Procedures Offered at The Hand Clinic

Carpal Tunnel Decompression

The patient is normally awake for the procedure and this would be conducted in Day Surgery.

A small amount of local anaesthetic is injected into the palm and a tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The nerve is freed in the tunnel and wounds are closed.

The wound should be kept clean and dry for two weeks and protected with a soft bandage.

Early use of the fingers and hand are encouraged, but heavy manual labour should be avoided until the wound has fully healed and hand strength has returned.

Once the wound has healed, the scar should be massaged with E45/Nivea cream or similar.


Cubital Tunnel Decompression

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The nerve is freed in the tunnel and wounds are closed.

The wound should be kept clean and dry for two weeks and protected with a soft bandage.

Early use of the fingers and elbow are encouraged but heavy manual labour should be avoided until the wound has fully healed and hand strength has returned.

Once the wound has healed massage the scar with E45/Nivea cream or similar.


Trapeziectomy

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The arthritic trapezium bone is removed and a small sponge space filler is put in its place.

The thumb and wrist are then placed in a temporary cast for 1 week and the wound is checked, at which stage a full cast is applied for a further 3 weeks. Then the cast is removed and a removable thermoplastic splint is fashioned.

Patients are then referred to the Hand Therapist for range of motion and strengthening exercises.

Once the wound has healed massage the scar with E45/Nivea cream or similar.


Trigger Finger Release

The patient is normally awake for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The tunnel is released and the tendon allowed to glide freely.

The wound should be kept clean and dry for two weeks in a soft bandage.

Early use of the fingers and hand are encouraged but heavy manual labour should be avoided until the wound has fully healed and the hand strength has returned.

Once the wound has healed massage the scar with E45/Nivea cream or similar.


Dupuytren’s release

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The Dupuytren’s tissue is removed and the wounds are closed. Sometimes the palm wound is purposefully left open to prevent early finger contraction. If the skin quality is poor, some skin is removed and replaced with a graft from your forearm or arm. The surgeon will advise you if this is likely before the surgery.

The hand is then dressed, sometimes using plaster. The wound is inspected within one week and a lightweight thermoplastic splint is fashioned by the hand therapist. Hand therapy is begins once the wounds have settled down. The wound should be kept clean, dry and covered until healed.

Early use of the fingers and hand are encouraged but heavy manual labour should be avoided until the wound has fully healed and the hand strength has returned.

Once the wound has healed massage the scar with E45/Nivea cream or similar.


Percutaneous Fasciotomy for Dupuytren’s Disease

The patient is normally awake for the procedure and this would be conducted in Day Surgery.

A small amount of local anaesthetic is injected over the diseased tissue and a needle is introduced to separate the disease.

The finger is gently manipulated to a straight position and the hand and fingers are dressed until the wounds heal.

The wound is inspected within one week and a lightweight thermoplastic splint is fashioned by the hand therapist. Hand therapy is begun immediately and patients are encouraged to regain full activity as soon as one week post procedure.


Xiapex for Dupuytren’s disease

Xiapex is a chemical treatment for Dupuytren’s disease.

This procedure can be performed in the clinic room.

A small amount of Xiapex is placed in the diseased tissue via a needle. The hand is dressed and the patient must not attempt to straighten their fingers themselves.

After 24 hours, the finger is anaesthetised and gently manipulated into a straight position.

The wound is inspected within one week and a lightweight thermoplastic splint is fashioned by the hand therapist. Hand therapy begins immediately and patients are encouraged to regain full activity as soon as one week post procedure.


Scaphoid Fracture Surgery

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The scaphoid is inspected and a bone graft is taken from the wrist or pelvis. This is placed in the scaphoid bone and screwed into position, to help with stability and therefore healing.

The wrist is placed in a temporary cast for two weeks, at which point a full cast is applied for a further four weeks. The cast is then removed and a radiograph (x-ray) of the wrist is taken. Depending on healing, either a removable splint or further cast is applied.

Early use of the fingers and elbow are encouraged but heavy lifting should be avoided until the scaphoid has fully healed. It is critical that the patient does not smoke for this period, as this will reduce the chance of the scaphoid healing.


Wrist Fracture Surgery

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The wrist is assessed for severity of injury and either a plate or wires are used to stabilise the fracture.
The wrist is placed in a temporary cast for two weeks, at which stage either a removable splint or a full cast is applied for a further four weeks, (depending on the stability of the fixation) to allow movement.

Early use of the fingers and elbow are encouraged but heavy lifting should be avoided until the wrist has fully healed. If the cast is removed at two weeks immediate physiotherapy is begun.

If wires are used, these are commonly removed in the clinic rooms at 4-6 weeks and if a plate is used this will sometimes require removal.


Joint replacement

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The arthritic joint is removed and replaced by an artificial joint.

The hand and wrist is usually protected immediately by a cast but after wound check the joint is usually encouraged to move. At this stage the hand is protected in a thermoplastic splint supplied by the hand therapist. The therapist supervises regain in motion and strength of the joint.

Joint replacement is usually followed up with radiographs (x-ray) and clinical examination for up to a year and perhaps longer, depending on which joint is replaced.


Tennis and Golfer’s elbow surgery

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The tendon is explored and the damaged section is removed.

The wound should be kept clean and dry for two weeks in a soft bandage.

Early use of the fingers and elbow are encouraged but heavy manual labour should be avoided until the wound has fully healed and the hand strength has returned.

Once the wound has healed massage the scar with E45/Nivea cream or similar.


Wrist Arthroscopy

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The fingers are suspended on finger traction to create space for a camera to pass into the wrist joint through a small keyhole incision.

Wrist arthroscopy is not only diagnostic, as multiple procedures can be performed through the keyhole incisions.

The wound should be kept clean and dry for two weeks in a soft bandage.

Early use of the fingers and hand are encouraged but heavy manual labour should be avoided until the wound has fully healed and the hand strength has returned.

Once the wound has healed massage the scar with E45/Nivea cream or similar.


Microsurgery

A small percentage of people require microsurgery.

The patient can be awake or asleep (anaesthetised) for the procedure and this would be conducted in Day Surgery.

A tourniquet (band around the arm stopping bleeding) is applied for the surgery.

The microscope is used to magnify the damaged nerves or blood vessels and these can then be repaired with microsurgical stitches.

The hand is then immobilised in a splint or cast for two weeks to protect the microsurgical repair.


Soft tissue coverage in the hand

Sometimes, due to absent tissue or poor quality tissue in the fingers or hand, the skin has to be replaced.

The choices of graft vary depending on the position and function of the skin they are needed to replace.

Your surgeon will discuss the type of graft and how the defect will be covered. Usually, a protective compressive dressing is stitched in place to keep the graft from moving.

Once the graft looks healthy, hand therapy is begun to increase the range of motion and strength in the fingers and hand.