The hand | Focus on precision and function

One focus of outpatient surgery is hand surgery. The procedures are usually performed on an outpatient basis and, if possible, under local anesthesia or regional anesthesia.

Common complaints and their surgical treatment:

Carpal tunnel syndrome:

Symptoms: Numbness in the fingers, especially at night, as well as limited fine motor skills and loss of strength.

Cause: Constriction of the median nerve in the area of the carpal tunnel.

Therapy: Surgical splitting of the ligament above it to relieve pressure on the nerve. The typical symptoms should disappear after the operation.

Trigger finger:

Symptoms: When bending, a finger can no longer be stretched. Pain and restricted movement occur because the tendon gets stuck in the tendon sheath.

Treatment: Surgical splitting of the tendon sheath to restore mobility.

Dupuytren's contracture

Symptoms: Hardening of the tendon plate causes the fingers (usually the 4th and 5th) to retract into the palm of the hand.

Therapy: In advanced stages, an operation can help to maintain mobility. However, it is not advisable to operate too early on only slight nodules.

The foot | An area that is frequently affected

Statistics show that around 50% of the adult population in Central Europe suffer from pain or deformities in the area of the forefoot and toes. The most common changes include:

• Hallux valgus: Deviation of the big toe outwards
• Hallux rigidus: painful restriction of movement in the big toe
• Claw and hammer toes: malpositioned toes
• Metatarsalgia: pain in the forefoot area when under strain, often without visible deformities

Non-surgical measures:

In many cases, conservative measures can alleviate complaints:

• Insole treatment: Custom-made insoles relieve the foot.
• Lifestyle changes: Weight loss and appropriate footwear help to reduce strain.

Surgical procedures | When conservative measures are insufficient

If conservative treatments are ineffective in the long term, surgery may be necessary. Modern procedures today offer gentle and effective solutions that are tailored to the individual needs of patients.

Arthroscopic meniscus operations

A meniscus tear has been diagnosed on the basis of your description of your knee problems and clinical examinations i.e. performing certain provocative manual tests. The medial and lateral menisci are sickle-shaped discs of cartilage between the thigh and shin bones, which serve to absorb shock and stabilise the knee joint. In the case of injury, such as rotation during sport or due to joint degeneration in advanced age, a meniscus may tear and parts of it become deposited in the joint-space. The results is pain on moving and when putting weight on the knee, as well as mechanical damage to the joint cartilage.

The aim of the arthroscopic meniscus operation is to remove all torn particles while preserving undamaged meniscus tissue. Only those parts are removed that inhibit the joint function, damage the joint surfaces or cause pain and inflammation. This is done using miniature instruments that have been especially developed for arthroscopic orthopaedics and surgical cutting instruments with a vacuum feature.  In some cases it is possible to arthroscopically suture the meniscus, for example when the tear is very close to the capsule. Removal of the meniscus is then no longer necessary.

Welcome side-effects of arthroscopic orthopaedics are the almost complete absence of pain following the operation, the lack of large scars and the possibility of carrying out ambulatory operations.

As mentioned above, the main advantage of the arthroscopic technique over ‘cutting operations’ is that all intact parts of the meniscus can be left untouched.

Arthroscopic operations for arthrosis and damaged cartilage

Cartilage damage can occur in the knee as a result of injury, overexertion or due to mechanical functions. Four stages can be differentiated:

• swollen cartilage
• frayed cartilag
• undermined and ruptured cartilage
• complete absence of cartilage

Cartilage damage can occur on the cartilaginous joint surfaces of the thigh and shines through mechanical disturbance caused by an old meniscus tear. Minimal incarcerations of meniscus particles between the joint surfaces cause fraying, which can progress to complete abrasion of the cartilaginous surface. The prognosis, with regard to load-bearing capacity and freedom from symptoms following arthroscopic operation of a meniscus, depends on the damage caused to the cartilage by the injury.

Frayed and shredded cartilage is smoothed using special arthroscopic cutting instruments with a vacuum function. All loose particles are sucked out of the joint. Depending on the extent of the findings, the patient needs elbow crutches to keep the weight off the leg for 1 – 4 weeks following the arthroscopic operation.

If there is already complete abrasion of the joint cartilage, treatment involves freeing the bone from dead superficial tissue in order to trigger cartilage production. Using a surgical shaving instrument the bone is superficially shaved until the blood supply to the bone is visible.  This is the only method that facilitates the development of new cartilage-like tissue from within the depth of the shaved bone in 3-6 months, and which is capable of taking over much of the function of the lost joint cartilage. In order to allow the covering layer to become as thick and durable as possible the patient has to use elbow crutches for approx. 6 weeks following the arthroscopic operation. This means that the operated knee only carries out walking movements without taking any weight. We will teach you how to walk using crutches and are sure that you will find it simple to learn.