Hand Surgery Frequently Asked Questions
The term arthritis describes a condition characterized by degeneration of the cartilage around one or more joints. It can be caused by systemic illnesses, such as rheumatoid arthritis or gout. Osteoarthritis refers to the degeneration of cartilage around a joint which is not linked to a systemic illness. This is usually secondary to previous injury, infection, or just use of the joint over time.
At Advanced Hand Surgery we treat osteoarthritis in the joints of the hand: The prevalence of osteoarthritis of the hand increases with age. It is more common in men than women until women reach menopause. The most commonly affected joints are those in the fingers and the base of the thumb.
One does not have to suffer from the pain of osteoarthritis in the hand. There are a variety of successful surgical and nonsurgical modalities which can bring relief to patients suffering from this common disorder.
Following injury, changes occur to a nerve both proximal and distal to the area. Distal to the injury, the nerve undergoes degeneration. Damaged parts of the nerve begin to sprout and travel distally to try to repair the nerve.
The development of modern microsurgical techniques along with better understanding of nerve injury and regeneration has resulted in improvements in nerve repair following injury. There are three main nerves which provide motor control and sensation to the hand and forearm: Median, Ulnar, and Radial.
Several treatments are available for Dupuytren’s disease. However, surgery may not be indicated immediately upon making the diagnosis. Isolated nodules or knuckle pads may be followed if they do not interfere with hand function.
There are currently two non-surgical treatments for Dupuytren’s Disease: needle aponeurotomy and collagenase injection (Xiaflex).
Needle aponeurotomy-this is an office procedure where a needle is used to make multiple passes through the abnormal tissue in the palm to weaken it. Then, the Dupuytren’s cord can be ruptured. This procedure does not remove the diseased tissue but can be repeated if needed. It is most appropriate for patients with a small area of disease or those who cannot undergo surgery.
Collagenase injection (Xiaflex)-this is a procedure where and enzyme is injected into the diseased tissue. The enzyme breaks up the collagen in the cord, allowing finger extension after 24 hours. The risks of this procedure include bruising, numbness, and allergic reaction. Some patients require more than one injection for complete release. The enzyme is often covered by insurance.
The recurrence rate for both needle aponeurotomy and collagenase injection may be higher than surgery, as the diseased tissue is not removed.
Surgery is indicated when there is loss of function or progression of the disease. The functional disability usually results from flexion contractures of any or all of the three digital joints, especially the proximal interphalangeal. Patients with mainly cosmetic concerns are discouraged from having surgery.