Hand Procedures

Ganglion Cyst Removal

Ganglion cysts are benign lumps that are often found around the wrist and hand. These cysts can be removed surgically, drained or treated with steroid injections to bring down the inflammation and reduce pain.

RA Hand Surgery

RA is an autoimmune disease that occurs when the body engages in friendly fire against its own joints – including the finger joints. If finger involvement is severe, reconstructive surgery may be needed. There are many types of surgery that can help treat the problems associated with hand RA. Sometimes, carpal tunnel surgery can help because many people with RA also have carpal tunnel syndrome. Tendon release or tendon repair can treat abnormal bending of fingers, or repair or reattach tendons, respectively. Surgeons can also remove inflamed tissue (synovium) in the hand. This can decrease inflammation and pain, and can be done in tandem with other RA-related hand surgeries.

Just as people can have other arthritic joints like their knees and hips replaced, finger joints can be replaced. This can be done by replacing damaged joint surfaces in the fingers with plastic or metal-and-plastic implants, or by removing, then replacing the ends of the joint bones with metal and/or plastic components.

Trigger Finger Surgery

Trigger finger occurs when one of your fingers or your thumb catches and becomes stuck in a bent, lock and loaded-type position. It is caused by a widening of the sheath that surrounds the tendon in the trigger finger. This is usually the result of inflammation. In a healthy finger, the sheath keeps the synovial fluid around the tendon; lubricating it as it glides back and forth. The beginning of this sheath is called the A1 pulley. Surgery is often a last resort for trigger finger treatment, and reserved for cases that do not respond to rest, finger exercises, massage and/or medications. During trigger finger hand surgery, a small incision is made in the palm to release the pulley system and allow the finger to glide again. Schedule an appoinment with Dr. Dehghan today to discuss your options.

Dupuytren’s Contracture Surgery

Surgery for this condition is only indicated for people who experience significant disability. Surgery is not necessarily a permanent solution for Dupuytren’s contracture as it may recur in the same spot or in other places on your hand. There are, however, several surgeries to treat this condition based on the degree of contracture and your hand anatomy. Your surgeon may use a needle or a scalpel to sever the cords of tissue under the skin. These surgeries are called needle aponeurotomy or subcutaneous fasciotomy, respectively. Dr. Dehghan may remove as much of the diseased tissue as he can with a partial fasciectomy. Another option is to completely remove the tissue on the palm of the hand (complete fasciectomy). Sometimes, the surgeon will use skin from another part of your body to replace the excised skin. In these cases, this operation is known as a complete fasciectomy with a skin graft. Talk to Dr. Dehghan about what surgery, if any, is best for your Dupuytren’s contracture.

Cubital Tunnel Syndrome

What is Cubital Tunnel Syndrome?

Cubital tunnel syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow. There is a bump of bone on the inner portion of the elbow (medial epicondyle) under which the ulnar nerve passes. This site is commonly called the “funny bone” . At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure. When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers.

Signs and symptoms of Cubital Tunnel Syndrome

Cubital tunnel syndrome symptoms usually include pain, numbness, and/or tingling. The numbness or tingling most often occurs in the ring and little fingers. The symptoms are usually felt when there is pressure on the nerve, such as sitting with the elbow on an arm rest, or with repetitive elbow bending and straightening. Often symptoms will be felt when the elbow is held in a bent position for a period of time, such as when holding the phone, or while sleeping. Some patients may notice weakness while pinching, occasional clumsiness, and/or a tendency to drop things. In severe cases, sensation may be lost and the muscles in the hand may lose bulk and strength.

Diagnosis of Cubital Tunnel Syndrome

Dr. Dehghan will assess the pattern and distribution of your symptoms, and examine for muscle weakness, irritability of the nerve to tapping and/or bending of the elbow, and changes in sensation. Other medical conditions may need to be evaluated such as thyroid disease or diabetes. A test called electromyography (EMG) and/or nerve conduction study (NCS) may be done to confirm the diagnosis of cubital tunnel syndrome and stage its severity. This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.

Treatment of Cubital Tunnel Syndrome

Symptoms may sometimes be relieved without surgery, particularly if the EMG/NCS testing shows that the pressure on the nerve is minimal. Changing the patterns of elbow use may significantly reduce the pressure on the nerve. Avoiding putting your elbow on hard surfaces may help, or wearing an elbow pad over the ulnar nerve and “funny bone” may help. Keeping the elbow straight at night with a splint also may help. A session with a therapist to learn ways to avoid pressure on the nerve may be needed.

When symptoms are severe or do not improve, surgery may be needed to relieve the pressure on the nerve. Dr. Dehghan may recommend shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. The nerve may be placed under a layer of fat, under the muscle, or within the muscle. Or he might recommend trimming the bony bump (medial epicondyle). Following surgery, the recovery will depend on the type of surgery that was performed. Restrictions on lifting and/or elbow movement may be recommended. Therapy may be necessary. The numbness and tingling may improve quickly or slowly, and it may take several months for the strength in the hand and wrist to improve. Cubital tunnel symptoms may not completely resolve after surgery, especially in severe cases.

cubital tunnel diagram

Carpal Tunnel Hand Surgery

The carpal tunnel is a narrow passageway of ligament and bones at the base of the hand that comprises the median nerve and tendons. Possibly caused by repetitive forced movements of the hand and wrist, carpal tunnel syndrome occurs when the median nerve and the nine tendons that run along the carpal tunnel become inflamed. A corrective hand surgery can release the pressure on this nerve which allows for better blood supply and improved movement. Your surgeon may make an incision from the middle of your palm to your wrist. Some surgeons may opt for an alternate procedure known as endoscopic carpal tunnel release. During this minimally invasive hand surgery, he or she accesses the median nerve by inserting a tiny flexible tube with a light and lens (endoscope) through small incisions.