Hand Surgery and Hand Treatments in Toronto

CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome is a pinched nerve in the wrist caused by increased pressure on the nerve. Symptoms of carpal tunnel syndrome include pain, numbness, tingling, weakness, clumsiness, and a tendency to drop things. The numbness and/or tingling most often affects the thumb, index, middle, and ring fingers. Electrodiagnostic studies are often used to confirm the diagnosis and rule out other conditions. Treatment options include wrist splints, activity modification, steroid injections, and surgery.

CUBITAL TUNNEL SYNDROME
Cubital tunnel syndrome is entrapment of the ulnar nerve as it travels across the elbow. Symptoms may include numbness and tingling in the ring and small fingers as well as the hand. Diagnosis is based on clinical examination as well as electrodiagnostic studies. When identified early, symptoms may be managed with conservative treatments such as activity modification, anti-inflammatory medication, and steroid injection. If conservative methods fail to provide relief, or if muscle weakness develops in your hand, surgery may be necessary to relieve pressure along the nerve. The results of surgery are generally good. However, if the nerve is badly compressed or if there is muscle loss, the nerve may not return to normal function and some symptoms may remain even after the surgery. Nerve recovery can take a prolonged period of time.

WRIST FRACTURES
The wrist is made up of eight small bones and the two forearm bones, the radius and ulna. A fracture may occur in any of these bones when enough force is applied, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or a fall off a roof or ladder. Osteoporosis, a common condition in which the bone becomes more brittle, may make one more susceptible to getting a wrist fracture. Examination and x-rays are needed so that your doctor can tell if there is a fracture and to help determine the treatment. Sometimes a CT scan or MRI may be used to get better detail of the fracture fragments and associated injuries. In addition to the bone, ligaments (the structures that hold the bones together), tendons, muscles, and nerves may be injured as well when the wrist is broken. These injuries may need to be treated in addition to the fracture.

WRIST PAIN
Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist pain can also result from long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome. Because so many factors can lead to wrist pain, diagnosing the exact cause can be difficult, but an accurate diagnosis is essential for proper treatment and healing. Dr. Wu will examine your wrist, to check its flexibility and stability and to see where it hurts. X-rays are taken to check the alignment of the wrist bones and to check for any fractures. Occasionally other studies such as Magnetic Resonance Imaging (MRI) may be performed.

WRIST ARTHROSCOPY
Arthroscopy is a minimally invasive technique of visualizing the inside of a joint. The wrist is a complex joint made up of many bones and ligaments, which hold the bones together. Wrist arthroscopy allows the surgeon to diagnose and treat many problems of the wrist through a series of very small incisions (portals). In the last 5 years, the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder. Because the incisions used with wrist arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized and recovery is often faster.

TRIGGER FINGER
Trigger finger occurs when normal tendon gliding is prevented by swelling and inflammation. Trigger fingers are more common with certain medical conditions such as rheumatoid arthritis, gout and diabetes. Repetitive tasks may aggravate the condition. In most cases, however, the cause of the trigger finger is unknown. Trigger finger may start with discomfort felt at the base of the finger or thumb. Other symptoms may include pain, catching or locking, and stiffness. Treatment options include anti-inflammatory medications, night splinting, steroid injections, and surgery. The goal of surgery is to open the tunnel at the base of the finger so that the tendon can glide more freely. Finger motion can return quickly, or there can be some stiffness after surgery. Occasionally, hand therapy is required after surgery to regain motion.

DE QUERVAIN’S TENDONITIS
First dorsal compartment tendonitis is a condition brought on by irritation or inflammation of the wrist tendons at the base of the thumb. The inflammation causes the compartment around the tendon to swell and enlarge, making thumb and wrist movement painful. Making a fist, grasping or holding objects—often infants—are common painful movements with de Quervain’s tendonitis. It usually caused by taking up a new, repetitive activity. New mothers are especially prone to this type of tendonitis: caring for an infant often creates awkward hand positioning, and hormonal fluctuations associated with pregnancy and nursing further contribute to its occurrence. A wrist fracture can also predispose a patient to de Quervain’s tendonitis, because of increased stresses across the tendons. Tenderness directly over the tendons on the thumb-side of the wrist is the most common finding.

TENDON REPAIR
Tendon repair is surgery done to treat a torn or otherwise damaged tendon. Tendons are the soft, band-like tissues that connect muscles to bone. When the muscles contract, the tendons pull the bones and cause the joints to move. When tendon damage occurs, movement may be seriously limited. The damaged area may feel weak or painful. Tendon injury may occur anywhere in the body where there are tendons. The joints that are most commonly affected by tendon injuries are the shoulders, elbows, ankles, knees, and fingers. Tendon repair surgery may be helpful for people who have tendon injuries that are making it difficult for them to move a joint or are very painful.

THUMB BASAL JOINT ARTHRITIS
Arthritis is thinning of the cartilage, which is the smooth surface of the joint. Thumb arthritis can result from a genetic predisposition and can also occur with age and long-term wear and tear. Patients with thumb arthritis report pain and weakness with pinching and grasping, opening jars, writing, and turning doorknobs or keys. X-rays can aid the diagnosis of arthritis, demonstrating narrowing of the joint space, bone spurs, and deformity. Initial options for treatment can include conservative methods such as ice/heat, anti-inflammatory medications, splinting, hand therapy, and injections. Surgical treatment is an option when conservative methods fail to provide adequate relief.

HAND FRACTURES
The hand is made up of many bones that form its supporting framework. A fracture occurs when enough force is applied to a bone to break it. When this happens, there is pain, swelling, and decreased use of the injured part. A fracture may cause pain, stiffness, and loss of movement. Some fractures will cause an obvious deformity, such as a crooked finger, but many fractures do not. Because of the close relationship of bones to ligaments and tendons, the hand may be stiff and weak after the fracture heals. Fractures that involve joint surfaces may lead to early arthritis in those involved joints. Medical evaluation and x-rays are usually needed so that your doctor can tell if there is a fracture and to help determine the treatment. Depending upon the type of fracture, Dr. Wu may recommend one of several treatment methods. A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Some displaced fractures may need to be set and then held in place with wires or pins without making an incision. This is called closed reduction and internal fixation. Other fractures may need surgery to set the bone (open reduction). Once the fracture has enough stability, motion exercises may be started to try to avoid stiffness.

GANGLION CYSTS
Ganglion cysts are common lumps within the hand and wrist that occur adjacent to joints or tendons and are filled with clear fluid or gel. The cause of ganglion cysts is unknown however joint strain and tendon irritation may play a role in their formation. Ganglions occur in patients of all ages. Ganglions may increase or decrease in size or even disappear altogether. They may or may not be associated with pain. The diagnosis is usually based on clinical examination. Treatment can include observation, aspiration or drainage, and surgical removal. Surgical treatment is generally successful although cysts may recur.

MICROSURGERY
Reconstructive microsurgery is a surgical field where specialized operating microscopes and precision instrumentation are utilized to perform intricate operations on tiny structures. The magnification of a microscope is needed to complete the complex task. Advances in reconstructive surgery have made it possible to reliably transfer a wide range of tissues and body parts from one location to another to correct fingers/hand and breast reconstruction. Dr. Wu specializes in hand and microsurgery to provide patients with complete care and current surgical techniques. He understands that trauma and breast reconstructive defects affects the patients ability to work, participate in activities that patients enjoy, and, in some cases, it affects the ability to perform normal, daily routines.