Surgeries

Surgeries

Ganglion Cysts

What are ganglion cysts?

Cysts are pouches of fluid.  Ganglion cyst is the name typically used to refer to cysts that arise from the fluid in joints and around tendons.  The most common location for cysts in the upper extremity is the back of the wrist.  No one knows exactly why cysts form.  A weak spot in the joint capsule allows the joint fluid to push out and form it’s own space.  Often the connection to the joint is maintained and fluid can move back and forth which means the cyst can fluctuate in size sometimes depending on activity.  

What does surgical excision of a ganglion entail?

The procedure consists of an incision most often directly over the cyst. The cyst is dissected away from the surrounding structures such as tendons.  Care is taken to ensure that the cyst is removed entirely including the stalk that connects it to the joint.  This minimizes the risk that the cyst will recur.

 

How long does the surgery take?

Patients are typically in the operating room for about forty five minutes to an hour.  The procedure itself takes about 20 minutes.

 

What kind of bandage will I have?

Patients have a wrist splint that is held in place with an ace bandage.  This can be left in place until follow up appointment 7-10 days after surgery.  The fingers and thumb will be free.  Moving them regularly will help maintain mobility and decrease swelling.

 

What are the possible risks and complications of surgery?

As with any surgery, there is a risk of infection, nerve injury, and post op stiffness.  Moving the fingers during the immediate post operative period is very helpful in preventing prolonged stiffness.  Some discomfort with finger motion is to be expected.

 

What is recovery like?

The initial bandage rigid on one side and will limit most wrist range of motion.  Your fingers and thumb will be free and you will be able to use the hand for very light tasks.  Moving your fingers immediately after surgery and in the first few days postoperatively is very helpful in limiting swelling and preventing stiffness.

 

When can I shower?

The surgical bandage should be kept dry.  You may shower with the bandage while using a plastic bag to keep the bandage dry.  Once the operative bandage has been removed, the wound may get wet.  After showering, pat it dry and apply a new dry bandaid or gauze.

 

Will I need to go to hand therapy?

While many patients do not need formal therapy to regain motion and strength after ganglion cyst excision, some patients develop more stiffness than others and find it helpful to work with a hand therapist to regain range of motion and strength.  We will decide together at the first post operative visit whether you may benefit from formal therapy.  

 

DeQuervain’s Tenosynovitis

What is DeQuervain’s Tenosynovitis?

Tendons are like ropes connecting the muscles to the bone.  Many of the muscles responsible for wrist, thumb and finger motion are located in the forearm.  The tendons travel across the wrist through tunnel like compartments.  DeQuervain’s tenosynovitis occurs when the tendons that bring the thumb up and out become inflamed as they run through this tunnel.

 

What are the symptoms of DeQuervain’s Tenosynovitis?

Patient’s with DeQuervain’s complain of pain on the thumb side of the wrist.  This is often aggravated by activities that put stress on the thumb especially if it is being held away from the rest of the hand.

 

What does DeQuervain’s release surgery entail?

The procedure consists of a small incision just over the bony prominence on the thumb side of your wrist.  The tendon compartment is incised to free up the tendons that are being irritated.  

 

How long does the surgery take?

Patients are typically in the operating room for about forty five minutes to an hour.  The procedure itself takes about 10-15 minutes.

 

What kind of bandage will I have?

Patients have a rigid dressing that extends from the thumb to the forearm after surgery.  The fingers will be free.  The dressing should stay on until the patient is seen in the office about one week after surgery.  

 

What are the possible risks and complications of surgery?

As with any surgery, there is a risk of infection, nerve injury, and post op stiffness.  A small nerve to the skin over the back of the thumb runs in operative area called the dorsal radial sensory nerve.  Irritation of this nerve resulting in a small area of numbness and/or sensitivity directly over the nerve is the most common complaint after deQuervain’s surgery.  It is often caused by moving the nerve out of the way during the surgery and typically resolves with time.

 

What is recovery like?

The initial bandage is rigid and will limit wrist and thumb motion.  Your fingers will be free and you will be able to use the hand for very light tasks.  Moving your fingers immediately after surgery and in the first few days postoperatively is very helpful in limiting swelling and preventing stiffness.  Some mild discomfort with finger movement is to be expected.

 

When can I shower?

The surgical bandage should be kept dry.  You may shower with the bandage while using a plastic bag to keep the bandage dry.  Once the operative bandage has been removed, the wound may get wet.  After showering, pat it dry and apply a new dry bandaid or gauze.

Will I need to go to hand therapy?

