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Hand Surgery

Last updated March 28, 2019

David Amsler

Hand Surgery is any surgical procedure that involves restoring and preserving normal functionality of the hand. Image showing an individual after hand surgery.


Background Information:

What are the other Names for the Procedure?

  • Surgery of the Hand

What is Hand Surgery surgical procedure?

Hand Surgery is any surgical procedure that involves restoring and preserving normal functionality of the hand.

What part of the Body does the Procedure involve?

A Hand Surgery may involve the hand, wrist, and forearm.

Why is the Hand Surgery surgical procedure Performed?

A Hand Surgery is performed to improve or preserve functionality of the hand, which may be affected by disease, injury, or a birth deformity.

What are some Alternative Choices for the Procedure?

Depending upon the condition, sometimes non-operative management with splint may be an effective alternative, for the procedure.

What are the Recent Advances in the Procedure?

The use of endoscopic surgical procedure is an advancement in this field.

What is the Cost of performing the Hand Surgery surgical procedure?

The cost of Hand Surgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Hand Surgery and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.plasticsurgery.org/reconstructive-procedures/hand-surgery.html

http://www.assh.org/Public/About/Pages/default.aspx

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006 

Prior to Hand Surgery surgical procedure:

How is the Hand Surgery surgical procedure Performed?

A Hand Surgery may be performed as:

Tendon repair:

  • The most common traumatic injury requiring a Hand Surgery is tendon repair. When a tendon is damaged or cut, it typically retracts
  • In such a condition, an incision is made on the hand, the retracted tendon is retrieved back and reconnected with sutures, in order to restore function

Carpal tunnel release:

  • Another common surgery performed on the hand is carpal tunnel release
  • A condition where there is increased pressure on the median nerve (a main nerve running along the length of the arm) as it enters the hand from the forearm through the carpal tunnel (located in the wrist)
  • During the surgery, an incision is made from the mid palm to the wrist. The incision is deepened to identify the constricted tissue, which is causing pressure on the nerve.
  • This tissue is then divided, following which the pressure is reduced
  • In an endoscopic carpal tunnel release procedure, smaller incisions are made on the hand and with the use of a surgical microscope, the pressure is released

Correction of birth deformity:

  • Fingers are fused at birth (webbed fingers), a condition termed as syndactyly
  • They may be joined by a web of skin or by skin and a partial fusion of bones
  • During surgery, the two fingers are separated to provide a normal appearance and full range of motion

Where is the Procedure Performed?

A Hand Surgery procedure is usually performed in an out-patient surgery center facility, a physician’s clinic/office, an emergency room, or a hospital. Normally, the individual can go home once the procedure is completed.

Who Performs the Procedure?

The procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

  • General surgeon
  • Hand surgeon
  • Plastic surgeon
  • Orthopedic surgeon

How long will the Procedure take?

It depends upon the type of surgery performed and may vary anywhere between 30 minutes to 3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Hand Surgery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Hand Surgery surgical procedure?

Before a Hand Surgery procedure, the patient has to undergo certain tests, such as:

  • Routine blood and urine analysis
  • X-ray of the hand

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is Hand Surgery?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Hand Surgery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

An injection of local anesthesia, regional anesthesia by injection, or general anesthesia is administered for this procedure.

How much Blood will you lose, during the Procedure?

The blood loss in a Hand Surgery procedure is generally minimal.

What are the possible Risks and Complications during the Hand Surgery surgical procedure?

There are general factors that increase the risk of getting complications during surgery, which include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Infection in the surgical wound
  • Anesthetic complications
  • Accidental injury to the neighboring tissues (nerves or tendons)

What Post-Operative Care is needed at the Healthcare Facility after the Hand Surgery surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Hand Surgery surgical procedure:

What are the possible Risks and Complications after the Hand Surgery surgical procedure?

Post Hand Surgery, the following complications may arise:

  • Excessive bleeding
  • Formation of blood clots
  • Irregular scarring reducing range of motion
  • Infection in the surgical wound
  • Change in skin sensation
  • Skin contour irregularities
  • Skin discoloration
  • Hand swelling

What is the Prognosis after the Surgery?

  • The prognosis depends on the surgery, the hand therapy administered after the surgery, and how well the physician’s instructions are followed
  • Therapy is critical to restoring normal function
  • It may take few weeks to several months, for return of normal function. If one attempts to return to normal function too soon, the risk of re-injury is possible

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling of the affected hand
  • Bleeding or fluid drainage around the surgical wound
  • The occurrence of any symptom that causes uneasiness, such as nausea and vomiting
  • Signs of an infection
  • Headache
  • Fever
  • Dizziness
  • Muscle aches
  • Fever
  • Feeling sick
  • Complications associated with prescription medications used for the treatment

What Post-Operative Care is needed at Home after the Hand Surgery surgical procedure?

At home, the following post-operative care is recommended, after a Hand Surgery procedure:

  • Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
  • Avoid all activities that are physically strenuous for about 4 to 6 weeks (sometimes for even longer)
  • Resume driving only when you are physically able, or follow the physician’s advise
  • Use a heat pad or warm compress to relieve pain, due to the incision
  • Keep the wound clean and dry
  • Keep your affected arm elevated above your heart. This can prevent or reduce swelling
  • Complete the course of prescribed medication, under advice of the physician
  • Take antibiotic medication to help combat or prevent infection
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if required
  • Eat a well-balanced diet, which can aid in a faster recovery
  • Compete prescribed rehabilitation program

How long does it normally take to fully recover, from the Procedure?

  • Final recovery with complete functionality of the hand may not be fully predicted
  • For some surgeries, like carpal tunnel release, modifying job habits may be recommended for long term improvement
  • Complete recovery may not be realized until after several months

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Hand Surgery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, physician’s office, emergency room, or hospital
  • An anesthesiologist (if anesthesia was administered)
  • General surgeon, hand surgeon, plastic surgeon, or an orthopedic surgeon

The patient is advised to inquire and confirm the type of billing, before the Hand Surgery procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 6, 2013
Last updated: March 28, 2019