Wrist joint (hand) is one of the most complex in its anatomy as it combines several joint structures.
The main problems of wrist are as follows:
- Arthritis of the wrist and hand: osteoarthritis, rheumatoid arthritis, arthritis at the finger base
- Acute tendon injury, nerve and artery
- Hand deformation (congenital and acquired) traumatic consequences
- Dupuytren contracture
- Fracture of the wrist and hand (distal radius, scaphoid, metacarpals and phalanges)
- Carpal tunnel syndrome, ulnar nerve compression
- Spastic conditions (cerebral palsy, post stroke reaction)
- Sports injuries of the wrist and hand
- Stenosing tenosynovitis (Trigger Finger) and de Quervain tenosynovitis (wrist)
- Tumors and tumor-like lesions such as cyst ganglion
Leading experts in hand therapy and surgery in Israel:
Dr. Igo Goldberg – Senior surgeon surgery department of the arm and hand, Rehabilitation Center for hands treatment of, Israel.
Dr. Yishai Rosenblatt – Senior physician, Department of Orthopaedic Surgery of the Hand, Medical Center, Tel – Aviv (Ichilov), Head of Department of the Hand and elbow Surgery , Assuta Hospital.
Dr. Lior Paz – Deputy Director of the Department of Surgery of the wrist joint and hand. Beilinson Hospital. MC. them. Rabin.
Dr. Batya Yafe – specialist in plastic surgery arm and hand. Head of the Department of micro-surgery arm and hand in the Sheba Medical Center, Tel Hashomer.
Dr. Esther Rubinraut – Heading the hand wrist unit at the Jonathan Orthopedic Center, Assuta.
Hand treatment
After careful examination and consideration images, MRI or CT of hand, treatment will be determine.
In cases when damage is not significant medication or injection therapy may be recommended.
Types of hand surgery
Hand surgery incorporates different types of surgery on the hand.
Our Plastic surgeons who perform hand surgery attempt to restore the function of the hand, while maximizing the hand cosmetic appearance as well.
Here are few examples of our experience:
Closed reduction and fixation
This type of surgery attempts to realign the fractured bone and then immobilize the area during the healing phase. Immobilization can be done with internal fixtures, such as with metal wires and other implant systems. This type of surgery is used when hand is fractured (Including fingers).
Skin grafts
Skin grafts involve replacing skin to a part of the hand that has missing skin. Skin grafts are done by taking a piece of healthy skin from another area of the body, and attaching it to the injured area. Our Doctor will consult with you about the area from where the skin will be taken.
Skin flaps
Like a skin graft, a skin flap involves taking skin from another part of the body. But this procedure uses skin that has its own blood supply. That’s because the section of skin that is used includes blood vessels and muscles. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of extensive tissue damage.
Tendon repair
Tendons are the fibers that attach muscle to bone. Repair of tendons requires high surgical skill. Tendon injuries can occur due to trauma, infection, or rupture. Repair of a tendon may be classified as primary, delayed primary, or secondary.
Primary repair is usually completed within 24 hours of the injury. Primary repairs usually involve direct surgical correction of the injury.
Delayed primary repair is usually performed a few days after the injury, but while there is still an opening in the skin from the wound.
Secondary repairs may occur two to five weeks or longer after the injury. Secondary repairs may include tendon grafts (inserting tendons from other areas of the body in place of the damaged tendon) or other more complex procedures.
Nerve repairs
There are three main nerves that operate the hand:
- The ulnar nerve
- The median nerve
- The radial nerve
Damage to any of these nerves may result in inability to move the hand and experience feeling. Sometimes nerve injuries may heal without surgery, however in many cases surgery may be required. Overall, about three to six weeks after the injury is the best time for nerve, to increase the likelihood of a full recovery. If severed, the nerve may be repaired by reattaching it directly to the other end of the nerve, or by using a nerve graft (inserting nerves from other areas of the body in place of the damaged nerve) to repair the damaged section.
Surgical drainage and wound cleansing
Infections of the hand are a common reason for treatment. The treatment for infections to the hand may include rest, use of heat, elevation, antibiotics, and surgery. Surgical drainage may be used if there is an abscess in the hand to help remove the collection of pus. Cleansing of a wound to prevent further infection and to help promote healing, may be used if the infection or wound is severe.
Fasciotomy
This procedure is done to help treat compartment syndrome. This painful condition occurs when there is an increased pressure in a small space, or compartment, in the hand. Often this is caused by an injury. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.
For a fasciotomy, our doctor will make an incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.
Replantation
This type of surgery reattaches a body part, such as a finger or hand, which has been completely cut from the body. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is using a microscope. In some severe cases, more than 1 surgery may be needed. The goal is to restore maximum functionality.
Joint replacement
This type of surgery, also called arthroplasty, may be used in people with severe arthritis of the hand. This involves replacing a joint that has been destroyed by the disease process with an artificial joint. This artificial joint may be made out of metal, plastic, silicone rubber, or the patient’s own body tissue (such as a tendon).
What can you expect after the hand surgery
Surgery is usually just the start of recovery. Rehabilitation may be necessary to regain optimal functioning of the hand.
- Your hand may be immobilized in a bandage or a external support after surgery. Our doctor will decide the length of time of the immobilization. After some surgeries, the hand may be immobilized for months at nighttime to reach the best recovery.
- There may be some restrictions placed on activities and work after the surgery. This also will be determined by our physician, based on an individual basis. For example in the case of bone implant time is required for the bones to regain full strength in order to be able to carry external forces applied to the hand. (Like weight carry of holding)
- Rehabilitation may be recommended such as therapy to increase the strength and function of the hand. A professional therapy expert will be recommended in such cases. Therapy can start in Israel and continue at home based on the instructions received.
Therapy of the hand may include the following:
- Physical Exercises for the hand (with or without devices such as springs or balls)
- Massage therapy
- Heat therapy
- Strapping to fix the hand in a certain position
- Bandages to help control swelling
- Nerve stimulation
The most common operations
In case of severe joint damage or partial failure of its functions doctor may recommend a surgery or arthroscopic (minimally invasive) as follows:
CarpalTunnelRelease. This procedure used when the carpal tunnel syndrome in which the patient experiences pain and weakness in hand. That is caused by pressure on the median nerve at the wrist. Using the procedure surgeon makes an incision transverse carpal ligament to relieve pressure on the median nerve. Sometimes around the nerve removed some tissue. This surgery is done on an outpatient basis, with no hospitalization.
Wrist Ligaments Repair. This operation is used to break and damage to the ligaments of the wrist and can be done in several ways:
Percutaneous Pinning and Ligaments Repair. Performed when pain syndrome lasts for several weeks after the injury. In this case surgeon may set metal pins to fix the bone on the healing of ligaments. This procedure is called percutaneous fixation and performed through a puncture in the skin (without cutting) under X-ray control to render the process of fixing. Retainers are removed usually within four to six weeks after the procedure.
Wrist Ligament Replacement. If ligament damage found after six months or more after the initial trauma they must also be reconstructed. In this procedure the incision is made above the wrist joint and the localization of the damaged ligament. Instead ligament graft is installed, usually the borrowed palmar tendon of the same wrist. The tendon is removed from the bottom of the wrist through one or two small incisions. During this procedure metal pins are also used for bone fixation, they removed after six to eight weeks after surgery.
Compound (Fusion). This procedure is done in the case of ligament instability shortly after trauma or arthritic. This removes the surface of the cartilage between the bones and combine two or more bones of the wrist. Gradually bones are fused, thereby stabilizing the movement between them and reduces pain caused by friction between the articular surfaces, arthritic, before surgery.
