Operative Orthopaedics
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Ligament reconstruction and interposition arthroplasty with the flexor carpi radialis tendon in rhizarthrosis (arthrosis of the root joint of the thumb)
is a surgical technique that removes a diseased bone with damaged cartilage in the root joint of the thumb. Previous operative techniques placed only the tendon of one of the wrist flexors in the place where the diseased bone was removed, which can be sacrificed without losing the function of the hand. Then the problem of pain was solved, but the patient would very quickly notice the lack of strength in the thumb. With today's technique, the ligament is reconstructed with the tendon so that the thumb has a new support and the grip strength of the thumb is preserved.
Carpal tunnel syndrome
refers to pain and a tingling sensation in the first three fingers and partially the fourth on the hands. Namely, the median nerve that brings sensation to those fingers can be pressed from the neck to the wrist in several places. Adequate clinical examination and electrical recording of nerve conduction - EMNG (electromyoneurography) we will find the place of pressure. The nerve can be pressed in several places at the same time. The most common combination is the neck and wrist. In this case, the pressure in the wrist can be minor but still causes discomfort, in contrast to the necessary stronger pressure if the nerve is not pressed in the neck. Conservative treatment with Physical therapy can be tried but is rarely successful. A simple operation under local anesthesia with a 1 cm incision reduces the pressure on the nerve. The patient notices an improvement almost immediately and can go home after the procedure. However, if the symptoms last longer than 9 months, sometimes a year, permanent nerve damage can occur. Then recovery takes longer. Sometimes complete recovery is also possible. Surgical treatment is recommended regardless because it is simple, and after surgery the existing complaints will not worsen.
atrophy of small hand muscles due to delayed surgical treatment of carpal tunnel syndrome
Trigger finger
is a painful or painless phenomenon when the finger on the hand can be easily bent, but difficult or impossible to extend again. The cause is the thickening of the tendon which, when extending the finger, encounters the first ligament that holds the tendon to the bone. When trying to extend the finger, a click is visible. The ligament is cut through a surgical procedure under local anesthesia and thus the tendon slides freely. The ligament can be cut without impairing the function of the finger.
Trigger finger immediately after surgery under local anesthesia
The surgical incision is placed in the natural groove of the palm
for a better aesthetic and functional result
Mb DeQuervain
is inflammation of the tendon of the extensor thumb on the hand in the area of the wrist. In that place, the tendons are in their narrow tunnel. With repeated movements of the wrist with a clenched thumb, friction and inflammation occur. Conservative treatment consists in the use of anti-inflammatory and pain medications, injections of long-acting anti-inflammatory drugs or platelet-rich plasma. In case of treatment failure, the tendon tunnel is opened with surgery in local anesthesia and the tendon bed as well as the tendons themselves are cleaned of adhesions that support the inflammation.
Glomus tumor under the nail
it is a very painful benign thickening of the blood vessels and nerves under the notes. Under local anesthesia, the nail is lifted, the formation is removed, and the nail is placed back in its bed with two sutures.
Ganglion and cysts
each joint has two sheaths. The solid so-called joint capsule that determines the ultimate range of motion
and stabilizes the joint and the inner soft so-called synovial sheath. It creates joint fluid that lubricates the joint and nourishes the cartilage. When in one place the tough shell weakens and breaks, the inner one pushes through the crack like a balloon and becomes visible under the skin. The change is usually not painful. It is possible to remove the typical content (as a gel) by syringe aspiration. However, the balloon, although currently deflated, remains present as well as the possibility of being filled again. During the operation, a place is found on the joint capsule where the ganglion comes from, and it is removed and the capsule is closed with a suture. It is possible for the ganglion to reappear, but not at the operated site but near it, because the capsule has weakened in the new place.
Aseptic necrosis of lunatum bone
Pain in the wrist can be caused by a circulation disorder in the lunatum bone. This may or may not be preceded by trauma. No changes are visible on the X-ray image until the last degree of damage. With magnetic resonance imaging, we can verify the disease at an early stage. Depending on the possible cause, the disease can be treated conservatively. However, surgical treatment is more common. Such patients have a significant difference in the length of the two forearm bones, which causes uneven pressure on the lunatum bone. An operation to shorten the longer bone of the forearm (eg. ulna - ulna) is often performed.
Injuries of the tendons and ligaments of the hand and fingers (eg. boutonniere deformity in rheumatoid arthritis, lateral ligament rupture, tendon extensor finger ...)
fingers are anatomically extremely complex. In addition to one extensor tendon and two flexor tendons, there are their interconnections. Thus, for example, the extensor tendon divides into three stripes above the first joint of the finger. The central part is attached to the next bone, while the two side parts have their attachement on the distal bone of the finger just before the nail. In boutonniere deformity, the central part of the tendon either ruptures or lengthens and becomes non-functional. The finger can no longer be fully extended in the first joint. Over time, the lateral parts of the finger extensor tendons move towards the flexor tendons and mimic their function. And finger become crooked. If the deformity persists for a long time, the joint capsule under the flexor tendons shrinks and the finger can no longer be moved, even passively. During the operation, the central part of the extensor tendon is reattached to the bone using two mini-anchors. The advantage of using an anchor compared to a classic operation is that the tendon is attached exactly at an adequate distance and tension, and not functionally shortend like in operations before the use of the anchors. This approach enables faster and more complete rehabilitation of the operated finger.
When the lateral ligaments that centers the extensor digitorum tendon just above the wrist joint is ruptured, the tendon is displaced into the space between the two joints. Since it is no longer taut, it is actually functionally too long, unable to fully extend the finger. Such injuries are possible in boxers. The operation reconstructs the lateral ligament, most often part of the tendon itself, and in this way the tendon is again centered exactly above the joint.
New and old fractures of the scaphoid bone
The scaphoid bone in the wrist has naturally poor circulation. In the case of a fracture of that bone, regardless of the treatement method, there is often prolonged healing and even non-healing of the bone. The so-called false joint - pseudarthrosis can occur. Such unhealed bone can completely damage the entire wrist in such a way as to damage the cartilage. In this extreme case, due to pain, it is necessary to immobilize the entire wrist. If, on the other hand, a fracture or unfused bone is diagnosed before major damage to the wrist, it is necessary to fix the bone fragments surgically with a screw with or without the insertion of a bone wedge for better healing. A bone wedge may also have its own blood supply. However, regardless of the operation, long-term immobilization is required.
Fractures of the radius near to wrist joint ( Colles - Smith fracture)
The most common bone fracture is a thumb bone fracture. Since it almost always breaks in the same - typical place, that's how it got its name. Non-displaced fractures are treated conservatively with forearm immobilization. A fracture with displacement must first be repositioned (under local anesthesia), followed by somewhat longer immobilization. In the event that the fracture is complex or when there has been displacement after repositioning, it is necessary to stabilize the fragments with a special low-profile plate and screws that do not protrude above the plate and do not interfere with the tendon glide. Osteosynthetic material (plates and screws) in the upper extremities do not need to be removed when the bone heals.