons can become painful, inflamed, and inflexible. In tendon repair surgery, the damaged or torn ends of the tendon are sewn together. 

Fracture surgery

Some hand fractures require surgery to realign the bones so that fragments heal together correctly. Dr. Shillito may use hardware such as screws and plates to hold fragments together while they heal. If a bone in the hand has been shattered or crushed, a bone graft may be necessary to fill the gaps.

Trigger finger release

Trigger finger, also known as stenosing tenosynovitis, is characterized by a finger getting stuck in a bent position. This occurs when inflammation reduces the space in the sheath surrounding the tendon. Trigger finger release is a surgical procedure to widen the tendon sheath tunnel opening so the tendon can glide through it more easily and prevent permanent stiffness.  

Dupuytren’s contracture fasciectomy

Dupuytren's disease causes the fascia—those fibrous layers of tissue that lies underneath the skin in the palm and fingers — to thicken and eventually tighten. Over time, the fingers are pulled inward, towards the palm, resulting in what is known as a Dupuytren's contracture. In severe cases, Dupuytren's contracture prohibits hand function and may necessitate surgery.

The surgical procedures most often performed for Dupuytren's contracture are

Ganglion cyst and other soft tissue mass removal

Any abnormal lump or bump in the hand or wrist is considered a tumor, though usually, they are not malignant. Tumors can occur on the skin or even the bone. Ganglion Cysts are the most common hand tumors and appear in the hand and wrist. These cysts are typically filled with fluid, and it will feel very firm. There are several treatment options for a ganglion cyst, including observation.

Trapeziectomy (removal of the trapezium)

Arthritis in the joint at the base of the thumb is very common. Corrective surgery involves removing a small bone called the trapezium, located at the bottom of the thumb. This provides more space for the thumb to move so that the arthritic bone surfaces are not rubbing together, causing pain.

Seek expert care

If you’re experiencing any pain or restricted mobility in your hand, wrist, or elbow, don’t suffer. Get help from board-certified orthopaedic surgeon and hand specialist Dr. Shillito at San Diego Sports Medicine & Orthopaedic Center. Contact Dr. Shillito by phone or online today.

For additional information about hand diseases and conditions, check out this reference site from the American Society of Surgery for the Hand.

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