Hand & Wrist

1. SPORTS AND SPINE ORTHOPEDICS
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2. Overview
Pain in the basal joint caused by arthritis makes it difficult for
patients to grip and hold or twist objects between the thumb and
fingers. This surgical procedure removes and rebuilds the basal
joint.
1.Accessing the joint
An incision is created at the lower sectionof the thumb and the wrist
area where the basal joint is located.
2. Joint removed
The surgeon removes the diseased joint by cutting and clearing away
the lower portion of the thumb metacarpal and also removing the
trapezium bone at the base of the thumb.
3. Tendon reshaped
A section of tendon or graft is Taken from another part of patient’s
own wrist or arm and reshaped into a bundle that will fit into the
cleared joint
4.End of Procedure
The graft bundle is placed into the joint space. After the surgery site
heals, the bundle of the tendon graft will act as a cushion for the
new basal joint
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3. SPORTS AND SPINE ORTHOPEDICS
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Overview
This outpatient procedure relieves the symptoms of De Quervain's
tenosynovitis by releasing the tendon sheath that wraps around the
tendons at the base of the thumb. This relieves pressure and friction on
the tendons, allowing them to glide freely.
Preparation
The patient is positioned , anesthesia is administered ,and the hand and
wrist are cleansed and sterilized. The surgeon creates a small incision on
the wrist at the base of the thumb to access the inflamed tendons.
Opening the sheath
The surgeon carefully releases the inflamed sheath surrounding the
tendon, allowing it to spread open. In many cases, a second sheath is
found inside the first. It is released as well. The surgeon may also
remove any thickened tissue found between the tendons. Creating more
space for the tendons relieves painful pressure and eliminates the
friction that can occur as the hand is used.
End of procedure
The incision is closed, and a local anesthetic may be injected for post
surgical pain relief. The wrist is bandaged, and a splint may be applied.
The patient is given pain medication and is able to go home the same
day. Thumb motion is usually encouraged after surgery.

4. Overview
The outpatient procedure is used to remove a ganglion cyst, a fluid-filled
sac that forms as a herniation from a joint capsule , ligament or tendon
sheath. Ganglion cysts commonly develop at the wrist.
Preparation
The procedure is performed in the operating room under sterile
conditions. Anesthesia is administered, a tourniquet is applied, and the
hand is cleaned and sanitized. The patient is positioned with the back of
the hand clearly visible to the surgeon
Accessing the Wrist
A small incision is made on the wrist, just above the location of cyst. The
surgeon isolates the cyst from the surrounding tissues in the wrist and
locates the base of the cyst stalk, where the cyst is attached to the joint
capsule, ligament or tendon sheath
Removing the Cyst
The base of the ganglion stalk is cut at its origin. The cyst is removed and
the defect in the joint capsule, ligament or tendon sheath may be repaired
with sutures
End of Procedure
The incision is closed with sutures, and a bandage is applied. An injection
of local anesthesia is often given for pain relief. The wrist is placed in a
splint, and the patient may go home the same day.
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5. Overview
The procedure is performed to relieve pressure on the medium
nerve, alleviating the pain of carpel tunnel syndrome and restoring
normal sensation to the hand and fingers. The procedure is usually
performed on an outpatient bases.
Incision Made
The surgeon creates a small incision (typically about two inches long)
in the palm of the hand to expose the transverse carpel ligament.
Guide Inserted
A thin metal guide is inserted between the transverse carpal ligament
and the median nerve. The guide will protect the median nerve during
the surgery.
Ligament Cut
The surgeon carefully cuts the carpel ligament, creating more space in
the carpel tunnel. This relieves the pressure on the median nerve
End of Procedure
The incision is closed with sutures. A splint is applied to the wrist, and
the patient is allowed to go home. After a period of healing, hand
rehabilitation therapy is performed to help rebuild wrist strength.
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6. Overview
During this minimally-invasive procedure, the surgeon opens a
narrow tendon pulley at the base of a finger or thumb affected
by trigger digit. Opening the pulley prevents the nodule from
catching, allowing the affected digit to flex and extend normally
with no triggering or pain
Preparation
The patient is positioned so that the palm of the hand is clearly
visible to the surgeon. Local or general anesthesia is
administered and the area is cleansed and sterilized
Accessing the Hand
After the hand is prepared, a tourniquet is applied. A small
incision is made in the palm of the hand over the pulley to be
released. The skin and soft tissue are spread to expose the
tendon and pulley. The nerves are protected.
Releasing the Pulley
The surgeon uses surgical scissors or a scalpel to carefully divide
the pulley, releasing the constriction on the tendon. The cutting
of this pulley will not negatively affect finger function.
End of Procedure
The incision is closed with sutures. The patient is given pain
medication and is able to go home the same day. Finger motion
is encouraged after the surgery. Hand therapy may also be
recommended.
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7. Overview
This minimally invasive outpatient procedure allows the surgeon to evaluate and treat injuries
and disorders of the ligaments, cartilage,and bones of the wrist. The surgeon uses a small
camera, called an arthroscope, and tiny instruments which are inserted through small incisions in
the wrist.
Preparation:
The patient lays flat with the arm secured to an arm table and the wrist suspended vertically with
traction .The arm is cleansed and sterilized, and a tourniquet is applied. General anesthesia is
usually administered. A regional nerve block may be used insead to numb the arm, and a
sedative provided to relax the patient.
Accessing the wrist:
The surgeon uses a needle to inject fluid into the joint. Several small incisions are made on top of
the wrist near the joint. An arthroscopic camera and a probe are then inserted. The camera
eliminates the need for a large incision, as it allows the surgeon to view inside the joint on a
monitor.
Repairing the joint:
Once the wrist has been diagnosed, the physician may use one or more of the arthroscopic
instruments to treat any damage. Damaged cartiliage may be removed, ligament tears may be
repaired or debrided, and bone may be shortened. Severe damage may require more extensive
surgery with an open incision.
End of procedure:
The incisions are closed with sutures or surgical tape. Local anesthetic is administered to the
wrist for pain relief. The wrist is then bandaged and usually splinted to immobilize the joint. The
patient will be given pain relievers and is allowed to go home the same day.
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