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Hand Surgery FAQs

    Hand Surgery Frequently Asked Questions

    Hand Surgery services are available at our Danbury office.

    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.

    Dupuytren’s disease is usually painless. The early signs of the disease include knuckle pads and palmar nodules. As the proliferation progresses it leads to joint contractures. The fingers most commonly affected are the ring and small fingers. The joints most commonly affected are the metacarpophalangeal and the interphalangeal joints. Prolonged joint contractures will lead to contractures of the skin, tendons, and ligaments around the affected joints.
    Dupuytren’s disease (or “Dupuytren’s Contractures”) is characterized by the development of new tissues in the hand usually in the form of nodules or thick cords on the palm and fingers. Dupuytren’s disease occurs mainly in Caucasians with a high incidence in Anglo-Saxon populations. A strong family history may be present. Males are more commonly affected. Although Dupuytren’s disease has been linked with many other disorders a simple cause and effect relationship has never been demonstrated. It remains essentially an idiopathic disorder.
    Certainly. Call our Hand Surgery center at (203) 830-4700. If you need a referral for insurance purposes we can help.
    There is no single test that confirms the presence of Carpal Tunnel Syndrome. A good history in addition to several clinical tests can be helpful. In addition, nerve conduction studies can be performed if the diagnosis is not clear based on examination.
    Patients with Carpal Tunnel Syndrome present with a wide variety of symptoms. The most common complaint is that of numbness and tingling in the hand localized to the thumb, index, middle, and half of the ring finger. These symptoms are often worse at night and may awaken patients. Symptoms may also occur while driving. Later on in the disease patients will complain of weakness or clumsiness of the hand, especially when grasping small objects. The numbness and tingling can even spread into the forearm or upper arm area. In the final stages of the disease, patients may start dropping things and may note wasting of the muscles at the base of the thumb.
    The causes of carpal tunnel syndrome are varied. Compression has been linked to many factors, including trauma, tumors, Diabetes Mellitus, and pregnancy. The actual cause of the disease in many patients cannot be found; however, the treatment is the same.
    One of the most common hand problems we see is Carpal Tunnel Syndrome (CTS). This term refers to a set of symptoms caused by compression of the median nerve as it crosses the wrist. The carpal tunnel is a space at the wrist through which travel nine tendons and the median nerve. This nerve carries sensation from the thumb, index, middle, and half of the ring finger. It also carries motor impulses to the muscles at the base of the thumb. Our doctors and our audiologists take the time necessary to perform a thorough, objective evaluation and make recommendations based strictly on your individual needs. Because we believe strongly in patient education, we explain the benefits and use of each type of hearing aid technology, so together we are able to make the right choice the first time. We also know your hearing aids need to be the right shape, the right size, and the right fit to be successful.
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