Hand surgery: The last resort in a series of treatments

Hand surgery is a general term for various surgical procedures which aim to reduce pain and restore function in the hand, wrist or forearm.

Mr Andreas Baumann, highly-regarded consultant hand and shoulder surgeon, offers an expert insight into hand surgery. He explains what exactly hand surgery involves, what are its potential complications and what is recovery like following surgery, among other important points.

When should hand surgery be considered?

Hand surgery is the last resort. Usually when I see patients in my clinic, they would have already seen the hand therapist or their GP, or used splints. So, when they come to see me, they usually are having very severe symptoms that affect their daily living and their activities. It impacts on their quality of life. If it's a condition that I know I can improve surgically, then this is the point where we discuss surgery. It is the last resort after several treatment options. 

What does it involve? How exactly is hand surgery performed?

Hand surgery is a very large topic, so I perform quite a wide range of operations. The majority of hand operations I do under local anaesthetic would include trigger finger surgery, surgery for carpal tunnel syndrome, but I do also fairly complex operations including Dupuytren's release or revision Dupuytren's release, which often involve general anaesthetic. 

The majority of hand operations will last anywhere between 20 minutes and two to three hours. Almost all of my patients will go home on the same day, even complex surgeries will be done as a day case procedure. Often with these operations, patients will have local anaesthetic or in a block for pain control, so usually for 6 to 8 hours there's no pain, and then there will be some pain from the surgery which can be managed with several painkillers. 

After the operation, patients will be seen by a hand therapist and often will have splints or dressings applied. For most of my operations stitches are used to close the wounds, which are then removed after about 10 days. 

What are the associated potential complications?

Fortunately, complications in hand surgery are rare. These operations are usually done in a bloodless field and I tend to use loupe magnification so I can expose all the nerves and blood vessels in the hand. 

Every operation does have potential complications, so there's a small risk of infection which I usually call as less than 1 per cent. There's a small risk of bleeding after surgery, but again it's extremely rare. For more complex operations such as Dupuytren's release there’s risk of damaging nerves and vessels. This will be discussed prior to each operation. 

How long does hand surgery normally take?

It depends very much on the actual operation, but the most common procedures that I do; carpal tunnel release and trigger finger release, these are done under local anaesthetic and are quick procedures. Usually they're less than 10 minutes (just the operating time) but some of the more complex operations like trapeziectomy and a ligament reconstruction, or Dupuytren's release can often take 90 minutes or more. For very complex operations that I do like revision surgery; these can take up to three hours. 

What is recovery time like, and what should I do and avoid doing after surgery?

Recovery very much depends on the actual operation. Usually for minor procedures such as carpal tunnel release, I would expect the recovery to last less than four weeks to get reasonable hand function back. 

It often takes a bit longer to get the grip strength back; for these procedures, my patients will be able to drive after approximately about four to six weeks after the operation. 

The complex procedures that involve extensive tissue release and some splintage, the recovery can take several weeks lasting anywhere from four to eight weeks. Again, it really depends on the operation and on the rehab programme. 

If you’re interested in booking a consultation with Mr Baumann, you can do so via his Top Doctors profile.