HAND AND ELBOW SURGERY
Dr Bond has wide experience of hand surgery.
These are most often Day cases and can be done under regional anaesthesia if requested
- Tennis elbow
- Tennis elbow is a bothersome condition
- After 6 months of failed conservative treatment consisting of activity modification, steroid injections and physiotherapy, surgery can be considered
- Most often surgery considts of debridemnt of the degenerative origin of the extensor tendons
- Carpal tunnel syndrome
- This a common condition
- It is caused by compression of the median nerve in the hand
- Patients will experience symptoms of pain and paraesthesias in the hand especially at night
- Treatment is a simple release of the transverse carpal ligament in the hand relieving pressure on the median nerve
- Ganglions
- These are gelatinous lumps caused by outpouching of synovium from tendon or joints in the wrist
- Treatment is generally excision for persistent ganglia
- Thumb carpometacarpal arthritis
- This arthritis is common
- Pain is experienced at the base of the thumb
- Steroid injection of the joint can help
- If pain and disease progressives surgical treatment of excision of the trapezium with tendon interposition is performed
- De Quervian tenosynovitis
- This is a common cause of radial sided wrist pain
- The extensor tendons are caught under the retinaculum and one experiences pain especially with lifting heavy objects eg. a kettle
- Again if steroid injection fails, a simple surgical release of the 1st extensor compartment will relieve symptoms
- Dupuytrons contractures
- Common condition of contractures of the palmar fascia of the hand
- Occurs in people of Nordic descent
- Usualy pain less but if cannot place hand palm down on a flat surface, will need surgery
- Surgery consists of excision of the thickened palmar fasia – partial fasciotectomy
- Trigger finger
- This condition is caused by a tight A1tendon pulley at the base of the finger
- The finger gets caught in a flexed position – “triggering”
- Treatment is initial steroid injection but this fails surgical release of the pulley is performed
Dr Bond has a special interest in foot and ankle surgery.
He treats a wide range of foot and ankle condition. Below is a range of foot conditions and the most common surgical procedures:
- Ankle sprains
- Ankle lateral ligament injuries are generally managed conservatively but if one has continued pain and instability after prolonged rehabilitation, one can perform lateral ligament reconstruction. The results of early ligament surgery are the same as late surgery.
- Brostrom and internal bracing surgery
- Day procedure
- Foot and Ankle arthritis
- Multiple joints form the ankle to the midfoot can get arthritis
- For the ankle one can do a replacement or fusion. There are various pro and cons of the latter procedures
- Lesser joints of the foot that are arthritic are generally fused
- Osteochondral defects talus
- arthroscopic microfracture or OATS procedure
- Achilles tendinopathy
- There are two types of achilles tendinitis – insertional and mid substance. The former generally requires surgery and the latter can be managed with heel raises and physiotherapy.
- Flat feet and posterior tibial tendon dysfunction and cavus feet.
- Conservative treatment of shoe inserts to surgical treatments will be discussed with you
- Surgeries are either tendon transfers and osteotomies for minor deformities and triple fusions of thw hind and midfoot for more severe deformities
- Bunions
- painful bunion deformity can be treated well with BOAT (best of all techniques) 1st metatarsal osteotomy, an Akin osteotomy of the proximal phalanx and a lateral soft tissue release
- Lesser toe deformities
- painful clawed and hammer toes are corrected with proximal interphalangeal fusions, Weil osteotomies and soft tissue balancing