Hand and wrrist

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Hand & Wrist

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Hand and wrrist

  1. 1. SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM
  2. 2. Overview Pain in the basal joint caused by arthritis makes it difficult for patients to grip and hold or twist objects between the thumb and fingers. This surgical procedure removes and rebuilds the basal joint. 1.Accessing the joint An incision is created at the lower sectionof the thumb and the wrist area where the basal joint is located. 2. Joint removed The surgeon removes the diseased joint by cutting and clearing away the lower portion of the thumb metacarpal and also removing the trapezium bone at the base of the thumb. 3. Tendon reshaped A section of tendon or graft is Taken from another part of patient’s own wrist or arm and reshaped into a bundle that will fit into the cleared joint 4.End of Procedure The graft bundle is placed into the joint space. After the surgery site heals, the bundle of the tendon graft will act as a cushion for the new basal joint SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM
  3. 3. SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM Overview This outpatient procedure relieves the symptoms of De Quervain's tenosynovitis by releasing the tendon sheath that wraps around the tendons at the base of the thumb. This relieves pressure and friction on the tendons, allowing them to glide freely. Preparation The patient is positioned , anesthesia is administered ,and the hand and wrist are cleansed and sterilized. The surgeon creates a small incision on the wrist at the base of the thumb to access the inflamed tendons. Opening the sheath The surgeon carefully releases the inflamed sheath surrounding the tendon, allowing it to spread open. In many cases, a second sheath is found inside the first. It is released as well. The surgeon may also remove any thickened tissue found between the tendons. Creating more space for the tendons relieves painful pressure and eliminates the friction that can occur as the hand is used. End of procedure The incision is closed, and a local anesthetic may be injected for post surgical pain relief. The wrist is bandaged, and a splint may be applied. The patient is given pain medication and is able to go home the same day. Thumb motion is usually encouraged after surgery.
  4. 4. Overview The outpatient procedure is used to remove a ganglion cyst, a fluid-filled sac that forms as a herniation from a joint capsule , ligament or tendon sheath. Ganglion cysts commonly develop at the wrist. Preparation The procedure is performed in the operating room under sterile conditions. Anesthesia is administered, a tourniquet is applied, and the hand is cleaned and sanitized. The patient is positioned with the back of the hand clearly visible to the surgeon Accessing the Wrist A small incision is made on the wrist, just above the location of cyst. The surgeon isolates the cyst from the surrounding tissues in the wrist and locates the base of the cyst stalk, where the cyst is attached to the joint capsule, ligament or tendon sheath Removing the Cyst The base of the ganglion stalk is cut at its origin. The cyst is removed and the defect in the joint capsule, ligament or tendon sheath may be repaired with sutures End of Procedure The incision is closed with sutures, and a bandage is applied. An injection of local anesthesia is often given for pain relief. The wrist is placed in a splint, and the patient may go home the same day. SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM
  5. 5. Overview The procedure is performed to relieve pressure on the medium nerve, alleviating the pain of carpel tunnel syndrome and restoring normal sensation to the hand and fingers. The procedure is usually performed on an outpatient bases. Incision Made The surgeon creates a small incision (typically about two inches long) in the palm of the hand to expose the transverse carpel ligament. Guide Inserted A thin metal guide is inserted between the transverse carpal ligament and the median nerve. The guide will protect the median nerve during the surgery. Ligament Cut The surgeon carefully cuts the carpel ligament, creating more space in the carpel tunnel. This relieves the pressure on the median nerve End of Procedure The incision is closed with sutures. A splint is applied to the wrist, and the patient is allowed to go home. After a period of healing, hand rehabilitation therapy is performed to help rebuild wrist strength. SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM
  6. 6. Overview During this minimally-invasive procedure, the surgeon opens a narrow tendon pulley at the base of a finger or thumb affected by trigger digit. Opening the pulley prevents the nodule from catching, allowing the affected digit to flex and extend normally with no triggering or pain Preparation The patient is positioned so that the palm of the hand is clearly visible to the surgeon. Local or general anesthesia is administered and the area is cleansed and sterilized Accessing the Hand After the hand is prepared, a tourniquet is applied. A small incision is made in the palm of the hand over the pulley to be released. The skin and soft tissue are spread to expose the tendon and pulley. The nerves are protected. Releasing the Pulley The surgeon uses surgical scissors or a scalpel to carefully divide the pulley, releasing the constriction on the tendon. The cutting of this pulley will not negatively affect finger function. End of Procedure The incision is closed with sutures. The patient is given pain medication and is able to go home the same day. Finger motion is encouraged after the surgery. Hand therapy may also be recommended. SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM
  7. 7. Overview This minimally invasive outpatient procedure allows the surgeon to evaluate and treat injuries and disorders of the ligaments, cartilage,and bones of the wrist. The surgeon uses a small camera, called an arthroscope, and tiny instruments which are inserted through small incisions in the wrist. Preparation: The patient lays flat with the arm secured to an arm table and the wrist suspended vertically with traction .The arm is cleansed and sterilized, and a tourniquet is applied. General anesthesia is usually administered. A regional nerve block may be used insead to numb the arm, and a sedative provided to relax the patient. Accessing the wrist: The surgeon uses a needle to inject fluid into the joint. Several small incisions are made on top of the wrist near the joint. An arthroscopic camera and a probe are then inserted. The camera eliminates the need for a large incision, as it allows the surgeon to view inside the joint on a monitor. Repairing the joint: Once the wrist has been diagnosed, the physician may use one or more of the arthroscopic instruments to treat any damage. Damaged cartiliage may be removed, ligament tears may be repaired or debrided, and bone may be shortened. Severe damage may require more extensive surgery with an open incision. End of procedure: The incisions are closed with sutures or surgical tape. Local anesthetic is administered to the wrist for pain relief. The wrist is then bandaged and usually splinted to immobilize the joint. The patient will be given pain relievers and is allowed to go home the same day. SPORTS AND SPINE ORTHOPEDICS SOSCCALIFORNIA.COM

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