While most patients do not need formal therapy to regain motion and strength after deQuervain’s surgery, some patients develop more stiffness than others.  We will decide together at the first post operative visit whether you may benefit from formal therapy.  

 

Carpal Tunnel Release

 

What is carpal tunnel syndrome?

Carpal tunnel syndrome occurs when there is too much pressure on the median nerve as it passes through a space in the wrist called the carpal tunnel.  The median nerve provides sensation to the three digits on the thumb side of the hand.  The floor of the carpal tunnel are the bones of the wrist and the ceiling is a thick band of tissue called the transverse carpal ligament.  

 

What does carpal tunnel release surgery entail?

The procedure consists of a small incision in the base of the palm.  The transverse carpal ligament is incised relieving the pressure on the median nerve.

How long does the surgery take?

Patients are typically in the operating room for about forty five minutes to an hour.  The procedure itself takes about 10-15 minutes.

 

What kind of bandage will I have?

Patients have a soft, bulky dressing after surgery.  The fingers and thumb will be free.  The dressing can be removed on the third day after surgery and a large band aid or dry gauze can be applied to the surgical area.

 

What are the possible risks and complications of surgery?

As with any surgery, there is a risk of infection, nerve injury, and post op stiffness.  The resolution of symptoms after carpal tunnel surgery is highly variable and depends mostly on the severity of symptoms preoperatively.  Patients who have long standing, severe carpal tunnel syndrome are unlikely to have complete resolution of their symptoms and improvements may take several months.  

 

What is recovery like?

The initial bandage is not rigid but is bulky enough that it limits most wrist motion.  Your fingers and thumb will be free and you will be able to use the hand for very light tasks.  Moving your fingers immediately after surgery and in the first few days postoperatively is very helpful in limiting swelling and preventing stiffness.

 

When can I shower?

The surgical bandage should be kept dry.  You may shower with the bandage while using a plastic bag to keep the bandage dry.  Once the operative bandage has been removed, the wound may get wet.  After showering, pat it dry and apply a new dry bandaid or gauze.

 

Will I need to go to hand therapy?

While most patients do not need formal therapy to regain motion and strength after carpal tunnel surgery, some patients develop more stiffness than others.  We will decide together at the first post operative visit whether you may benefit from formal therapy.  

 

Trigger Finger

What is trigger finger?

Tendons are like ropes connecting the muscles to the bone.  In the fingers and thumb, the tendons that bring the fingers down, such as when you make a fist, run through a pulley system.  The pulleys are bands of connective tissue that hold the tendon close to the bone.  Trigger finger occurs when the tendons become irritated as they enter the pulley system.  Due to thickening of the pulley and/or swelling in the tendon, the tendon can no longer glide smoothly through the pulley and starts to catch and eventually lock.

 

What does trigger finger release surgery entail?

The procedure consists of a small incision in the palm at the base of the affected finger.  The pulley is identified and incised to allow for smooth gliding of the tendon with finger range of motion.  

 

How long does the surgery take?

Patients are typically in the operating room for about forty five minutes to an hour.  The procedure itself takes about 10-15 minutes.

What kind of bandage will I have?

Patients have a soft bulky dressing.  The fingers and thumb will be free.  After three days, the dressing can be removed and replaced with a bandaid or dry gauze dressing can be applied to the surgical area.

 

What are the possible risks and complications of surgery?

As with any surgery, there is a risk of infection, nerve injury, and post op stiffness.  Patients who had prolonged triggering and/or locked digits preoperatively are at most risk for persistent stiffness postoperatively.  Moving the fingers during the immediate post operative period is very helpful in preventing prolonged stiffness.  Some discomfort with finger motion is to be expected.

 

What is recovery like?

The initial bandage is not rigid but is bulky enough that it limits most wrist motion.  Your fingers and thumb will be free and you will be able to use the hand for very light tasks.  Moving your fingers immediately after surgery and in the first few days postoperatively is very helpful in limiting swelling and preventing stiffness.

 

When can I shower?

The surgical bandage should be kept dry.  You may shower with the bandage while using a plastic bag to keep the bandage dry.  Once the operative bandage has been removed, the wound may get wet.  After showering, pat it dry and apply a new dry bandaid or gauze.

 

Will I need to go to hand therapy?

While most patients do not need formal therapy to regain motion and strength after trigger finger surgery, some patients develop more stiffness than others.  We will decide together at the first post operative visit whether you may benefit from formal therapy.  

 

© 2019 Design created by Karin Charbit-Harnevo. for Petit Moses © Emily Slate