Wittenborn Plastic Surgery
Part of Riverchase Dermatology & Cosmetic Surgery
Williams S. Wittenborn, MD

Hand Surgery

Fort Myers Hand Surgery - Wittenborn Plastic Surgery

Hand Surgery

Dr. Wittenborn did a year long fellowship in hand surgery at the University of South Florida. He is experienced in routine as well as complicated problems of the hand and wrist

Carpal Tunnel

The median nerve gets pinched at the wrist. This nerve runs near the middle of the wrist and goes to the palm side of the thumb, index, middle, and half the ring finger. Pinching of the nerve may cause tingling or numbness to these fingers. It may cause pain that may be at the wrist, hand or radiate up the arm towards the shoulder. It may be caused by repetitive motion, however not in all cases. People will often complain of pain at night that wakes them up. They may experience numbness during certain activities such as driving, or holding a telephone. People will often sleep with their wrists bent and this will pinch the nerve while they sleep. Splinting the wrist prevents the pinching, and can help with symptoms. Diagnosis can be by history and exam as well as nerve conduction studies that can show if there is slowing along the nerve fibers, and can pin point if the nerve is pinched at the wrist, or elsewhere since the nerve originates from nerve roots in the neck.

Basal Thumb Arthritis

This is a common problem people experience. Usually there is a burning pain at the base of the thumb. It can be felt near the middle of the wrist and be mistaken for carpal tunnel. Usually symptoms are worse with movement such as pinching, using scissors, shears or twisting jar lids. This arthritis comes from years of use. Sometimes the pain can be due to a laxity in the joint capsule surrounding the basal thumb joint. The increase motion within the joint space is responsible for inflammation that causes pain. X-rays can show if there is arthritis in the joint. Examination will help to localize the pain to a particular area. Splinting of the joint can help to relieve symptoms.

Ganglion Cysts

These are commonly found at the wrist, or seen on the top of the wrist. You may notice a mass that is circular. It usually arises from the wrist joint, and is filled with a clear jelly. The cysts can cause pain because they get compressed when the wrist is moved. They can increase, or decrease in size related to wrist movement. There is a communication from within the joint out towards the skin. Not all cysts need treatment. If they are causing problems such as pain they can be drained with a needle or removed surgically.

Mucous Cysts

These are ganglion cysts that occur at the joints closest to your finger nails, or the distal interphalangeal joint(DIPJ). They occur because of arthritis at these joints, and fluid from inflammation in the joint tracts out towards the skin. They can cause grooving of the finger nails because they can exert pressure on the nail matrix where the nail originates. The skin over these cysts can become thinned. These cysts should be removed if the skin gets too thin, or if they cause pain

Tendon Injuries

Tendons originate from the muscles in the forearm and insert on to the bones of the wrist and fingers. There are flexor and extensor tendons. Injury to tendons can have adverse consequences on hand function. The results of extensor tendon repair are uniformly better than flexor tendon repair. The results depend upon where the tendon was injured (at the wrist, in the palm, or the finger) if there are other associated injuries( nerve injury, fractures), and the age the patient. As a general rule tendons are best repaired within 2 weeks of the injury, because tendons tend to retract and can be difficult to stretch back out after this time period. Late tendion repairs require staged procedures with tendon spacers and tendon grafts

Trigger Finger

This occurs when the tendon gets stuck in the tunnel it glides through. It is caused by inflammation of the tendon. The tunnel remains the same. The tendon usually gets stuck when the finger is flexed down, and it is difficult to extend the finger out of the palm. This can be treated by injecting cortisone into the tendon to help relieve the inflammation. This works 80% of the time, unless someone has diabetes. Resolution of symptoms may not be permanent, and surgery is sometimes required to release the constraining tunnel.

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