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Treatment | Hand | Tendons

Tendons

The tendons are the power transmitters of the muscles. What has already become Achilles’ doom can also occur on the hand: multiple diseases can develop, from tendon tears to overloading with a snapping finger. The procedures can range from complex multi-stage reconstruction to simple release with finger snapping.

What tendon problems are there?

The 33 muscles involved in the movement of the hand have at least one tendon which performs its function in the hand. In principle, each tendon can be either diseased or injured. Typical tendon problems are tenosynovitis (tendovaginitis), which is very painful or, as with flexor tendons, can lead to snap phenomena (trigger finger). Such inflammations are often an expression of a certain overload. Tendons can also be torn or pulled during cuts or sports activities. As a rule, these injuries then require surgical therapy. Due to the high functionality of the hand, this disease and injuries quickly become noticeable and lead to considerable functional losses up to the complete loss of function of one or more fingers. In the case of epicondylitis, the origins of the long forearm muscles in the area of the elbow are inflamed and thus lead to pronounced discomfort up to the hand.

Which tendon problems require surgery?

If tendons are injured or torn, surgery is usually unavoidable. The procedures range from direct suturing to complex multi-stage reconstruction. In the case of snap fingers, a non-surgical procedure can usually be initiated first by means of injections and hand therapeutic measures. If the problems persist, surgery is recommended. In the case of a tennis or golf elbow (epicondylitis), the conservative repertoire should be exhausted before surgery is recommended. Therapy with PRP (Platelet Rich Plasma) can also provide relief. If a tendon is torn, only surgery can help in almost all cases. Sometimes several operations are necessary for complex reconstructions of tendons after accidents.

Am I the right candidate for surgery?

If the non-operative possibilities have already been completely exhausted and the complaints persist, the operation is usually the definitive solution. What such procedures look like depends on the type of discomfort. For patients with snap fingers who still have residual symptoms despite the infiltration, surgical release of the anular ligaments is the method of choice. In the case of persistent pain with tendovaginitis de Quervain, an extension plasty in the area of the extensor tendons can be a definitive solution. If old or fresh tendon injuries are present, only an operative procedure can usually help.

What can I expect?

The result again depends on the diagnosis and the therapy. Good to very good results can usually be expected with surgical release of the anular ligaments. Patients are often completely symptom-free for just a few days or weeks. If tendons are severed, the tendons are sutured and the postoperative procedure including hand therapeutic exercise is relatively demanding. Here the final results are good if the postoperative regime is well followed. Close hand therapeutic support is indispensable here.

What happens during consultation hours?

During the initial consultation we will try to make a diagnosis. Here the conversation regarding the complaints and the examination is decisive. Imaging is used for special questions. Usually by ultrasound or MRI. The treatment plan is worked out together and any operations are discussed in advance.

What's the surgery like?

Depending on the diagnosis, the surgical intervention is planned. Release of the anular ligaments and extension plasty surgery are performed on an outpatient basis in our certified operating theatre. If complex tendon interventions such as tendon transplants are indicated, an inpatient stay may be necessary under certain circumstances. Regional anaesthetic procedures are possible for short interventions limited to the hand.

How does the post-treatment look like?

Since every intervention, no matter how small, involves a certain risk of complications, certain measures should be observed. The first few days you will feel normal, timely pain, which can be relieved with painkillers. For larger operations, in-patient stays are possible. Regular wound checks are carried out to ensure safe wound healing. Depending on the anatomical region affected, immobilization may also be necessary. A hand-therapeutic accompaniment to mobilisation may also be indicated. All follow-up treatments have in common the goal of early movements with great safety and freedom from pain. The follow-up treatment is already discussed in the initial consultation so that you can plan the postoperative phase already and any help for everyday life and inability to work can be organized.

What are the risks?

Every intervention, however small, involves a certain risk of complications, since an operation in the broadest sense always leads to tissue injuries. A complication does not necessarily occur due to an error. Rather, the human body reacts individually and has certain tendencies to complications. The initial clarifying discussion serves to address such tendencies and to take appropriate precautions.

Risks associated with every surgical intervention

  • secondary bleedings
  • wound healing disorders
  • infections
  • excessive scars
  • thromboses
  • embolisms

Specific risks associated with tendon interventions depend on the diagnosis and localization of the operation. We will be happy to provide you with specific advice as part of the surgical clarification.

Would you like to learn more?

Do you have the impression that you have a trigger finger or have been diagnosed with any other tendon problem?

Since the trigger finger is one of the most common diseases in the hand area, the symptoms are known to many people who are not medically trained. The typical snapping does not always occur, but rather the pain is more likely to occur during flexion. With golfers or tennis elbows, severe stabbing pain occurs when the wrist is bent or stretched. Often these problems have existed for a long time and different therapies have been carried out with more or less success.

We will be happy to advise you in the context of an initial consultation on referral by your family doctor or directly with us. Please note whether you are in an HMO or other family doctor model and inform your family doctor.  During the initial consultation, we will work out the diagnosis together and, if necessary, take the first therapeutic steps. An operation will always take place later and should be well weighed.

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