Hand Surgery

Dupuytren’s disease (palmar fibromatosis) causes the formation of nodules and, subsequently, fibrous cords in the palm that “pull” the fingers into flexion. As the disease progresses, extension becomes difficult, and simple gestures – washing the face, shaving, placing the hand on a table – are limited. When contracture exceeds the functional threshold or when uncomfortable deformities appear, surgical treatment is the solution that restores finger alignment. The intervention is usually performed under local anesthesia or regional block; through incisions planned in relaxation lines, the surgeon identifies and removes the fibrous bands that contract the fingers (limited fasciotomy or partial fasciectomy), protecting digital nerves and vessels. After surgery, guided mobilization begins early, and, depending on the case, temporary nocturnal splinting and physiotherapy are recommended to maintain the gained extension. The scar is cared for with massage and topical silicone; recurrence is possible, being a disease with genetic substrate, but correction of the main sources of contracture usually offers good years of improved function.

Trigger finger occurs when the tendon sheath at the A1 pulley level narrows, and the flexor tendon “catches,” producing extension blockage and painful snapping. In the morning, the finger may lock in flexion, requiring manual “unlocking.” When conservative measures (rest, splint, selective infiltration) do not resolve the problem or when pain and blockages are frequent, surgical intervention is simple and efficient. Under local anesthesia, through a 0.5–1 cm incision, the A1 pulley is released (tenolysis), allowing the tendon to glide freely. The finger is mobilized immediately on the table to verify sliding. The dressing is minimalist, sutures are removed at 10–14 days (depending on area and suture type), and light activities are resumed quickly. The risk of recurrence is low, and complications (nerve injuries, stiffness) are rare when the technique is correctly executed and rehabilitation begins early.

Carpal tunnel syndrome represents compression of the median nerve at the wrist. It manifests through numbness and tingling in the first three and a half fingers, especially at night, decreased strength, dropping objects, and in advanced stages – thenar atrophy. Diagnosis is based on clinical examination (maneuvers such as Phalen/Tinel) and often on nerve conduction studies (EMG). When symptoms persist, when there is electrical involvement, or when conservative treatments (nocturnal splint, ergonomic modifications) are no longer sufficient, surgical decompression of the nerve is recommended. The intervention releases the flexor retinaculum (transverse carpal ligament), widening the canal through which the median nerve passes. It is performed under local anesthesia or regional block, through a small incision (minimal open approach or endoscopic, in selected cases). Fingers are mobilized immediately, the dressing remains clean and dry, and sutures are usually removed at 10–14 days. Most patients notice improvement of paresthesias from the first nights, with strength returning progressively in 6–12 weeks. Office work is often resumed in 5–10 days, and intense hand effort is gradually reintroduced.

Synovial (ganglion) cysts are the most frequent formations at the wrist and finger level. They appear as elastic “swellings,” variable in size, connected to the joint capsule or a tendon sheath. Some are asymptomatic, others hurt with effort or are aesthetically bothersome. Aspiration may be a temporary solution, but recurrence is common. Surgical excision – with removal of the cyst sac and its pedicle to the joint origin – offers the lowest recurrence rate. The procedure is done under local anesthesia, with special care on the volar radial aspect (proximity to radial artery). Recovery involves clean dressings, early mobilization, and relative protection from effort for a few weeks. The scar is small, and wrist shape gradually returns to normal as tissues settle.

Ingrown nail (onychocryptosis) causes pain, inflammation, and sometimes recurrent infections at the lateral edge of the nail, especially in the hallux. Causes include incorrect nail cutting, tight footwear, repeated trauma, or anatomical particularities. When conservative measures do not help or when infections recur, surgical intervention offers a stable solution: partial avulsion with resection of the lateral nail bed strip and, frequently, chemical matricectomy (phenolization) to prevent future growth of the “corner” into tissue. The procedure is done with digital block (local anesthesia at the base of the finger), is rapid and well tolerated. Subsequent care includes local baths, dry dressings, and comfortable footwear; usually, patients return to normal walking immediately, and sports activities are resumed after complete tissue healing.