Hand Surgery

Hand surgery procedures can help change a person’s life by restoring the function of their hand through treating a disease or injury that has left them impaired. These procedures are highly specialized and used to treat carpal tunnel, arthritis, dupuytren’s disease and other abnormalities in the hand. If your hand is impaired in any way and inhibiting you from doing the things that you love, contact Dr. Tahernia’s Beverly Hills office at 310-614-9701 to set up a consultation and see if hand surgery is right for you.

Hand Procedures

Hand Procedures

Carpal Tunnel

When pressure is placed on the median nerve that leads to your hands and fingers, carpal tunnel syndrome can be the result. The narrow passageway on the underside of your forearm that protects this median nerve is called the carpal tunnel. When pressure is placed on the median nerve, a dull to severe pain main be caused in the wrist and forearm region. Symptoms can also include Tingling in the fingers, a weakness of the hand and numbness.

How To Diagnose Carpal Tunnel Syndrome?

Dr. Tahernia will first begin the appointment with a thorough physical examination and review the symptoms that you are showing. He will perform tests to check the feeling in your fingers as well as the strength that your hand has. To check the severity of the pain, Dr. Tahernia may apply pressure to the median nerve by bending the wrist or directly pressing on the nerve. This can cause one or more of your fingers to begin to tingle.

Dr. Tahernia may need to order specific tests such as a nerve conduction study or a electromyogram to help further in his diagnosis of carpal tunnel. This will help him to find what the severity of the problem is and if carpal tunnel syndrome is indeed the root of the pain. A nerve conduction study helps to measure the strength of the contractions in the muscles. This is done by sending a small electrical impulse to stimulate nerves. Dr. Tahernia can then see if the impulses are slowed by the carpal tunnel. The other test that may be used is called electromyogram which measures the electrical activity in muscles. This test will show if there is any in depth muscle damage.

Carpal Tunnel Syndrome Treatments:

The best treatment for carpal tunnel can vary from person to person depending on the severity of the condition, previous treatments that may have been used, the overall health of the patient and the preference the patient has. Potential treatments may include:

Non-Steroid Anti-Inflammatory Drugs - Medications such as aspirin may be able to be used to alleviate pain and act as a viable temporary solution.

Brace or Splint - If the severity of your carpel tunnel syndrome is moderate, a brace or splint may be able to give you enough support to minimize the pressure that is being placed on the median nerve. Some patients have had symptoms disappear with the use of a splint alone.

Corticosteroid Injections - To relieve pain symptoms a corticosteroid such as cortisone may be injected to the affected area.

Carpal Tunnel Release Surgery - When all other treatment options have not sufficed in treating the pain, surgery may be the next best option. Dr. Tahernia will discuss the different surgical options that you have for carpal tunnel release surgery. During carpal tunnel release surgery, Dr. Tahernia will make cuts at the tissue that holds the joints together to help in relieving the pressure on the median nerve.

The surgery can be performed either endoscopically or open. During an endoscopic surgery, only one or two incisions are needed in the hand or wrist. ZA camera is then used to navigate around the carpel tunnel. With open surgery, an incision is made in the palm over the carpel tunnel and a cut is made to the carpel tunnel ligament.

 

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Dupuytren’s Disease

Dupuytren’s disease can be a debilitating condition that restricts you from being able to use one or more of your fingers. It can also alter the way that your hand looks. This disease causes the tissues underneath the skin on your palm to become shorter and thickened and therefore, pull your fingers inward in a bent position. It may be the case that the person is unable to straighten their fingers at all. As the disease progresses it slowly gets worse, but will rarely cause pain. Typically, those most often affected are people in their 50’s or older.

Symptoms Of Dupuytren’s Disease:

The beginning signs of this condition start with a lump on the palm of the hand where your ring finger and pinkie finger meet. As the condition progresses, the development of a fibrous cord may begin in the palm of the hand. As this cord further develops, it may begin to pull your fingers inward towards the palm. When the fingers begin to pull inward, this is referred to as Dupuytren’s Contracture. The condition may cause it to be difficult or impossible to bend back your fingers or to press your hand flat on a table. Daily activities such as picking up things may become difficult.

What Causes Dupuytren’s Disease?

Unfortunately, the cause of this condition is unknown. It has been considered that the disease may be inherited as it has seen to be consistent in families. Dupuytren’s disease may also be an affect of diabetes, smoking or alcoholism.

How Do You Diagnose Dupuytren’s Disease?

When you visit with Dr. Tahernia, he will check for changes in the skin on the palm to see if there are knots. He will also ask you to move your fingers, hand and wrist so he can see if there are noticeable restrictions. Dr. Tahernia will also want to know about your family history and if you smoke or use alcohol.

Dupuytren’s Disease Treatments:

The main goal of treating this condition is to restore the functionality of the hand. In the beginning stages of the disease a splint or finger stretchers may be used. In some cases, doctors use a treatment called needle aponeurotomy. This helps to separate the tightness of the cords. There is also a medicine called collagenase which is injected into the hand to dissolve the tight tissue. In more severe cases, where all other conservative treatments have failed, surgery will be required. Especially in the case where the patient is unable to pick up things anymore because of the condition, surgery will be the best option.

Fractures

When a fracture occurs in the hand it can either happen in one of the smaller bones such as the fingers, or to one of the long bones such as the metacarpals. Fractures can be casued from a variety of activities especially in direct or contact sports. Fracture in the hands can also be caused by a crushing injury like that caused when shutting your hand in the door. No matter how minor it may seem, it is important to seek immediate medical attention in the case of a fracture.

