Hand Surgery Melbourne

Hand surgery encompasses a range of treatments designed to amend the function and appearance of the hands. Dr Sally offers treatment for acute hand injuries, including treatment of soft tissue infection, repair of lacerations, tendon repair, and fracture management. More details for acute hand injuries can be located in the trauma section. 

Dr Sally also offers a range of hand surgery for patients with nerve compression and degenerative disorders. This includes conditions such as carpal tunnel syndrome, Dupuytren’s contracture, ganglion cysts, osteoarthritis etc. 

If you have a hand condition requiring treatment, we advise you to book your consultation with Dr Sally Ng to discuss your options.

Treating Carpal Tunnel Syndrome and other Nerve Compression 

Nerve compression syndromes occur when a nerve is compressed as they travel through a tight passage within the body. In the upper limb, this can often occur at the back of the elbow (cubital tunnel), or at the wrist (carpal tunnel). Common symptoms include pain, numbness and muscle weakness in the affected nerve. 

Nerve compression syndromes are often caused by repetitive injuries. Other conditions such as rheumatoid arthritis, diabetes, hypothyroidism, and pregnancy can also play a role. 

The two most common types of nerve compression in the upper limb include carpal tunnel syndrome and cubital tunnel syndrome. 

Carpal tunnel syndrome is the most common nerve compression syndrome. It occurs when the median nerve is compressed at the palm of the wrist. The main symptoms include numbness and tingling in the thumb, index and middle finger, with weakness in the thumb. 

Cubital tunnel syndrome occurs when the ulnar nerve is compressed at the elbow. The ulnar nerve is responsible for the sensation that you get when you hit the funny bone. Compression can cause numbness and tingling in the ring and little fingers especially when the elbow is bent, as well as weak grip due to weakness in the affected small muscles of the hand. 

As part of the assessment, Dr Sally will take a history and examine the hand to see if there is any loss of sensation and weakness in the area supplied by the nerve. She will then arrange a nerve conduction study to assess the degree of compression. This will give an indication of the severity and the likelihood of regaining the nerve function after treatment. 

Treatment options may include splinting, anti-inflammatory medication and steroid injections. Surgical release is often reserved for those who fail conservative measures. The surgery aims to release the compressed nerve and the outlook for the surgery depends on many factors, including how long you have had symptoms, how severe your symptoms are, and the presence of other contributing health conditions. In general, most patients notice symptom improvement after the nerve is decompressed. Dr Sally will discuss the benefits and risks of the surgery with you in detail. 

In terms of recovery, patients are generally advised to avoid heavy lifting for 6 weeks post-surgery. It is recommended you see a hand therapist post-surgery to minimise scarring across the nerve and to rebuild the strength on the affected side. 

Please contact us today if you have any questions regarding carpal tunnel treatment.

Treating Dupuytren’s Contracture

Dupuytren’s contracture is a disabling hand disorder in which there is an abnormal thickening of the skin in the palm of the hand and may extend into the fingers. Over time, the band pulls the fingers into an abnormal position and affects the function of the hand. The ring and little fingers are most affected. The exact cause is not known but it does seem to run in families. 

Surgical release of the diseased tissue bands remains the most definitive treatment option. This may be combined with joint manipulation and skin graft to the palm. It should be noted that this is a complex procedure, and its success is partly reliant on the severity of the problem. You can anticipate significant improvement following successful surgery.

Please contact us today if you have any questions regarding Dupuytren’s contracture surgery.

Treating Ganglion Cysts and other Soft Tissue Growth

There are many soft tissue tumours that can occur in the hands as there are so many tissue types (skin, tendon, fat, ligament, bone etc.). Some may require surgical removal and these include ganglion cyst, giant cell tumour, epidermal cyst, lipoma, neuroma, fibromas, glomus tumours, and bone spurs from arthritis or trauma. Most of these tumours are benign. 

Ganglion cyst is the most common tumour in the hand and wrist. It is a sac of gelatinous fluid that forms from a joint or tendon sheath. They are often seen in the wrist but can also occur around other joints. They form when a portion of the capsule or tendon sheath balloons out and becomes filled with the fluid that usually lubricates the joint or tendon. If there is pain associated, it is often due to underlying tendon inflammation or arthritis if it is overlying a joint. 

When you see Dr Sally about your hand tumour, she will assess the lump to narrow down the possibilities as to the type of tumour you have. She may request an XR or ultrasound to assess the tumour. 

Typically, the treatment depends on the size, location and symptoms. Once the diagnosis is established, the patient may choose to observe it first, especially if it is not causing any symptoms. However, most tumours will grow and with time can become a nuisance. Surgical excision is the most definitive way to remove the tumour. Dr Sally will discuss the risks, benefits and consequences of each treatment option with you to assist with your decision making. 

Please contact us today if you have any questions regarding the ganglion cyst or the surgery involved.

Treating Trigger Fingers

Stenosing tenosynovitis, commonly known as trigger finger, is a condition that causes pain, stiffness and a sensation of locking or catching when you try to bend or straighten your finger.

In patients with trigger finger, a pulley at the base of the finger that keeps the flexor tendon sliding correctly becomes inflamed or thickened, making it harder for the flexor tendon to glide through it smoothly as the finger bends.

Over time, the tendon may also become inflamed and develop small nodules on its surface. When the finger bends and the nodule passes through the pulley, it gives the sensation of catching which is often painful. In severe cases, the finger locks and becomes stuck in the bent position. Sometimes patients need to use their other hand to straighten their fingers. 

Trigger fingers and trigger thumb can also occur in children. The condition occurs when the tendons that move the finger and thumb enlarge and do not slide smoothly. In 30 percent of children, the trigger thumb and finger will resolve before they reach their first birthday. For those whose trigger does not resolve on their own, surgery is often then required to release the tendon. 

In adults, treatment ranges from splinting, steroid injection to surgical release of the pulleys. Steroid injection can be useful but may require repeat injection. 

The goal of surgery is to release the pulley that is blocking the tendon. This is performed through a small incision in the palm under local anaesthetic. 

The majority of patients who have surgery experience significant improvement in function as well as relief from the pain of the trigger finger. If loss of motion is present before the surgery, complete range may not be restored fully. 
For more information or to request a consultation, please contact us today.