After Carpal Tunnel Surgery
It is good to move your fingers after surgery, this prevents adhesions within the carpal tunnel and stiffness later.
If your fingers are puffy, then you probably aren't using your fingers enough.
If the base of your palm is puffy and sore, you might be doing a bit too much.
Your bandage is designed to minimise bruising and bleeding, so it can be removed after 24 hours. Most dressings on the palm fall off in the tropics, because the sweat will lift most glues. You can apply any dressing that sticks to your skin. Waterproof dressings tend to hold the sweat in, and cause a moist wound. Water pervious dressings don't work well in the shower!
What doesn't work:
1. Steroid Injections
2. Shock wave therapy
4. Strapping or splinting
What does work:
1. Tenocyte injection (if MRI scan shows an 'enclosed' tear)
2. Surgical release - arthroscopic or open
Suave Kapandji Procedure
What a strange thing to do!
Break a bone here, and fuse another bone there!
Basically, the forearm / hand can't twist over if the two bones of the forearm are fused together.
So, two clever people came up with the same idea at similar times.
The idea is, you can fuse a distal radio-ulnar joint, as long as you break the ulna, and allow it to move part of the way up the forearm.
Unfortunately this part of the forearm can move around in ways which are uncomfortable for some people. However, most patients are happy with their choice of procedure and have normal hand / wrist rotation.
Rotator Cuff Repair FAQ
Clicking after surgery?
Sometimes the suture ends can be prominent for 6-8 weeks, which will make a slight click with movement.
What do Bone Anchors look like?
They are made of metal or bio-compatible plastic.
Biceps muscle wasting after tenotomy?
The wasting improves with activity, but it will always be deficient in the top half.
Do the stitches dissolve?
No, they are permanent.
Can I take Aspirin after my surgery?
Yes - but you will get more bruising if you take a blood thinner within 7-10 days of your surgery. You must take blood thinners if you have had significant cardiac or stroke events.
Does the tendon stick to the bone?
Yes - but your body provides the glue at a rate dependent on your general health and age.
How tight is the repair?
Very tight - it is under significant tension at the completion of your surgery, with your arm at 45 degrees away from your side.
1. Infection - smokers have 4 times more infections that non-smokers. The infection rate for shoulder arthroscopy is likely to be 0.3% or 3 per thousand procedures. Unfortunately if this occurs, further surgery is required and the repair will need to be re-done once the infection is controlled.
2. Re-tear occurs in 10 - 20%, but is usually associated with a fall
3. Pain after surgery - pain is a multi-factorial experience, and the body remembers pain for a long time after an injury has settled.
Most patients take pain relief for 1-2 weeks after surgery, but some patients can require pain relief for months.
4. Stiffness / frozen shoulder - there is always some stiffness after a SLAP repair, which can take 12 months to settle - particularly into external rotation.
5. Biceps tendinitis - some patients have pain associated with their biceps tendon as it passes over the front of the shoulder, after surgery. This can settle with time, but some patients request steroid injections to help them. Simple anti-inflammatories may be sufficient.
It's always hard to think of a fusion as a way of improving function, but it seems to be a good outcome for people with severe wrist arthritis.
What is a fusion? A fusion is a term used when a joint (which moves) is stiffened. This is basically achieved by removing all the cartilage and leaving the bare bones which stick to each other.
At the wrist, this can help with pain, as a painful wrist has very limited movement, anyway. The shoulder and elbow have to do more work, but they can cope.
The wrist is fused with a plate (a thin piece of metal which reaches from the back of the hand to the forearm bone (radius)), which is then screwed into place.
The bone itself then has to knit, which takes a variable amount of time. This is significantly slower if you smoke. Most patients like a fibreglass cast for 6 weeks, and then may use a splint for another 6 weeks.
At this point, there is better movement of the fingers, and the arm becomes more functional.
If the plate is uncomfortable, it can be removed at a later date.
Strangely, despite many excellent design elements, there seem to be a few significant flaws in the human body.
The one the troubles me the most at my age, is that at 40, there seems to be a use-by-date on a number of structures. The most obvious is the lack of eggs for reproduction, but this awful affliction also affects the musculoskeletal (bone and joint) system.
The tendons which flex the fingers are secured to the bone by a number of bridges which are known as pulleys. Unfortunately with age, and diabetes, these tendons swell. They then rub on the bridges and form a perfect storm of inflammation. Eventually the tendon is so swollen that the patient can pull them through the bridge but without using the other hand, they can't straighten them. With the application of force, they 'pop' back - sometimes accompanied by severe pain! Quite a strange state of affairs if you think about it.
The treatment options include:
1. Anti-inflammatories - useful in a mild case
2. Splint - by preventing flexion of the finger, then it can't get trapped
3. Steroids - these may be very useful if the swelling is still quite soft and pliable
4. Surgery - by releasing the bridge over the tendon, it is once again, able to move. This is done under local anaesthetic as a day surgery procedure.
Carpal Tunnel Syndrome
:Patients are often labelled Carpal Tunnel Syndrome and it becomes a grab-bag for anyone complaining of anything to do with their hand. Well-meaning friends will tell stories about surgery and the success or otherwise.
Carpal Tunnel Syndrome (CTS) is a very specific condition. The median nerve (which usually supplies sensation to the thumb, index, middle and half of the ring finger) is crushed by pressure from swollen tendons at the level of the wrist joint. While this can sound a bit severe, it doesn't take much swelling to irritate the nerve. As such, when the nerve is irritated, it fires off pins and needles and eventually numbness information to the brain. This usually wakes you at night, forcing you to hang the hand over the side of the bed or shake it. While CTS itself is not always a problem, the sleep deprivation can be significant.
The treatment options are:
1. Splint (worn at night and prevents curling your wrists during the night)
2. Steroids (this has varying success, but some think it is worth a try)
3. Surgery Obviously the surgeon is most familiar with the surgery and can discuss it with you. It is up to you which option you take, but if your thumb muscle is getting weak, then you should seriously contemplate surgery.
Tooth Knuckle Injuries
Anatomy of Hand Nerves
Orthopaedic Surgeon in Cairns, Far North Queensland