Signs & Symptoms Of Hand Fractures:

Although some fractures are readily apparent, others can be hard to detect. You may think that you just hurt your hand very bad and simple ice and rest will hurt. However, it is important to look out for the fallowing symptoms in the case of a hand injury:

  • Tenderness of the affected area
  • Immediate Swelling
  • Deformity
  • Inability to move the fingers or hand
  • Finger is bent across other fingers
  • Depressed Knuckle (known as a boxer’s fracture)
  • Finger or Fingers have a shortened appearance.

Diagnosing A Fracture:

When diagnosing a fracture a physical examination of the hand is first performed to check the position of the fingers and is the fracture has affected the skin in anyway. The examination may include a range of motion tests and assessment of feeling in the fingers to asses if there is any nerve damage. An X-Ray of the hand however will be the true determining factor of the fracture.

Hand Fracture Treatments:

Depending on the severity of the fracture, Dr. Tahernia will determine the best method of treatment whether it be a nonsurgical or surgical treatment.

Nonsurgical Treatment -In less severe situations, the bones can be realigned to their original orientation without the use of surgery. A cast will be applied to mobilize the repositioned hand and hold everything in place. The case will most likely need to extend down to the elbow to ensure that the bones stay in a fixed place. Another X-Ray will be taken after the cast is put on to make sure that the bones remained in the correct position. The cast will need to be worn for at least 6-8 weeks, or until directed by the doctor.

Surgical Treatment - For more severe injuries, surgery will be required to stabilize and realign the bones. Usually fractures of this type will have broken through the skin or were caused by a crushin accident. With the use of wires, screws and plates, the surgeon will be able to hold the fractured pieces of bone together. After the bone has healed, the surgeon may remove the implants, or will leave them in place. The doctor will also need to see you regularly to ensure that the joint does not tighten during the healing process. The joints may be very stiff after being immobilized for such a long time, but with the help of physical therapy you will be able to restore its function.

Tendon Injuries

Tendon problems in the hands can occur because of a variety of reasons. For many, surgery may not be the best options to treat their tendon conditions either because of medical history, the extent of the severity, or simply patient preference. In this case, injections can commonly be used to treat tendon problems. Injections help to deliver a high concentration of medication to the affected area to minimize side effects.

Different injections such as cortisone and PRP injections are used depending on the type of condition.

Cortisone Injections – This injection is a strong anti-inflammatory medication. This injection is most commonly used to treat minor cases on tendentious, or for more chronic tendon problems.

PRP Injections – This injection type is of more recent development. It uses the patient’s own cells to stimulate healing in areas where chronic tendon damage have occurred.

Common Conditions Treated:

Most commonly, tendonitis and arthritis are treated with the use of steroid injections. Most of the tendons that are in the hand and wrist pass through sheathes that keep them properly moving. If the patient overuses the tendon or injuries it doing a specific activity, it will often times swell and make it hard to navigate through the sheath tunnel. This will lead to swelling and pain in the hand or wrist. With the use of a steroid injection, swelling and associated pain can quickly be reduced. In the case of temporary onset conditions like carpel tunnel during pregnancy, tendon injections can safely be used to restore the body to a pain free state.

Tendon Injections For Arthritic Hands:

When the articular cartilage at the ends of the bones are reduced or completely lost, pain, stiffness and swelling will be caused by bone to bone contact. This is consistent amongst arthritic conditions. With the use of a steroid injection, the inflammation and pain will be greatly reduced and will allow for the patient to resume to their day to day activities. Even though the effect of the injection can be temporary, the benefits can last for many months in some cases.

Trigger Finger

Trigger finger, medically referred to as stenosing tenosynovitis, occurs in either the fingers or thumb and causes for them to get stuck in a bent position and pop when straightened, somewhat like a trigger being released. Hence the name trigger finger. This condition can often times be painful and in severe cases can cause the fingers to lock up in a bent position.

Trigger finger is caused when the sheath that surrounds the affected fingers tendon is narrowed. This condition is most commonly found in people that have jobs or hobbies that involve constant gripping actions. It is also found to be more common in people that are diabetic and women.

How Do You Diagnose Trigger Finger?

When diagnosing trigger finger, there is no use of X-rays or lab tests. Dr. Tahernia will first do a physical examination of the hand and fingers and ask you about the level of pain you feel when your finger is in certain positions. It may be the case that the finger affected is swollen with a noticeable bump over the joint, or it is locked in a bent position. Depending on the severity of the trigger finger diagnosed, the best treatment will be chosen for you.

Treating Trigger Finger:

When treating trigger finger, the first thing to do is to limit the activities that aggravate your finger. Dr. Tahernia may use a splint to help restrict the joint movement during your path to recovery. If even after these efforts the trigger finger is still painful or locked in a bent position, anti-inflammatory medications may be prescribed, or a steroid injection may be necessary. After trying all the conservative measures with still no signs of improvement, Dr. Tahernia will recommend surgery to release the tendon sheath and restore the movement to the finger or thumb.

Trigger Finger Recovery:

Trigger finger recovery can vary from patient to patient and is also dependent on the type of treatment that was required. Most patients recover from the condition rather quickly through rest and limiting their daily activities that lead to the trigger finger. In more severe cases recovery can be 6-8 weeks. Anti-inflammatory medication and in some cases pain medications will be prescribed to help during your recovery.

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