Hand & Wrist Surgery
There are many pathologies in the upper extremity, ranging from acute traumatic injuries (e.g. fractures and lacerations) to chronic conditions (e.g. Dupuytren's and osteoarthritis) that require a solid understanding of all the anatomical structures and how they interact. Below are common conditions that I manage.
1
These are very common injuries and can lead to significant functional impairment. There are different ways by which fractures can be fixed depending on the mechanism of injury, fracture pattern, time of injury, etc. After surgery, patients will work with my Hand Therapy team to regain strength and motion.
2
In the hand and wrist, painful joints can arise due to injury (e.g. ligament sprains, dislocations, or fractures involving the joint) or from chronic conditions like osteoarthritis, rheumatoid, and other inflammatory conditions.
3
Trigger fingers, DeQuervain's tenosynovitis, tendon lacerations or ruptures, and contractures are some common examples that can cause stiffness and decreased grip or strength. Tendon release, repair, or transfers are procedures that can help patients improve function.
4
From ganglions, mucous or retinacular cysts to giant cell tumours, hemangiomas, nerve tumours, or lipomas, there are many masses that can develop in the upper limb and affect form/function.
5
This is a genetic condition that can prevent patients from fully extending their fingers. Different treatment options for this include needle aponeurotomy, Xiaflex injections (not available in Canada), and surgery.
6
Traumatic Injuries & Infections
These conditions affect more than one type of tissue in the hand and can lead to profound stiffness. After the initial trauma and infection are clear, patients will work diligently with the hand therapy team on a regular basis to minimize the risk of stiffness.
Procedure Overview
Below are summaries of what you can anticipate before and after common procedures, including the type of anesthesia you may have, the anticipated post-operative course, when you can expect to return to work.
Please take your time to review ones that apply to you.
Hand Fractures
Anesthesia
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Local with sedation (fingers), or
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Regional block with sedation, or
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General
Duration of Surgery
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Simple fractures: 1 h
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Complex fractures: >2h
Wound Care
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If closed, pin care
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If open, after 5 days, wash with soap and water daily
Post-op Recovery Time
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If closed:
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2 weeks - repeat X-rays, transition to a thermoplastic splint​
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3-4 weeks - repeat X-rays +/- pin removal, start therapy
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If open:
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1-2 weeks - start therapy +/- protective splint​
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Bone typically heals by 3-4 weeks and regains strength by 6-8 weeks​
Scars
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If closed, pin site only
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If open, usually on the back or sides of the fingers or hand
Return to Work/Play
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This varies depending on the fracture pattern, mechanism of injury, and the type of work you do
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Usually 8-12 weeks after therapy starts
Base of thumb arthritis surgery
Anesthesia
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Regional block with sedation
Wound Care
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Denervation: remove bandage in 5 days, wash over steri-strips daily with soap and water
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Trapeziectomy: keep dressing dry until follow-up
Duration of Surgery
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Denervation: ~1 h
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Trapeziectomy, ligament reconstruction: ~2 h
Post-op Recovery Time
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If denervation, 4-6 weeks
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If trapeziectomy, 3-4 months​
Scars
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Linear scar over the back or side of the thumb
Return to Work/Play
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If denervation, 4-6 weeks
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If trapeziectomy, 3-4 months​
Tendon repair surgery
Anesthesia
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Regional block with sedation
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You may be "woken up" and asked to move your fingers during surgery
Wound Care
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Keep dressing dry until follow-up
Duration of Surgery
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1-2 hours depending on the operation
Post-op Recovery Time
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Typically, therapy starts 1 week post-op and a new splint is given​
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Tendons within 8-10 weeks
Scars
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If flexor tendon, incisions on the palm side of your hand
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If extensor tendon, incisions on the back side of your hand
Return to Work/Play
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Approximately 2-3 months
Trigger finger release
Anesthesia
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Local anesthesia only or
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Local anesthesia with sedation
Wound Care
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Keep dressing dry for 5 days then wash daily with soap and water
Duration of Surgery
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20-30 minutes
Post-op Recovery Time
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2 weeks - suture removal, continue gently ranging fingers
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3 weeks - scar massage
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4 weeks - resume heavy lifting, gripping, pushing, pulling
Scars
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Incisions on the palm side of your hand
Return to Work/Play
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No restrictions after 4 weeks
Hand mass excision
Anesthesia
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Local anesthesia only or
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Local anesthesia with sedation
Wound Care
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Keep dressing dry for 5 days then wash daily with soap and water
Duration of Surgery
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Varies depending on location, size and shape, as well as the type of the mass
Post-op Recovery Time
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2 weeks - suture removal, continue gently ranging fingers
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3 weeks - scar massage
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4 weeks - resume heavy lifting, gripping, pushing, pulling
Scars
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Incisions on the palm side of your hand
Return to Work/Play
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No restrictions after 4 weeks
Dupuytren's fasciectomy
Anesthesia
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Regional block with sedation
Wound Care
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Keep dressing dry until follow-up
Duration of Surgery
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Varies depending on how many fingers are involved
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Typically, 1-1.5 hours
Post-op Recovery Time
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1 week - start gently ranging fingers and nighttime splinting
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2 weeks - suture removal
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3 weeks - scar massage
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4 weeks - resume heavy lifting, gripping, pushing, pulling
Scars
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Incisions on the palm side of your hand
Return to Work/Play
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No restrictions after 4 weeks
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Typically, 2-3 months once therapy starts
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Night time splinting for 3-6 months