Hand Surgery Sunshine Coast
Nerve Compression and Restricted Movement

Conditions such as Dupuytren’s disease and carpal tunnel syndrome can restrict movement and cause discomfort, affecting the ability to perform simple daily tasks and reducing quality of life. Plastic surgeon Dr Grant Fraser-Kirk can treat these conditions, relieving symptoms and improving mobility.

What do the procedures involve?

The chosen treatment method will depend on the type of condition and the complexity of the condition. Dr Fraser-Kirk will discuss the treatment options with you during a consultation, creating a personalised treatment plan while considering your personal preferences, ensuring that you feel empowered throughout your surgical journey.

Dupuytren’s disease

Dupuytren’s disease, also referred to as Dupuytren’s contracture, is characterised by the accumulation of scar tissue in the palmar fascia, the layer of tissue beneath the skin of the palm. The build-up of scar tissue can cause nodules of thick tissue to form around the tendons, which contracts the fingers and impairs the ability to move the fingers freely. Due to the contraction, the fingers tend to be pulled towards the palm and unable to extend outwards.

The condition more commonly affects men than women and is more likely to impair movement in the ring and smallest, or ‘pinky,’ fingers. While the condition can hinder the ability to perform daily tasks, which can affect overall quality of life, it is generally not known to cause pain.

Treatment for the condition can involve:

• Collagenase injection
  A non-surgical treatment that involves injecting an enzyme into the affected area, to weaken the thickened tissue. The patient will need to return to the clinic after two days, where Dr Fraser-Kirk will assist the patient in extending the affected finger, causing the contracture to rupture.
• Fasciotomy
  A surgical procedure in which an incision is made in the palm to divide the thickened tissue in the affected area. The procedure can be performed with local anaesthetic, and patients will need to wear a splint during recovery as the wound is left open to heal.
• Subtotal palmar fasciectomy
  A surgical procedure in which as much of the thickened tissue is removed from the affected area as possible. The procedure often involves a longer incision than used in the fasciotomy and is considered a more complicated and extensive procedure. The procedure may be performed under local anaesthetic, however, general aesthetic is available if preferred. The wound may be left open to heal or a skin graft may be required, which involves taking skin from another area of the body and using the tissue to close the wound on the hand.

 Carpal tunnel release

The carpal tunnel is an area at the base of the hand that contains a number of important structures, particularly the median nerve. The carpal tunnel is made of the flexor retinaculum, a thick band of tissue that covers the carpal bones, therefore, it is a strong and secure space. When the pressure inside the carpal tunnel increases, the median nerve is compressed, which restricts movement and sensation in the hand.

When the median nerve is restricted, patients can experience a numb, tinging sensation, particularly when the wrist has remained in a flexed forward position for an extended period of time. The condition can restrict movement due to the numbness in the fingers and a weakened grip strength.

 Treatment for the condition can involve:

• Open carpal tunnel release
  A surgical procedure that involves making a small incision at the base of the palm to cut the flexor retinaculum, relieving the carpal tunnel of the pressure that compresses the median nerve.
• Endoscopic carpal tunnel release
  A surgical procedure that uses a small camera (endoscope) to perform keyhole surgery, allowing the flexor retinaculum to be cut, relieving the pressure that causes the median nerve to become compressed.

The procedure steps that are involved with each treatment method can be discussed in further detail during your consultation. Please contact us if you have any questions about the procedures listed.

What can I expect during recovery?

The specifics of your recovery will depend on your treated condition, and the type of procedure that you have had. Patients may experience swelling and pain after undergoing treatment for the listed conditions.

Patients can general feel relieved of their symptoms during the first week of recovery, however, rehabilitation may be needed to support the regained movement of the hands.

Dr Fraser-Kirk will discuss the details of your recovery during your consultation.

Recovery may involve:

• Wearing a splint
• Undergoing hand therapy
• Attending follow-up appointments

General recovery instructions:

• Keep your hand/s elevated above the heart to help to reduce swelling
• Gently try to move your fingers to reduce a sensation of stiffness
• Care for surgical wounds as instructed
• Avoid alcohol consumption
• Avoid taking specified medications and supplements that can slow down the body’s healing process
• Avoid overusing the hands, making sure to rest and allow the hands to heal
• Avoid underusing the hands, as gentle movement will support the rehabilitation of the hands
• Do not smoke for a specified period of time, generally at least four weeks
• Care for your general health by eating healthy, drinking plenty of water and sleeping well

How much will the treatment cost?

Costs will depend on the type of treatment, the complexity of the procedure, surgeon’s fees, anaesthesia fees and hospital fees. Additional treatment to assist in recovery, such as hand therapy, may increase the overall treatment costs.

When a treatment is deemed as medically necessary, the costs of the treatment may be covered by Medicare. For more information about receiving a Medicare rebate, please contact us, contact your GP or discuss your eligibility during your consultation. Generally, a Medicare rebate requires a GP referral.

What risks and complications are associated with the procedures?

Dr Fraser-Kirk will outline the risks and complications of your specific procedure during your initial consultation, as well as how you can prevent these complications from occurring.

General associated risks of hand procedures may include:

• Pain
• Swelling
• Bleeding
• Stiffness
• General discomfort
• Scarring
• Infection
• Loss of sensation
• Injury to nerves
• Injury to blood vessels

Book your consultation with Dr Grant Fraser-Kirk

If you are suffering from Dupuytren’s disease or carpal tunnel syndrome, there are a variety of treatment options that can restore mobility and relieve discomfort. During a consultation, Dr Fraser-Kirk will assess the complexity of your condition, discuss your treatment needs and consider your personal preferences to determine the best treatment option for you.