Complications following hand and wrist surgery are fortunately rare and vary depending on the specific procedure performed, the patient's overall health, and other individual factors.

Surgery should always be viewed as a last resort having explored and considered non operative options including :

• Do nothing and allow the natural history of the condition to play out
• Pain killers including paracetamol and NSAID's
• Rest and splinting 
• Physiotherapy
• Injections – cortisone etc.

Most patients experience positive outcomes from hand and wrist surgeries however complications can occur even in the hands of the best and most experienced of surgeons. 

The risks of surgery will be discussed in person at the time of consultation should you require surgery. Mike would be happy to see any patient at a separate consent clinic if they require more time or information over and above what was discussed at the appointment or outlined below.

This list of risks and complications is not designed to scare you or put you off surgery as the majority of his patients are very pleased with the results but do allow the patient to make an informed decision on whether to go ahead with surgery.

 

Failure to resolve symptoms

Our aim is to improve your symptoms.  On rare occasions unfortunately, this may not occur and maybe related to your case complexity. 

Some conditions can recur even after initial successful surgery including Dupuytrens contracture and carpal tunnel syndrome.

Infection

The hand has an excellent blood supply and therefore post-operative infections are rare. Signs of infection would be redness, pain and swelling around the surgical site and developing after a few days (3-10 days) rather than immediately post operation (1-2 days) which may be a normal reaction to surgery.

If you have any concerns, please do not hesitate contact Mike to review your wounds by photograph, video consultation or face to face assessment. 

Most infections are superficial and can be easily treated with dressings or oral antibiotics. More severe cases may have a deep infection that require a further operation to clean the wound ( debridement) or intra venous antibiotics as an inpatient. 

Very occasionally, about 1 in 20 patients develop a small pin head size white area around the white dissolvable suture (vicryl rapide) that can easily be released with a small sterile needle. This is a poorly understood reaction to the dissolving stitch rather than an infection. If this occurs simply send Mike a photo for reassurance and advice.

Ongoing pain

After any operation there will be some pain. We would hope that the majority of discomfort will settle within the first few days or week of the operation. The duration of post operative pain will depend upon the type of operation and this can be discussed in clinic.

Swelling

All wounds swell after an operation and the majority of swelling will have settled within the first week and swelling after 1-2 weeks would need reviewing.

Bleeding

There will always be a small amount of ooze into the dressings  after an operation and is preferable to allow the blood to escape than remain inside the wound developing a haematoma (collection of blood) which can be prone to infection. If bleeding continues after a few days we would need review the wound. A haematoma is a collection of blood outside a blood vessel and if very large, may need releasing. 

Scarring

Scars on the hand heal very well and often barely noticeable. Mike tends to use a stitch called vicryl rapide that dissolves and can be brushed off after 2-4 weeks. On the palm of the hand the stitches are usually interrupted and exposed, whereas on the back of the hand they are buried under the skin and called subcuticular and cannot be seen, apart from two small knots at either end of the wound. His open carpal tunnel stitch however tends to be subcuticular and buried.

Bruising

Bleeding is inevitable after an operation and sometimes this comes to the skin as a bruise. This will be red after a few days turning black and blue before fading after a week or 10 days. 

Weakness

Weakness can be caused by ongoing pain or a restriction of movement. Most operations hopefully maintain or increase strength, but occasionally patients can experience a mild degree of weakness. Severe weakness would be very rare.

Stiffness

After an operation you may develop internal scarring, which in turn can restrict the range of movement of a joint. We would hope that most of the movement would return but there may sometimes be a permanent restriction of movement. This does not usually cause much in the way of functional problem.

Nerve injury

Nerves are small soft electrical “wires” that transport information to and from the brain to the periphery.

Most nerves are mixed and have motor (movement) and sensory (sensation) roles.

The motor component sends information to a muscle to tell it to contract, while the sensory component carries information back from the skin about a variety of sensations including touch, temperature and pain.

Nerves may be injured as part of an injury but in very rare occasions can be injured during surgery. Mike takes particular care to identify all important nerves during your surgery and retract them out of harms way. Despite this very rarely they can still be injured.

