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Hand Surgery

As one of Surrey’s leading private hospitals, we provide the very best surgical care for hand conditions. We offer rapid access to appointments with our expert hand surgeon, extensive modern facilities to allow accurate diagnosis, a day unit suitable for minor operations and a fully equipped ultra clean air theatre that’s particularly appropriate for orthopaedic procedures.

Common procedures we perform include: carpal tunnel release, cubital tunnel surgery, trapeziectomy, finger joint replacement surgery, Dupuytren’s contracture surgery, ganglion excision and fracture surgery.

North Downs Hospital offers rapid access to a specialist’s opinion and tests for wrist pain. The following Consultants specialise in hand surgery at North Downs Hospital

Mr Harley

Mr Shafighian

Mr Teo

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is caused by a trapped nerve in the wrist. This important nerve, called the median nerve, controls sensation and movement in your hands. If the median nerve becomes trapped, you may have painful, sore, heavy and tingly hands that can cause clumsiness. Often these symptoms are worse at night or when you’re at work.

In many instances it’s not known why the median nerve becomes compressed although it’s sometimes related to pregnancy, thyroid problems, diabetes or rheumatoid arthritis. It can affect adults of all ages yet presents more commonly in women than men.

Non-surgical treatments include the use of splints or steroid injections and may be appropriate for mild carpal tunnel syndrome.  If these don’t relieve your symptoms or if there’s a risk of permanent nerve damage, then your hand surgeon will recommend surgery.

Carpal tunnel release surgery, or carpal tunnel decompression is performed under local anaesthetic as a day case procedure and takes less than half an hour. During surgery your hand surgeon will cut the roof of the carpal tunnel, known as the carpal ligament, to reduce pressure on the median nerve in the wrist. It often resolves symptoms within a few days. Light work, gentle activities and driving can be resumed within a week of surgery.

Cubital tunnel syndrome

Cubital tunnel syndrome, also known as ulnar nerve entrapment, arises due to the trapping of the ulna nerve at the elbow.

Numbness and a tingly feeling in the ring and little fingers is an early sign of cubital tunnel syndrome. The numbness may develop into pain and you may feel a weakness in your hand. These symptoms are often felt when your elbows are bent for long periods or when leaning on your elbow. If your symptoms are constant, surgical release may be needed to prevent permanent nerve damage.

When making a diagnosis a nerve conduction test is required. It measures the speed of the impulses traveling along your nerve. Impulses are slowed when the nerve is compressed.

Sometimes carpal tunnel and cubital tunnel syndrome occur together.

Cubital tunnel surgery is carried out under general anaesthetic as a day case procedure and takes approximately one hour. The aim of surgery is to release the pressure on the ulnar nerve where it passes through the cubital tunnel. This is performed by cutting the tissue that forms the roof of the cubital tunnel. Within a week after surgery you’ll be able to drive and perform light work and activities. Sometimes nerve recovery can be slow or incomplete.

Thumb Arthritis

Thumb arthritis is caused by osteoarthritis (wear and tear). The trapezium is a small bone in your wrist at the base of your thumb which is commonly affected by arthritis.

If you have thumb arthritis, you’ll feel pain where your thumb joins your wrist when performing activities and while resting. It can first become apparent following a knock or a sprain. It tends to affect women over 50 years of age but many men also develop thumb arthritis too.

Thumb arthritis is simply diagnosed by way of an x-ray and a hand specialist’s opinion.

Steroid injections may initially treat thumb arthritis.

For long term pain relief, your hand surgeon will advise surgery, called trapeziectomy. This is a day case procedure performed under general anaesthetic that takes approximately one hour. It involves the removal of the trapezium bone. Trapeziectomy is at least 90% effective in providing pain relief and patients typically have good strength, mobility and function after surgery. Light work, activities and driving are normally possible within four weeks following surgery.

Joint replacements in fingers

Arthritis, both osteoarthritis and rheumatoid arthritis, can affect any joints in the fingers and cause pain, stiffness and swelling in the joint.

Diagnosis is achieved using x-ray and a hand specialist’s opinion. These painful joints can be treated by joint replacement, a day case operation, often performed under local anaesthetic. Surgery usually takes approximately 45 minutes for each joint and several joints can be replaced during one procedure. Joint replacement surgery is at least 90% effective in providing long term pain relief. Normally you can drive again and perform light work duties and activities within four weeks of the surgery.

Alternative treatments for arthritic joints include steroid injections and surgical joint fusion.

Dupuytren’s contracture

Dupuytren’s contracture is a thickening and tightness of the skin in your palm and fingers. It generally progresses with worsening tightness and can result in your fingers becoming bent and unable to be fully straightened. It’s a harmless disease and isn’t usually painful apart from at first.

A hand specialist will diagnose this condition and no tests required to make the diagnosis.

There are various surgical treatments available and your hand surgeon will advise the most appropriate surgery depending on the severity of your disease. The best results of surgery are achieved if performed when your fingers are bent between 30 to 45 degrees. Dupuytren’s contracture surgery is performed as a day case procedure, normally under local anaesthetic, even for more complex cases. Light work, activities and driving are usually possible within one to three weeks following the operation, depending on the severity of the contracture and complexity of surgery.

Ganglions

Ganglions are cysts filled with a sticky gel. They can grow in adults of all ages in several of the joints in the hand and wrist, especially the back of the wrist or at the finger tips. They can empty or fill spontaneously and may disappear without treatment or remain long term. Ganglions can be painful and unsightly but they’re harmless.

Surgical removal is the most reliable treatment for ganglions which persist. It’s an outpatient procedure, normally performed under local anaesthetic, that removes the cyst and a small part of the involved joint capsule. Light work, activities and driving are usually possible within a week after surgery. Ganglions may return in the future.

Breaks and fractures of hand bones

Breaks and fractures of hand bones are common injuries. They cause pain, swelling, stiffness and a decreased use of the injured part. Medical evaluation and x-rays are usually needed to diagnose the fracture and determine the best treatment. Specialist treatment is performed by a hand surgeon and hand therapist.

The best window of opportunity for treating a fracture is within one week of the break and after two weeks it becomes more difficult. 80% of hand bone breaks and fractures can be treated without surgery when a splint or cast may be used.

If surgery is required for your fracture your hand surgeon will set the bone and hold it together using complex miniature plates, screws, pins and wires. Usually bones take three weeks to set and three months to become fully strong. You will be advised to gradually return to activities during this time several hand therapy sessions are essential part of your post operative recovery.

Points to note

Health insurance companies will usually cover fracture treatment and this may be more convenient than a local NHS fracture clinic.

If you’ve had an initial diagnosis elsewhere then please bring copies of x-rays (CD Rom / picture on phone) so that we don’t need to repeat these.

Wrist pain

Wrist pain is an extremely common complaint, and there are many common causes of this problem, relating to bones, tendons, ligaments and nerves in the wrist. The pain may be spontaneous or it may be caused by a recent or old injury.

It’s vital to get an accurate diagnosis of the cause of your symptoms by a specialist hand surgeon so that appropriate treatment can be directed at the cause. Often complex investigations are necessary including: x-ray, CT scan, MRI scan, ultrasound, keyhole camera ‘arthroscopy’ and nerve conduction tests. Unfortunately, sometimes the cause of wrist pain is not identifiable despite modern medical testing and expertise.