Hand Surgery FAQs

General FAQs
  • Q1 :

    Do all hand problems require surgery?

  • No, most hand problems are treated with nonoperative means. A minority of these difficulties actually require surgical intervention.
  • Q2 :

    Do stitches have to be removed in the office and is it painful?

  • No. For young children we use absorbable stitches that do not have to be removed.
  • Q3 :

    If surgery is required, when is the appropriate time?

  • Most hand surgeries are not done during the newborn period. We most often wait until the child is 12 to 18 months old, at the youngest.
  • Q4 :

    Ligaments and Tendons in Rheumatoid Arthritis - Can surgery alleviate the pain associated with damage to ligaments and tendons in the wrist and hands as a result of rheumatoid arthritis?

  • The hand pain in rheumatoid arthritis (RA) may originate from a large variety of causes, chief amongst them are the inflammation of the synovial membranes. Synovium is specialised tissue that allows gliding to occur and  secretes the lubricant and nutrient synovial fluid essential to normal joint function and the function of some tendons. In rheumatoid arthritis this tissue becomes inflamed and instead contributes to the destruction of the joint and its adjacent ligaments (which are the stays that effectively constrain the joint and render it stable but mobile). As the joints and ligaments decay, so they may become unstable and deviate or adopt abnormal attitudes or positions, putting increased strain on the remaining ligaments. Such inflamed and swollen joints are painful in their own right, and some pain may arise from the joint surfaces or from the capsule that surrounds the joint including the ligaments that bear abnormal strains.

    Surgery in this condition has several aims. Some doctors believe that in particular circumstances there is a place for “prophylactic” or preventative surgery in which the destructive diseased synovium is removed to prevent its adverse effect on adjacent tissues. Further, some feel that when the joints begin to deviate, corrective surgery to the ligaments and soft tissues (as opposed to bone) may allow realignment of the joint surfaces and prevent the erosion of those surfaces that comes from chronic malalignment. This surgery is particularly appropriate for the metacarpophalangeal joints (at the junction between fingers and palm) which commonly deviate away from the thumb side of the hand, sometimes well before the joints themselves require replacement.

    It should however be borne in mind that other causes of pain occur in rheumatoid arthritis in the hand, and important amongst these are nerve compression pains from swelling of adjacent joints or tendons, and subsequent compression of the nearby nerves. A good example of this is rheumatoid arthritis associated carpal tunnel syndrome. Any one suffering from rheumatoid arthritis with any new type of hand pain should be evaluated by a hand specialist or rheumatologist where possible, and regular checks by a rheumatologist or hand surgeon are sensible; in this condition. The individual indications for surgery for pain may then be discussed in detail.
  • Q5 :

    Missing Digits - What causes this and is there anything that can be done?

  • There are numerous causes of this problem.

    It is that this is very unlikely to represent a disability and very unlikely to influence whether the child has a happy and fulfilled life or not.
  • Q6 :

    Replacement finger joints MCP/PIP - After surgery when can full function be expected. What are my new joints made of?

  •  The MCP (metacarpophalangeal) joints are the knuckle joints where the finger joins the palm. The PIP joints (proximal interphalangeal) are the middle joints of the fingers.

    MCP replacement with prostheses is most commonly undertaken for advanced rheumatoid arthritic change with deviation and loss of function at these joints. By far the commonest replacement joint is made from Silicone rubber. Because of its structure it does not accurately replicate the biomechanics of the joint it replaces, and so full function is never restored. In addition it is made of a friable material and for this reason it is subject to attritional wear. Most surgeons therefore use it almost exclusively in the low demand low load hands of rheumatoid patients where it can be very successful indeed.

    In addition the joint has no inherent lateral stability, which is not a problem in the MCP because the adjacent joints bolster it, but in the PIP it can pose problems resisting lateral stress.

    Many of us believe that the ideal range of motion after an MCP joint replacement is about 30 to 40 degrees, compared with 90 degrees in the unaffected hand.
  • Q7 :

    Supernumery digits - What exactly causes this abnormality and is it common?

  • This condition describes extra digits on the little finger side of the hand, or ulnar border.

    The digits are usually attached by a slight stalk, rather than truly articulating with the rest of the skeleton: hence the ease of removal.

    The condition can have a hereditary element.
  • Q8 :

    What are nonsurgical ways to treat hand problems?

  • There are several nonsurgical treatment methods including therapy, medicine, splinting, casting, gentle stretching, and observation.
  • Q9 :

    What causes congenital hand differences?

  • There are many factors that can affect the development of the human hand. Generally it is caused by a spontaneous alteration during development and is not from any outside factor or event of pregnancy.
  • Q10 :

    What is Dupuytrens Contracture and can anything be done about it?

  • This is a genetically predisposed disease of unknown etiology, but is common in those countries that received the "Viking diaspora": ie Scandinavia, Britain, and then the British colonies. It is almost unheard of in native africans for instance.

    The condition is simply a fibrous scar like affliction of the fascial layer of the palm. which is the layer that binds the skin of the palm or sole to the underlying skeleton. Without this layer the skin would skid about as it does on the back of the hand, preventing firm grasping. The first sign of the affliction is a nodule, usually in the palm in line with the ring or little finger. This may persist for mnay years without progressing. Conversely it may develop bands running from the lump to the finger and palpable beneath or even within the skin. These bands then contract slowly and draw the finger inexorably toward the palm. they may proliferate into other adjacent digits, or appear in the opposite hand, or foot. Very occasionaly they can afflict the penis.

    There is no medical treatment, despite press hype to the contrary. Surgery is reserved for treatment of contractures and is NOT generally advisable for the isolated nodule, since the paradox of surgery is that it may hasten the development of the disease. Simple surgery is often effective, and further surgery may be necessary after some years if the disease progresses or appears elswhere. In sveere cases recurrence can be delayed or contained by careful use of skin grafts to eliminate involved skin areas in discrete zones of the hand.

    There are associations with the disease, but no serious systemic manifestations, and there is no predisposition ot malignancy of any sort.
  • Q11 :

    When should my child be seen for a hand problem?

  • The sooner the better, but there is no emergency. It is best for the child to be seen early so physicians can follow growth and progress.
  • Q12 :

    Will my child have a prolonged hospital stay after surgery?

  • No. Most hand surgeries are done as outpatient surgery and the child is allowed to go home the same day.