Carpal tunnel syndrome is a condition in which there is increased pressure on the median nerve at the wrist.  This generally occurs because of swelling of the flexor tendons at the wrist.  The swelling of these tendons causes pressure on the median nerve which is next to the tendons.  The median nerve is the nerve that provides sensation to the thumb, index, middle fingers and to a portion of the ring finger.  Symptoms commonly associated with carpal tunnel syndrome include numbness and tingling primarily in the thumb, index and middle fingers and night pain which will often wake a patient at night.  Symptoms may also include pain in the arm, hand and fingers.

Carpal tunnel syndrome in its' early stages often responds to use of a splint at night as well as to anti-inflammatory medication and avoidance of highly repetitive activities. As carpal tunnel syndrome becomes more advanced, the doctors at Associated Hand Surgeons will generally order a nerve conduction study to evaluate whether any permanent damage is being done to the median nerve.  If permanent nerve damage is occurring, then carpal tunnel syndrome is best treated with carpal tunnel release surgery.  In cases where permanent damage is not occurring to the nerve, cortisone injections are sometimes helpful as well.  Not everybody with carpal tunnel syndrome will need surgical treatment but if damage is occurring to the median nerve, this is generally the preferred treatment.  The doctors at Associated Hand Surgeons make every effort to use conservative treatments before proceeding to surgical intervention.

A ganglion cyst is a mass or bump which has developed because of a weakness in the underlying joint capsule or tendon sheath.  All of the joints in our bodies contain fluid known as synovial fluid which bathes the joints.  Tendons also have fluid of this type surrounding them.  If the tendon sheath or a joint capsule develops a weakness, then synovial fluid can leak out and form a ganglion cyst.  In many cases we cannot identify the specific cause of a ganglion cyst although some cysts are associated with trauma.

Treatment of a ganglion cyst ranges from simple observation to aspiration or surgical excision.  Ganglion cysts are benign masses and aggressive treatment such as surgical excision is only necessary when they are causing significant discomfort.

De Quervain's Tendinitis is inflammation of the tendons that extend the thumb.  These tendons are found on the radial or thumb side of the wrist.  Irritation of these tendons can cause them to swell.  When they swell, they no longer fit through their tendon sheaths.  The rubbing of these tendons on their tendon sheaths causes increased inflammation and pain.

De Quervain's tendinitis usually responds to splinting and the use of a cortisone injection.  When it does not respond to these treatments, then a simple surgical procedure to release the tendon sheath is very effective.

Dupuytren’s disease is a condition in which the layer just beneath the skin in the palm of the hand (the palmer fascia) becomes thickened. Characteristically this starts with nodules in the palm. These can extend into the fingers and can cause the fingers to contract. In the early stages of Dupuytren’s disease the nodules are generally non-painful and can be left alone. As Dupuytren’s disease develops over time the fingers will often become contracted and when this occurs the Dupuytren’s tissue should be removed and the fingers should be released in order to regain motion in the fingers. If Dupuytren’s disease is left untreated it can cause very severe contractures which become progressively harder to treat. Unfortunately, there is no cure or prevention of Dupuytren’s disease. This condition tends to run in families and tends to occur in both hands of individuals who develop the condition. If you believe you have developed Dupuytren’s disease, you should come in for an evaluation of your hands as it is important to obtain treatment before the contractures become severe.

The physician members of Associated Hand Surgeons have privileges at all the hospitals in the Santa Barbara area. The majority of the surgery is done at De La Vina Surgery Center which is an outpatient facility. This allows for highly highly personalized care in a pleasant and efficient outpatient surgery setting.

The majority of the hand surgery performed by members of Associated Hand Surgeons is performed with regional anesthesia.  This means that most patients requiring hand surgery do not have to be put to sleep and undergo a general anesthetic.  In some cases general anesthesia is required but in many cases this can be avoided.  Regional IV block anesthesia is the most common type of anesthesia used for hand surgery procedures.

The length of time for recuperation after hand surgery varies depending on the procedure performed. We at Associated Hand Surgeons are committed to individualized care for the patient.  We will be happy to discuss return to work issues with you prior to your surgery or any other care that you receive.  Most of our procedures allow patients to return to work fairly soon following surgery but the final decision depends on the type of surgery performed and the type of work that the patient will be returning to.

All patients are encouraged to be active and mobile and walking the day of surgery.  Most patients can return to some level of more vigorous physical activity within 24 hours after surgery.  We will be happy to discuss the details of your situation with you individually prior to any surgical procedures being performed.