Why should I see a Hand Surgeon?

What kind of surgery? Is surgery dangerous?
When and how can I avoid surgery? To operate or not to operate?

As hand specialists, we can accurately identify your disorder and also its possible consequences, assess them thoroughly and clearly advise you on the right therapy with the appropriate information.

“If my Porsche has a problem, I also won’t go and ask the mechanic down the street…”

The hand is a very complex organ – equally important both for work and for all activities of daily life. We advise you to not just go to any doctor, but to see an experienced hand specialist.

Our expertise and excellent services will allow you to feel comfortable and confident that we can and will successfully help you.

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Symptoms

What do the changes on my hands mean?

Numb Fingers

Numb fingers are often caused by a compression of a nerve in the forearm or the wrist. The median nerve is most frequently constricted at wrist level; if the first three fingers of the hand are tingling, this often hints at a ‘carpal tunnel syndrome’. If the little and the ring finger are tingling, the ulnar nerve is usually constricted at the level of the elbow joint. In many cases, nerve compression syndromes can first be treated by temporarily wearing a splint. If this is not successful, an operation may be necessary, which can usually be performed on an outpatient basis and with local anesthesia.

Trigger Fingers

First symptoms are often a pain in the palm or at back of the hand. If one or more fingers “are stuck” while trying to stretch the respective finger, the cause usually is an inflammation of the flexor tendon sheath and a so-called tendon entrapment: The flexor tendons are too thick to glide smoothly through the pulleys in the palm of the hand and the digit will then lock in flexion and will require passive manipulation for extension.

If this condition impairs the function of your hand and an injection with a corticosteroid does not help, a minor surgical intervention under local anesthesia, in which the pulley is severed, will help.

Pain in the Thumb

Pain at the level of the first joint of the thumb is often the precursor to the “trigger thumb” (see above).

Pain, which originates more between the wrist and the thumb, is often caused by osteoarthritis, i.e. wear and tear of the cartilage surfaces on the thumb basal joint.

In the initial stage, a splint or an injection treatment often helps, in the advanced stage, an operation can almost always achieve a pain-free use of the thumb.

Pain in the Interphalangeal Joints

Pain in the interphalangeal joints is often caused by wear and tear of the joints (osteoarthritis). A trigger finger can also cause pain in the finger joints.

Wrist Pain

The wrist is a complex joint whose scope of  biomechanics has not yet been fully clarified (ulna and radius, eight carpal bones and partly also the adjacent metacarpal bones are involved). Pain can be caused by disorders inside and outside the joint as well as by injuries.

The most important point in treating pain in the wrist area is the exact clinical examination; the experienced wrist specialist can then usually give or determine a diagnosis. If necessary, further examinations such as ultrasound, X-rays or tomography (CT, MRT) should be carried out after the examination by a specialist. In some cases, wrist arthroscopy is necessary; in addition to the possibility of examining the joint from the inside, this “buttonhole” method can often also be used to fix the problem at the same time.

Tumors of the Hand and Wrist

Most “bumps“ have a benign and harmless cause. Nevertheless, an examination by a specialist can rule out if further diagnostic tests or therapy are necessary.
The most common tumors are so-called “ganglions”, which in many cases disappear on their own. If they are annoying, painful or cause other worries, they can be surgically removed. This may often be done on the wrist by means of an arthroscopy (see above) and a larger incision can thus be avoided.

Treatment

Surgery – what do I need to know?

The first Appointment

Please bring all existing examination results from previous consultations with other doctors to the first appointment. In addition, we need all images taken in advance (x-rays, MRI and CT images including the report of the radiologist who made them) – even if no pathological findings were discovered on the images. If possible, no paper printouts should be brought along, but CDs or conventional X-ray foils or paper foils.

In the case of accidents at work or at school, information about the initial treatment („D-Arzt report“ or „H-Arzt report“, if available) as well as information about the responsible Berufsgenossenschaft (if known) is required.

The insurance card is required for patients covered by health insurance.

Before Surgery

General information:
Please make an appointment with your family doctor for a preliminary examination concerning things such as ECG, blood tests etc. In addition, and only after consultation with your family doctor, do not take any anticoagulant medication such as ASS, Aspirin, Marcumar, Plavix, Godamed, Eliquis, etc. before surgery.

On the morning of the surgery, please shower with water, soap or shower gel, wash especially your hand(s) and arm, using a new towel. Remove jewellery, watch, etc. Please put on fresh underwear.

There should be no healing wounds, crusts or scabs, redness or inflammation etc. in the area of the hand before surgery. In case of doubt, the practice must be called. The fingernails should be cleaned and cut short. Nail varnish (even colourless!) and artificial fingernails must be removed completely, otherwise there is an increased risk of infection.

For all procedures that are not planned in local anesthesia, you should refrain from eating, drinking and smoking from midnight on (don’t eat, don’t chew gums, etc.)! On the morning of surgery, you may only drink small (!) quantities of non-carbonated water or unsweetened tea without milk up to 2 hours before the planned operation.

Surgery: Options

Surgical treatment offered by the Hand Centre comprises several modalities:

The very first thing is your appointment at our medical office, where we’ll examine and diagnose your problems. If surgery is necessary, we will advise you whether this should be done on an outpatient or inpatient basis.

Surgery under local anaesthesia is usually performed in the practice.

Some operations will be done in the PAN Klinik, in operating theatres equipped  the latest standards with surgical microscopes, X-ray and arthroscopy units.

If in-patient treatment is indicated, this also can be provided in the PAN Klinik

After your surgery

You will receive detailed information during your visit shortly after your operation. Later you will receive a medical report with detailed information about the surgery and the follow-up treatment. You will also receive the surgeon’s mobile phone number, in case any problems occur.

General advice:
When walking or standing, please always hold the operated hand up (for the first few days – depending on the size of the operation – approximately at shoulder height). The use of a sling is not recommended because of the danger of stiffening of the shoulder joint.

If possible, please place your hand lifted, e.g.on a pillow in bed.

Please keep moving the fingers that are not immobilised: stretch your fingers completely several times a day for about 5 minutes and open and close the fist.