Hand Surgery: Types, Procedure, Benefits, Cost, Risk & Recovery

• Hand Surgery (Carpal Tunnel, Tendon Repair)

Introduction

Hand surgery, specifically for conditions like carpal tunnel syndrome and tendon injuries, plays a vital role in improving the quality of life for individuals experiencing chronic pain, dysfunction, or limited mobility in their hands. These disorders commonly develop through overuse, trauma, or underlying medical illness and negatively affect the ability to perform activities of daily living.

This integrative review will address the definition, need and operative steps of routine surgeries such as carpal tunnel release and tendon repair, indications, complications, cost in India, and choice of hospitals for hand and wrist surgeries in Delhi.

What is Hand Surgery?

Hand surgery is any surgical operation used for treating different conditions of the hand, wrist, and forearm. By and large such procedures tend to be of benefit towards recovery of hand use, pain relief and the ability of the patient to carry out activities of daily living. Hand surgery can treat various problems such as fractures, tendon avulsions, nerve entrapment, and deformities.

Common hand surgeries include: 

• Carpal Tunnel Release: Carpal tunnel syndrome (CTS) treatment, the compression of the median nerve at the wrist.
• Tendon Repair: Surgical repair of injured tendons that mediate hand and finger motion.
• Joint Replacement: Substitution of arthritic or damaged joints in the hand or wrist.Fracture Fixation: Surgical management of displaced/fractured hand, wrist, and finger bones.
• Deformity Correction: Procedures for the correction of congenital or acquired abnormalities of the hand.

Why is Hand Surgery Needed?

Surgeons indicate hand surgery when conservative management (e.g., exercise or medication) fails to relieve symptoms or when the condition selectively causes significant impairment in activities of daily living. Below are some of the main reasons that hand surgery may be required.

1. Carpal Tunnel Syndrome: Compression of the median nerve at the wrist gives rise to numbness, paresthesia and weakness in the hand. If left untreated, it can cause irreversible nerve injury.
2. Tendon Injuries: Tendon injury may be caused by incision, laceration, or trauma. Tendons play a crucial role in hand motion and damage to the tendinous structures or tendons can have overwhelming functional consequences.
3. Fractures and Dislocations: Accidents or falls may cause hand trauma (fractures or dislocation) that necessitates surgical repair if splints or casts cannot treat the fracture.
4. Arthritis: Arthritis, both osteoarthritis and rheumatoid arthritis, can have debilitating effects on hand joint pain and deformation, requiring surgery to restore function and motion.
5. Congenital Deformities: There are people born with malformations of the structure or function of their hand who may need surgery corrected.

Types of Hand Surgery

There is a variety of hand surgery, all of which are indicated to treat a certain pathology. The most common surgeries include:

• Carpal Tunnel Release Surgery

• Carpal tunnel syndrome is a condition where the median nerve, traveling from the hand to the palm located in the forearm, compresses at the wrist. It results in symptoms such as paresthesia, numbness and weak hands. Surgeons perform carpal tunnel release surgery to release the pressure on the median nerve by cutting the ligament that is the culprit.
• Procedure: This operation can be performed either through traditional open surgery or by a minimally invasive approach. The surgeon makes a tiny incision on the wrist and releases the ligament thereby relieving pressure on the nerve.

• Tendon Repair Surgery

• Lacerations, cuts, or trauma may cause tendon lesions. Tendons are types of connective tissues that help to move the hand and the fingers. If a severed or ruptured tendon occurs, it can cause loss of function or deformity.
• Procedure: During tendon repair surgery, the surgeon binds the ends of the tendon or reinserts it in an attachment to the bone. The procedure may also require a graft from a donor tendon, depending on the level of damage, if the medical team does not sufficiently repair the injured tendon.

• Joint Replacement Surgery

• Arthritis/joint damage can be so severe that it requires joint replacement surgery. Surgeons excise the damaged joint and substitute it with a prosthesis. They very often perform this clinical procedure at the thumb joint or other hand joints with arthritis.

• Fracture Fixation Surgery

• A fracture to a bone of the hand or wrist may necessitate surgery to restore the alignment of bones and guarantee correct healing. Plates, screws or rods may be applied for fixation of the fracture and for taking advantage of the healing process.

• Deformity Correction Surgery

• This surgery alleviates congenital deformities or malformations affecting the hand, e.g., webbing of the fingers, underdeveloped thumb, or other structural problems. The aim is to enhance both the aesthetics and the function of the hand.

