The Division Plastic and Reconstructive Surgery at the University of Nebraska Medical Center is committed to the care and treatment of patients suffering from conditions affecting the hands. Some of the more common conditions treated are described below.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition characterized pain and tingling in the fingers and wrist and sometimes extending into the arm. The tingling most often affects the thumb, index, middle and half of the ring finger. Patients with carpal tunnel syndrome often awake in the middle of the night with these complaints. In severe cases patients will complain of weakness of grip and clumsiness of the fingers. The cause of carpal tunnel syndrome is compression of the median nerve as it passes through the wrist. Often pregnancy will bring it on or make symptoms worst. Medical conditions such as hypothyroidism, kidney disease, and diabetes are associated with carpal tunnel syndrome.
Nerve conduction studies can be performed to confirm the diagnosis. Treatment initially involves splinting and modification of work or recreational activity. Steroids are sometimes injected as well. If conservative treatment has failed then surgical release of the carpal tunnel is indicated, and involves releasing the transverse metacarpal ligament in the wrist which relieves the pressure.
Dupuytren's disease is a condition of abnormal thickening of the fascia and skin of the palm and fingers that causes the fingers to bend into the palm so that they cannot be fully extended. The condition can become so severe that patients are unable to place their hands into their pockets, put on gloves or participate in activities involving use of the affected hand. Pits, nodules and involvement of the knuckles can also occur. The cause of Dupuytren's disease is not known but seems to be more common in people of Scandinavian background.
Treatment. Mild case may require no treatment at all. For more significant conditions surgical removal of the thickened fascia and cords is appropriate. Despite surgical intervention sometimes the fingers continue to bend somewhat into the palm.
Trigger finger also known as stenosing tenosynovitis is characterized by locking or triggering of the finger as it is flexed and extended. Patients often complain of discomfort involving the knuckles at the palm and finger. The condition is due to disproportion between the tendon and the pulley that it glides through. The swollen tendon must squeeze through the pulley/flexor tendon sheath and causes the symptoms.
Treatment involves wearing splints and taking anti-inflammatory medications, and sometimes steroid injections. In cases that are severe or have failed conservative treatment, surgical release of the pulley is indicated. The procedure is relatively simple and is performed on an outpatient basis.
Ganglion cysts are probably the most common lumps that occur in the hand. They are firm mucous filled sacs that communicate with an underlying joint or tendon and can be found in the wrist, on top of the hand or the fingers. X-rays are often obtained to evaluate possible underlying problems with the joints.
If the cysts cause significant pain or interference with activity or are cosmetically displeasing they can be removed by aspirating the fluid with a needle and injecting steroids. If these treatments fail then the cysts can be surgically removed.
Other common hand problems treated at the Plastic and Reconstructive Surgery Hand Center at the University of Nebraska Medical Center include traumatic injuries such as fractures of the hands and fingers, tendon injuries and arthritis involving the fingers and hand.
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