Handy to know: All about hand surgery

Surgery for various common and complex hand conditions such as carpal tunnel syndrome, Dupuytren's contracture and ligament reconstruction, can address severe symptoms that patients can experience.  

Here to provide a detailed look at how effective hand surgery can be, when surgery is suitable and what’s involved in hand operations, is leading consultant hand and shoulder surgeon, Mr Andreas Baumann.

When should hand surgery be considered?

Hand surgery is the last resort. Usually when I see patients in my clinic, I would have already seen a hand therapist or a GP, or someone that would have used splints to treat them. When they come to see me, they're usually having very severe symptoms that affect their daily living, impacts their quality of life, and 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 for hand conditions.

What does it involve and how exactly is hand surgery performed?

I do quite a wide range of hand operations. The majority of them I do under local anaesthetic. This includes trigger finger surgery and carpal tunnel syndrome surgery, but I also do fairly complex operations including Dupuytren's release or revision Dupuytren's release which often then involves a 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 the ones with complex surgeries will be done as a day case procedure. Often with these operations, patients will have local anaesthetic or a block for pain control, so usually the first six to eight hours is no pain and following this, there will be some pain from surgery which can be managed with simple 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, the stitches used to close the wounds will be removed in about 10 days. 

What are the associated potential complications of hand surgery?

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 of the blood vessels in the hand. 

Every operation does have a potential complication, so there's a small risk of infection which I usually call as less than one per cent. There's a small risk of bleeding after this surgery, but again it's extremely rare, and for more complex operations such as Dupuytren's release there's a 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. For the most common procedures that I do, carpal tunnel release and trigger finger release are done under local anaesthetic, and they are quick procedures usually less than 10 minutes - just the operating time. 

Some of the more complex operations like trapeziectomy (removal of the small bone at the base of the thumb), ligament reconstruction, or Dupuytren's Release, can often take 90 minutes or more. Very complex operations that I do, like revision surgery, can take up to three hours.

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

Again, recovery time 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, and for these procedures my patients will be able to drive after approximately four to six weeks after the operation. 

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

If you’re in Greater Manchester and want expert treatment for a hand condition that may require surgery, arrange a consultation with Mr Andreas Baumann today.