Dr Hartley performs a select number of hand operations. These include:
Carpel tunnel syndrome is caused by pressure on the median nerve that runs through the wrist (carpus).
Carpal tunnel syndrome is due to pressure on the median nerve as it passes through the wrist. It is called a tunnel because there is an arch of bones at the back of the wrist which is joined at the front by the transverse carpal ligament, forming a complete tunnel.
Carpal tunnel syndrome causes pain in the wrist and paraesthesia (pins and needles and numbness) in the fingers and thumb. The thumb, index and middle fingers are most commonly affected. It is common to wake up during the night with pain in the wrist or hand.
Carpal tunnel release is performed as day surgery. It is usually four hours from drop-off to pick-up. A small incision is made in the palm of the hand and the ligament at the front of the wrist is divided. This increases the size of the carpal tunnel and decreases pressure on the median nerve.
You will leave hospital the same day. Leave the bandage on your hand and keep the area dry until your follow-up appointment which will usually be within a week of surgery. There will be no sutures to remove as absorbable sutures beneath the skin will be used.
Trigger finger is a painful condition where one of your fingers or your thumb gets stuck in the bent position and may suddenly ‘snap’ back into a straight position. It is caused by a swelling in the tendon and the name of the operation to release your finger or thumb and allow it to move freely once again – is the trigger finger release.
A small incision is made in the palm of the hand about 1cm long at the base of the affected finger. A small portion of the sheath surrounding the tendon is divided which allowing the tendon to move freely without triggering.
Trigger finger release is performed as day surgery. It is usually four hours from drop-off to pick-up. Your hand will be bandaged for a few days. You will then return to Dr Hartley's rooms for a wound review. Your strength will return over the following days or weeks.
Dupuytren’s disease is a contracture of the fingers causing ‘clawed fingers’. This causes an inability to grasp objects or to put your hands in your pockets and can seriously restrict your lifestyle and quality of life.
Dupuytren’s disease often requires hand surgery, which divides or removes the thickened bands to help restore your finger motion. Skin grafting may be needed, it just depends on the extent of the hand surgery that is required to resolve your condition. Surgery is recommended once it has been confirmed that the disease is progressing. Some patients turn to surgical treatment when hand function is limited; they have trouble grasping objects or putting their hands in their pockets.
Several types of incisions will be made, but yours will most likely be made along the natural creases and lines in the hand helping the scar appear less noticeable once the hand is healed. Once the palmar fascia is exposed, it will be carefully separated from nerves, arteries, and tendons. Special care will be taken not to damage the nearby nerves and blood vessels. Dr Hartley will remove enough of the palmar fascia to allow you to straighten your finger. After the diseased tissue is removed, and if the patient has ignored this problem for a long time, the joint capsule or the ligaments of the joint may be stiffened or contracted. Dr Hartley may also release this tissue to allow the finger to straighten. Once the fibrous tissue is removed, the skin will be sewn with fine stitches.
As we age and the thumb joint starts to be affected by wear and tear, arthritis of the thumb can develop; it may also result from traumatic injuries or overuse of the thumb.
Osteoarthritis of the base of the thumb triggers pain and stiffness in the thumb and hand, as well as a deformity of the affected joint. So you may suffer from a loss of function and associated weakness in the hand and thumb, as well as feeling pain. If the condition is affecting the base of the thumb it can be very painful and sometimes the only relief is obtained by surgical intervention. We have seen people who are otherwise very healthy, but whose lifestyle has been dramatically altered by the pain and disability caused by arthritis of the thumb.
Arthritis of the thumb often requires hand surgery to improve mobility of the joint and to lessen your pain.
Clinical assessment will be necessary to make the diagnosis, this may also require an x-ray. Dr Hartley can discuss your condition, any other problems and different management options. There are many types of surgery for the base of the thumb and they all have the same aim: to reduce pain and increase function.
Initial treatment may consist of:
When nonsurgical treatment is no longer effective, surgery is an option. The operation can be performed on an outpatient basis, and several different procedures can be used. One option involves fusing the bones of the joint together. This, however, will limit movement. Another option is to remove part of the joint and reconstruct it using either a tendon graft or an artificial substance. Dr Hartley will discuss the options and select the one that is best for you.
Following surgery, Dr Hartley will arrange a wound check after two weeks for a wound check. Absorbable sutures will be used. You will be in a splint for four to six weeks, and arrangements for physiotherapy will be made.
Ganglions of the hand and wrist are not usually painful and rarely cause loss of function. These ganglions can quickly appear, surprising many people, but they can also disappear of their own accord just as quickly. In some cases however, ganglions of the hand and wrist can actually be quite painful or restrict hand and wrist movements. So surgical intervention may be required to relieve pain and to restore function.
On the other hand, many of these ganglions can be resolved non-surgically by aspirating the ganglion (removing the jelly-like insides of the ganglion with a needle), but if they return, hand surgery is often required, because they can be quite unsightly. Dr Hartley will recommend hand surgery for ganglions of the hand and wrist, if your symptoms have not been relieved by nonsurgical methods, such as aspiration.
Dr Hartley will recommend surgery if your symptoms have not been relieved by nonsurgical methods, or if the ganglion returns after aspiration (removal by needle). The hand surgery to remove ganglions of the hand and wrist is called an excision.
If the mass is painful, interferes with the hand and wrist’s ability to perform normally, or causes the hand or fingers to experience numbness or tingling, surgery may be recommended. The minor surgery is a quick day procedure with a fast recovery time.
Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion. Even after excision, there is a small chance the ganglion will return. Ganglions requiring treatment are most reliably managed by surgical removal. Ganglions are less likely to recur if removed surgically.
As the cause of a ganglion cyst is not known, it is difficult to tell how to prevent them. Early evaluation and treatment are recommended.
Excision is typically an outpatient procedure and patients are able to go home after a period of observation in the recovery area. There may be some tenderness, discomfort, and swelling after surgery. It is recommended that patients generally wait two to six weeks after their surgery before resuming normal activities.
De Quervain’s disease is a painful condition caused by swelling of the tendons in the thumb. This causes some people to have problems gripping objects and performing many of the actions we take for granted in our daily lives. The tendons from your hand to your thumb pass through a protective tunnel, however in De Quervain’s disease, these tendons become swollen and the walls of the tunnel rub against your tendons, causing pain.
You might recognise De Quervain’s disease by its alternative name as ‘washerwoman’s sprain’, because it can be caused by repetitive hand and wrist movements. Lately, people have been referring to it as ‘blackberry thumb’ because it is increasingly being diagnosed in young people, who text a lot of their phones.
Hand surgery involves a complete inspection of the tunnel to find out where the actual problem is occurring. The tunnel is then cut, releasing the pressure on your tendons and allowing them to glide freely once again. The tunnel will eventually heal closed, but it will be larger than it was before the surgery, and eventually allow for scar tissue to fill the gap where the tunnel was cut.
This procedure can usually be completed on an outpatient basis, which is more convenient for the patient, so that they can return home on the same day as the surgery.
Dr Hartley is a leading hand surgeon on the Gold Coast, specialising in hand surgery for Carpel tunnel syndrome, trigger finger release, Dupuytren’s disease, osteoarthritis of the base of the thumb (arthritis of the thumb), ganglions of the hand and wrist and De Quervain’s disease.
For more information on any of these conditions - please call our receptionist - Annie Thomas on 1300 447 563 or complete our online enquiry form.