Adelaide Plastic Surgery

GP Information Regarding Hand Plastic Surgery

Treating Hand Trauma
Treating Hand Trauma

Ganglion

Ganglions are common synovial-fluid cysts associated with joints.

Investigation
While they can often be diagnosed clinically, an ultrasound can confirm the diagnosis and differentiate it from other possible pathologies.

Treatment
Ganglions are benign and do not require treatment in the absence of symptoms. If they are causing discomfort or are large they can be treated in one of two ways. A radiologist can aspirate the ganglion under ultrasound control and inject it with corticosteroid. This is a good way of providing relief in people who are reluctant to have surgery, although there is a significant recurrence rate. Alternatively, a minor surgical procedure to excise the ganglion may be required.

Surgical—Refer to a Plastic Surgeon.
Surgical Excision

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the most common compressive neuropathy, occurring in 10% of people at some stage in their life.

Investigation
Nerve conduction studies are the investigations of choice for confirming the clinical diagnosis of carpal tunnel syndrome. The test will evaluate the site and severity of the nerve compression.

Treatment (Conservative)
The mainstay of early treatment is rest, wrist immobilisation with a splint (in the neutral position) and NSAIDs. Corticosteroid injections may be employed in mild cases but their benefit is usually temporary.

Surgical—Refer to a Plastic Surgeon.
Surgery is usually indicated for persisting symptoms that are not responsive to conservative treatment. If nerve conduction studies confirm moderate or severe disease, or if the patient is frequently woken at night with hand pain, surgery should be expedited.

Trigger Finger

Trigger finger (stenosing tenosynovitis) is a defect in a tendon causing a finger to jerk or snap straight when the hand is extended. Diagnosis can be confirmed by ultrasound.

Treatment (Conservative)
If minor trigger finger cansometimes be managed by avoiding precipitating activities and NSAIDS.

Surgical—Refer to a Plastic Surgeon.

Treatment may be two fold:

  1. Steroid can be injected into the inflamed area, particularly if treatment is sought within 3 months of onset of symptoms.
  2. For persisting or troubling symptoms, a simple surgical release of the inflamed pulley will provide reliable cure of symptoms.

Dupuytren’s Contracture

Dupuytren’s disease is a thickening of the palmar fascia which forms nodules and cords. Over time the cords can cause contractures of the digits.

Dupuytren’s disease is slowly progressive and no treatment cures the disease.

It generally requires treatment when the patient is unable to hold their hand flat on a table or if any joint has a contracture of 30’ or more.

Treatment (Conservative)
Corticosteroid injection may be useful for managing tender nodules but does not affect the progression of the disease.

Surgical—Refer to a Plastic Surgeon.
There are a number of surgical options from limited fasciectomy (which can be performed under local anaesthetic) to extensive fasciectomy (with release of contracted joints).

Trauma (hands)

Hand trauma is generally best managed by immediate referral to a Plastic Surgeon. We encourage GPs to make use of our 24 hour emergency number – 0400 131 883.

Vascular Compromised/Open Wounds
Full or Partial Amputations require X-ray and immediate Referral to Plastic Surgeon (0400 131 883 for GP use only).

Advice
Apply a simple non-stick dressing, splint or stabilise joint as required. Advise patient to fast and provide analgesia if required.

Infected or Contaminated Wounds
All bites or open dislocations, crush injuries, nail bed trauma, fingertip injury X-ray and referral to Plastic Surgeon within 24 hours (0400 131 883 for GP use only).

Advice
Irrigate open wounds with saline, commence antibiotics, apply non-stick dressing if required, advise patient to fast if appropriate.

Fractures, Dislocations and Closed Wounds
X-ray and referral to Plastic Surgeon within 24 hours (0400 131 883 for GP use only).

Sprains, strains X-ray (if clinically indicated) and referral to Plastic Surgeon within 7 days (0400 131 883 for GP use only).

Advice
Splint the affected area.