Procedure Steps for Hand Surgery

The exact procedure for hand surgery depends on the procedure to be performed. However, the general steps include:

1. Preoperative Consultation: At the consultation, the surgeon examines the patient’s condition and suggests the most appropriate surgical procedure. Medical professionals can conduct imaging tests, such as X-rays or MRIs, to determine the scale of lesions.
2. Anesthesia: Surgeons normally perform surgery on the hand either under local (of the affected area) anesthesia, creating the sensation of numbness, or under induction of general anesthesia, as a function of the degree of the surgery.
3. Surgical Procedure: The surgeon performs the surgery using an open (making a larger incision) or a minimally invasive (making a small incision and specialized instruments) technique.
4. Postoperative Care: Following surgery, the hand is immobilized in bandages to rest the area in a splint or cast. Pain management and infection control are critical during the recovery period.
5. Rehabilitation: Physical therapy is often prescribed to enhance hand function and restore strength and flexibility. Rehabilitation in some instances may have to be completed over a few months.

Benefits of Hand Surgery

Hand surgery provides various advantages, particularly for those who have complaints of chronic pain or dysfunction:

1. Pain Relief: Hand surgery can therefore have a dramatic effect on pain, particularly in conditions such as carpal tunnel syndrome or arthritis, which impose constant pain.
2. Restored Functionality: Surgeons use surgery to restore hand function in daily living as a result of improvements in hand mobility, hand strength, and hand dexterity.
3. Improved Quality of Life: Hand surgery can enhance the quality of life of patients not only by relieving symptoms and restoring function but also by returning to work and leisure activities.
4. Cosmetic Improvement: Surgeons can use surgical intervention to correct hand deformities or injuries to regain a more natural appearance.
5. Long-Term Solution: A lot of hand surgeries are useful in giving long-term relief for chronic pain, lessening the requirement for further treatments or interventions.

Cost of Hand Surgery 

• Carpal Tunnel Release Surgery: $1,000 to $2,500 
• Tendon Repair Surgery: $1,500 to $4,000 
• Fracture Fixation Surgery: $2,000 to $5,000
• Joint Replacement Surgery: $3,000 to $7,000 

Here’s how it compares to costs in some countries:

• United States: $5,000 to $15,000 
• United Kingdom: $4,000 to $10,500 
• Australia: $4,000 to $7,500
• India: $1,200 and $7,000 

Best Hospitals in India for Hand Surgery

India has several world-class hand surgery hospitals that offer best-in-class care. Some of the best hospitals in India, particularly in Delhi, for hand surgery include:

• Metro Hospital, Faridabad—Top Hospitals in India for Treatment.
• Max Super Speciality Hospital, Delhi
• Fortis Memorial Research Institute, Gurgaon
• Apollo Hospitals, Delhi

Risks and Complications of Hand Surgery

While hand surgery is generally safe, there are risks and potential complications associated with the procedure. These include:

1. Infection: As a consequence of surgery, there is a potential for infection, which can lead to delayed healing, necessitating further therapy.
2. Nerve Damage: In surgeries near the nerves, there is a risk of damaging the nerves, which could lead to numbness, weakness, or loss of sensation.
3. Scarring: Surgical incisions can lead to cosmetically undesirable and clinically visible scars.
4. Stiffness or Reduced Mobility: In small counts, despite surgery, the hand can become stiffened or inelastic with a decreased range of motion and then needs physical therapy.
5. Blood Clots: As with any surgery, there is a risk of developing blood clots, particularly in patients who are immobile during recovery.

Recovery from Hand Surgery

The recovery time for hand surgery depends on the type of surgery performed, the patient’s overall health, and the extent of the damage being treated. However, most patients can expect the following stages:

1. Initial Recovery: Patients would normally go for several hours up to one day at the hospital in observation following surgery. A cast or bandage can fix the hand to reduce movement.
2. Postoperative Care: In the first few weeks, doctors recommend that patients do not move their hands excessively and adhere to procedures for wound care that will prevent infection.
3. Physical Therapy: Physical therapy plays an important role in regaining muscular strength, flexibility and mobility. Therapy may start after the primary healing phase, with exercises to enhance finger function.
4. Return to Normal Activities: Full recovery up to several months may depend on the type of surgery. Patients will be able to resume their normal activities after its complete healing and regaining power in a hand.

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