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Our Services / Hand Surgery in Toronto

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is a condition which arises from the compression of the median nerve within the wrist due to inflammation of the tissues neighboring it. This median nerve runs from the forearm into the hand, and provides sensation to the palm side of the thumb, index, middle and half of the ring fingers. The carpal tunnel itself houses the median nerve and nine tendons which control the movement of the fingers. The ligament acts as a roof called a deep transverse ligament to hold these tendons and the nerve together. When the wrist is overused in repetitive motions often in daily functions, friction between the tendons and tissues can cause the area to swell, thereby compressing the nerve. Inflammatory conditions such as hyperthyroidism and rheumatoid arthritis can cause carpal tunnel syndrome.

What are the signs and symptoms?

Carpal tunnel presents itself with initial symptoms such as numbness, pain, and a tingly feeling in the wrist and fingers which are under control of the median nerve. These sensations can sometimes appear to radiate up the arm along the nerve. They may first appear at night, or after just waking up in the morning for people who sleep with their wrists bent. In more developed cases, these sensations can be felt during the day, and a decrease in grip strength may also be observed. This will lead to difficulty grasping small and/or heavy objects. Finally, in chronic cases, a deterioration of muscles in the thumb will occur, called thenar atrophy, and sensitivity to temperatures will decrease. All the above symptoms can appear in both hands simultaneously, though the more severely affected hand will be treated first.

What kind of tests will I have to undergo?

Physicians may conduct simple physical exams such as pressing down on the nerve in the wrist to see if numbness occurs from this slight compression. In addition, the palms of both hands may be brought together, and the wrist bent at 90° to test for pain. More advanced tests by a neurologist to further justify the diagnosis include an electromyography where a fine needle is inserted into the muscles in the wrist to test for conduction and therefore the amount of damage to the median nerve. Another test is a nerve conductance study where electrodes are placed on the hands and wrists to measure the speed of the nerve impulses in response to a small electric shock.

What are the treatment options?

In the mildest cases, injections of corticosteroids can be given to the wrist to decrease inflammation, as well as anti-inflammatory drugs. A splint may also be worn at night and during strenuous activities to decrease wrist flexion. Vitamin B supplements can also be effective. However, in more serious cases, surgery is the best option.

What can I expect from surgery?

The goal of this reconstructive surgery is to release the carpal tunnel to allow more room for the median nerve and tendons. The procedure itself lasts approximately 5 minutes, and is performed under local anesthesia. A small incision will be made in the palm after a pressure cuff is applied. Cessation of aspirin or blood thinners prior to surgery minimizes bruising. The incision is then closed up, and a cast will be given to immobilize the joint. This cast cannot come into contact with water, and will need to be covered during bathing. A little over a week later, the stitches will be removed, and physiotherapy will commence to regain use of the wrist and affected fingers. Recovery time depends on the severity of the compression, age of the patient, other medical conditions such as diabetes, and your willingness to do therapy. To achieve the best results, perform regular exercises as directed by the physiotherapist, and regularly massage the area to reduce swelling. Regular follow-up appointments will also be made with Dr. Hong to ensure that the wrist is healing properly.

What are the risks?

The risks of surgery are very rare, and include bleeding, infection and nerve injury. However, with proper care and caution, these complications are rare. To further reduce bruising immediately after surgery, hold the wrist above the level of the heart for the first three hours. Pain should also be expected after surgery, but is usually mild and can be alleviated with regular Tylenol.

When will I see results?

Immediately after surgery, the numbness and weakness should improve or subside. Full recovery depends on the patient and the severity of the case, though normally it can take months. Heavy lifting and strenuous work should be avoided. Recurrence is rare so long as the patient takes care not to overstrain the wrist.

How much will it cost?

The consultation with a doctor as well as the surgery and follow-up appointments are covered by OHIP.

CUBITAL TUNNEL SYNDROME

Cubital tunnel syndrome is a condition which arises from the compression of the ulnar nerve in the elbow. This nerve runs from the shoulder into the hand, and provides sensation to the palm side of the little and inside half of the ring fingers. The cubital tunnel itself is located on the inside of the arm, between the elbow and the medial epicondyle, which is the bone that sticks out and faces your body when you put your palms facing up and your elbow is at a 90° angle. In some cases, the ulnar nerve flicks over the medial epicondyle as the arm is bent and straightened. This constant abrasion causes damage to the nerve. However, generally the surrounding tissues or muscle puts pressure on the nerve and compresses it, especially when the elbow is in a bent position. Inflammatory conditions such as thyroid disease and diabetes can cause cubital tunnel syndrome.

What are the signs and symptoms?

The most common symptoms of cubital tunnel syndrome include numbness, pain, and/or a tingly feeling in the little and ring fingers. For people who sleep with their elbows bent, these symptoms will be most apparent in the morning. In more advanced cases, it can be hard to pinch things or to pick up small objects. In the most severe cases, sensation will be lost to the little and ring fingers and the small muscles in the hand may have wasted. This is called muscle atrophy

What kind of tests will I have to undergo?

