At Plastic Surgery Northwest, our team of board-certified plastic surgeons has specialized training in complex hand surgery procedures. In Spokane, WA, our surgeons strive to restore normal function of fingers, hands, and wrists injured by trauma or malformed from birth. They also treat diseases and conditions such as arthritis and carpal tunnel syndrome that cause pain and impair the strength, function, and flexibility of the hands, wrists, and fingers. Our team offers effective procedure options for people who have cosmetic concerns about the appearance of their hands, as well.
Common Hand Procedures
Carpal Tunnel Syndrome
This condition is caused by pressure to the median nerve within the wrist, or “carpal tunnel” near the base of the palm. If you suffer from carpal tunnel syndrome, you may experience one or a combination of the following:
- Tingling sensations
- Numbness in your fingers
Carpal tunnel syndrome is associated with multiple conditions, including:
- Repetitive motion or overuse
- Fluid retention during pregnancy
- Injury to the nerve in the carpal tunnel
- Rheumatoid arthritis
Carpal tunnel syndrome tends to be slightly more common in women as they get older, and very common in people with certain diseases such as diabetes.
For patients with mild symptoms, simply reducing repetitive activity or taking more frequent breaks to rest and stretch may be enough to keep things under control. Anti-inflammatory medicines may be helpful to settle down a short-term flare up. If the nighttime numbness is the main issue, wrist braces worn while sleeping, cannot keep people comfortable. If symptoms are not adequately controlled with the above treatments, consideration sometimes is made for surgery. The surgery is a very safe and is typically done as an outpatient procedure that does not require general anesthesia. For most people with surgery only needs to be done once.
Cubital tunnel syndrome is a condition brought on by increased pressure or stretching of the ulnar nerve at the inner side of the elbow, a site commonly called the “funny bone.” Symptoms of cubital tunnel syndrome typically include pain and/or weakness in the forearm, numbness, and/or tingling most often in the ring and little fingers.
Rheumatoid arthritis is just one of the many types of arthritis. While this condition can affect many parts of the body, two-thirds of patients with rheumatoid arthritis have wrist and hand problems. It is most common in the wrist and knuckles and typically affects both hands. Often, the joints feel hot and look red. Patients with rheumatoid arthritis often wake up with stiff and swollen joints. Early on, many patients feel tired.
Other Types of Arthritis
Three other common types of arthritis include:
- Osteoarthritis (“wear and tear” arthritis)
- Gouty arthritis
- Psoriatic arthritis
Treatments for arthritis include anti-inflammatory medications, disease-modifying antirheumatic drugs, and a class of drugs called biological response modifiers (commonly called biologics). A physician may recommend splints or braces, exercise, and modification of daily activities. If joint synovitis cannot be controlled with medications, or if the tendons of the hand and wrist become inflamed or weakened by the disease, surgery may be needed. Surgery may also be needed to correct deformities of the fingers that often result from the disease and is performed by our board-certified plastic surgeons.
This is a disabling hand disorder where thick, scar-like tissue bands form within the palm and may extend into the fingers. Eventually, the contraction may progress to where it is difficult to fully straighten the fingers. There is no known way to halt the process, either by medication, stretching exercises or bracing. Some individuals may not require any intervention in their lifetime while others may have multiple procedures. As a general rule, if someone can still place their entire palm flat against a table, no intervention is usually required.
When the impact of hand function becomes unbearable, effective treatment is considered. Most treatments involve some form dividing, removing or dissolving the thickened tissue from the affected digits. This is typically done in an outpatient setting, often followed by therapy to restore motion and minimize recurrence.
This is a common disorder in older adults characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. “Trigger finger” is actually inflammation and thickening of the tendon sheath and can affect almost any tendon in the wrist and hand. The tendons get stuck as they try to pull, causing a clicking or catching sensation with bending of the joints. In a more advanced case, the affected digit actually will get stuck in a flexed position The causes are over activity, rheumatoid arthritis, carpal syndrome, systemic diseases (such as diabetes), and trauma.