Physicians may conduct simple physical exams such as pressing down on the nerve in the elbow or bending it to see if numbness occurs from this slight compression. More advanced tests by a neurologist to further justify the diagnosis and to investigate the severity of the case include an electromyography where a fine needle is inserted into the muscles in the elbow to test for conduction and therefore the amount of damage to the ulnar nerve. Another test is a nerve conductance study where electrodes are placed on the elbow to measure the speed of the nerve impulses in response to a small electric shock.

What are the treatment options?

In the mildest cases, an elbow pad may be worn over the affected area to decrease the amount of irritation to the nerve. This splint may be especially worn at night if the patient bends their elbows in their sleep. However, in more serious cases, surgery is the best option.

What can I expect from surgery?

The goal of surgery is to relocate the ulnar nerve from the cubital tunnel to just above the medial epicondyle. This way, the nerve will not be irritated as it runs through the narrow tunnel. The procedure itself lasts approximately 30 minutes, where an incision will be made into the side of the elbow, and the nerve will be secured in a pocket of the surrounding muscles to relieve the tension caused by bending of the elbow. The muscles will also help to keep the nerve in place during flexion of the arm. Cessation of aspirin and other blood thinners will help to reduce bruising. The incision is then closed up, and a cast will be given to immobilize the joint. A little over a week later, the stitches will be removed, and physiotherapy will commence to regain use of the elbow and affected fingers. Recovery time depends on the severity of the compression, age of the patient, other medical conditions such as diabetes, and your adherence to therapy. To achieve the best results, perform regular exercises as directed by the physiotherapist, and regularly massage the area to reduce swelling. Regular follow-up appointments will also be made with Dr. Hong to ensure that the wrist is healing properly.

What are the risks?

The risks of surgery are very rare, and include bleeding, infection and nerve injury. However, with proper care and caution, these complications can be avoided. Pain should also be expected after surgery, but is usually mild and can be alleviated with regular Tylenol.

When will I see results?

After surgery, the numbness and weakness should improve. Full recovery depends on the patient and the severity of the case, though normally it can take months. Heavy lifting and strenuous work should be avoided. Recurrence is rare so long as the patient takes care not to overstrain the elbow.

How much will it cost?

The consultation with a doctor as well as the surgery and follow-up appointments are covered by OHIP.

TRIGGER FINGER

Trigger finger is an inflammatory condition that is usually caused by repetitive use of the hand. The swelling around the tendon causes triggering as well as locking of one's digit. If the condition is severe, there can be a nodule on the tendon. These nodules then make it harder for the tendon to slide through a covering called the tendon sheath, which holds the tendons close to the bone. Inflammatory conditions such as rheumatoid arthritis, diabetes and gout can provoke trigger finger.

What are the signs and symptoms?

The characteristic symptom of trigger finger is a popping feeling in the affected digit when extending it. This results in difficulty while moving the finger, and is often associated with pain. The sufferer has to passively use extra force to extend the digit. This stiffness of the hand is worse after inactivity, especially in the morning. The most commonly affected digit is the ring finger, followed by the thumb.

What are the treatment options?

In mild cases, or for temporary relief, injections of corticosteroids can be given into the finger to reduce inflammation and hopefully reduce the size of the nodule, making it easier for it to move through the tendon sheath. For severe cases, surgical release is needed.

What can I expect from surgery?

The goal of surgery is to release the tendon sheath, which allows the tendon to move freely through the sheath. The procedure itself takes approximately 5 minutes, and is performed under local anaesthesia. A small incision will be made in the palm at the bottom of the affected finger. From there, the tendon sheath is released or excised. The incision is then closed up. Cessation of aspirin and other blood thinners prior to surgery minimizes bruising. About a week later, the stitches will be removed, and physiotherapy will commence to regain normal movement of the finger. Recovery time depends on the severity of the swelling, age of the patient, other medical conditions such as diabetes, and your willingness to comply with therapy. To achieve the best results, perform regular exercises as advised by your physiotherapist, and regularly massage the area to reduce swelling. Regular follow-up appointments will also be made with Dr. Hong to ensure that the finger is healing properly.

What are the risks?

The risks of surgery are very rare, and include bleeding, infection and nerve injury. However, with proper care and caution, these complications will be avoided. To further reduce bruising immediately after surgery, hold the finger above the level of the heart for the first three hours. Pain should also be expected after surgery, but is usually mild and can be alleviated with regular Tylenol.

When will I see results?

Immediately after surgery, the catching and popping should disappear. Full recovery depends on the patient and the severity of the case, though normally it can take months. Heavy lifting and strenuous work should be avoided. Recurrence is rare so long as the patient takes care not to overuse the fingers.

How much will it cost?

The consultation with a doctor as well as the surgery and follow-up appointments are covered by OHIP.

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Dr. Colin Hong is a Board certified Toronto Plastic Surgeon serving cosmetic surgery patients from across the GTA including Toronto, North York, Richmond Hill, Scarborough and Mississauga.