A ganglion cyst is a firm or spongy lump under the skin near a joint or tendon. While the cause of this type of cyst is not known, it is more common in women than men and in people who are 15 to 40 years old. Ganglion cysts are typically harmless. While they usually dissipate on their own, ganglion cysts that are painful, interfere with the use of the joint, or are unsightly may be treated through aspiration or surgical removal. They are filled with joint space or tendon sheath fluid.
De Quervain’s Tenosynovitis
This condition causes pain on the thumb side of the wrist due to irritation or inflammation of the wrist tendons at the base of the thumb. It may be caused by an injury or repetitive motion. Signs of this condition include pain over the thumb side of the wrist when making a fist, or when grasping or holding objects. If splinting and over-the-counter anti-inflammatory medication do not work, we can administer cortisone injections to reduce swelling, or perform surgery to allow the tendons to move freely. This is common amongst new parents from frequently picking up their child.
Hand & Wrist Fractures
If left untreated, fractures may limit use of the affected finger, hand, or wrist. Signs of a fracture include pain, swelling, deformity, and/or the inability to move the finger, hand, or wrist. In most cases, it’s important to seek medical care right away after an injury or trauma. We specialize in surgery of the hands and wrists, and are qualified to offer appropriate treatments, both surgical and nonsurgical, for fractures of varying degrees.
Tendon injuries cause pain and swelling in the affected finger or joint. Tendons in the hands and wrists connect muscles to bone, making it possible to move the fingers, wrists, and forearms. If a tendon is stretched but intact after an injury, the associated joint is typically able to function within a few days. In this case, rest, compression, and restricted movement may be sufficient. When a tendon is severely torn or completely severed, the ends pull away from each other like a broken rubber band, and the tendon must be repaired through surgery. If properly repaired and allowed a period of recovery, a severed tendon can heal.
Artery & Nerve Repair
Repair of the arteries and nerves requires specialized expertise in microsurgery of the hand to be performed properly. The two main arteries of the forearm that run into the hand are:
- Radial artery runs along the thumb side of the forearm
- Ulnar artery runs along the outside of the wrist.
A major nerve of the forearm, the median nerve, runs down the arm, passes through the carpal tunnel in the wrist, and branches out into the hand. If an artery or nerve in the hand or wrist is severed, it’s important to seek medical care from a specialist as soon as possible to avoid losing function or sensation.
This very intricate process involves reattaching the blood supply to a fractured bone. It may also include repair of the bone, tendons, muscles, nerves, and the overlying skin. Surgeons on our team are highly trained in hand surgery, reconstructive surgery, and cosmetic surgery, and are able to provide optimal outcomes for both function and aesthetics.
Cosmetic Hand Rejuvenation
Often we neglect the back of our hands leaving them to look older than we truly are. Our hands need attention too. While we spend time taking care of our face and body with creams and treatments, our hands are not usually the focus of our beauty regimen. Hands are often exposed to the harsh elements and sun (especially while driving) and by our late 20s have what is known as “loss of volume” – leaving thin skin on the back of the hand that is wrinkled and shows many of our tendons and veins.
Hand rejuvenation is a treatment option available Plastic Surgery Northwest. Your specific hand rejuvenation plan, which may include injectable fillers or laser treatments, will be tailored to your needs and expectations by board-certified plastic surgeon Dr. Laura Bonneau. Hand rejuvenation often provides a number of benefits to help your skin look healthier and younger, including:
- Improved skin texture and elasticity
- More volume and plumpness to the skin
- Improved skin tone
If you are embarrassed or dismayed by the look of your hands because age spots, sun damage or wrinkles have taken their toll, Dr. Bonneau can accurately evaluate your possible candidacy for hand rejuvenation and recommend effective treatment options.
To learn more about reconstructive hand surgery and cosmetic hand rejuvenation in Spokane, WA at Plastic Surgery Northwest, request a consultationrequest a consultation online or call (509) 838-1010 to schedule an appointment.