If a nerve is injured, then the function may be affected. Some nerves are bruised and recovery may occur over a few months. Some nerves are permanently injured and therefore recovery is not possible leaving areas of numbness and weakness to a muscle or group of muscles.

Neuroma

A neuroma occurs when a nerve is injured. The end of the nerve that is cut or damaged overgrows and forms a knot of nerve tissue that is very painful. Neuromas can be difficult to treat. Common treatments include hand therapy to desensitise the area, neuromodulation (using variety of techniques including vibration to re-educate and settle the nerve end) and ultimately surgery to locate the neuroma and bury into a protective environment such as an adjacent bone or muscle.

Numbness

Numbness may occur if a sensory nerve is bruised after an operation and recovers over a 3-6-month period. If a nerve is cut, then sensation may never recover.

Tendon injury

Tendons are smooth cord like structures that connect a muscle to a bone. When a muscles contracts it shortens and pulls on the tendon that is attached to a bone and moves the bone and adjacent joint. Tendons can be injured in surgery and this would affect the joint(s) moving. Tendons are identified during the operation and protected but very rarely they still can be injured.

Some tendons can rupture spontaneously (without surgery or intervention) and this can occur for example after a wrist fracture.  The tendon may have a compromised blood supply due to swelling, become macerated as it passes over a rough sharp edge of bone or in some diseases such as rheumatoid arthritis.

Fractures

Fractures can occur during an operation despite careful handling of the surrounding tissues and bones. Fractures are rare and the majority are small cracks in the bone that heal uneventfully and without intervention. Larger cracks may need fixation at the time of surgery to prevent problems post operatively. 

 

Complex Regional Pain Syndrome (CRPS)

CRPS can occur after any injury including surgery. As its name suggests it is a complex condition with many factors at play. To reduce the risk of it occurring we always recommend to move the hand and fingers as soon as possible after surgery and keep them moving. Sometimes fingers and wrists are immobilised after an injury or operation and cannot be moved but all the other joints should be kept moving.

CRPS causes redness, swelling and pain. In severe cases the hand may become red and shiny and abnormal hair growth forms. CRPS is very rare in Mike's practice and much less that 0.5%.

Mike routinely uses a hand therapist post operatively and is likely to be one of the reasons for his low rates of CRPS.

Instability

Joints are connected to each other by ligaments. Ligaments can be injured in an accident or during surgery. Mike knows where the important ligaments are in the hand and wrist and will avoid injuring them. However, sometimes after operations such as joint replacements or joint reconstructions the ligaments do not function as well causing instability (abnormal excessive movement of a joint) and ultimately dislocation when the joint comes out of socket. 

Dislocation

This occurs when a joint – artificial or the original joint comes out of place resulting in pain and reduced movement. The treatment is usually to put the joint back into place and stabilise with either a splint or in rare occasions another operation to revise the artificial joint or stabilise it.

Joint replacement

When a joint is replaced, it is done so with an artificial material that will wear out over time and in such cases they may need revising to a new implant or an alternative procedure.

Joints that are replacement can dislocate and come out of socket.

When placing an implant into the bone a fracture can occur despite great care taken to avoid this. Depending upon which bone is affected a variety of techniques are required to resolve or salvage the situation.  

Compartment Syndrome

After an injury or major operation swelling can occur in the limb. The swelling may be constricted by the surrounding firm fibrous bags inside the hand and arms. 

Pain starts to develop progressively getting worse and worse, and becomes disproportional to the pain one would normally expect after an operation or injury. Tingling in the fingers is a very late stage and extreme pain is the main symptom particularly on moving the fingers. This is a surgical emergency and the pressure needs relieving by a trained doctor often removing the dressings and cast but sometimes releasing the tight fibrous bags in the arm with open surgery. If you have any concerns you should contact Mike immediately or attend an emergency department for advise.

Cold intolerance

Cold intolerance is poorly understood and can occur as a result of injury to the fingers including surgery. An abnormal response may occur to cold environments and cause colour change, pain, stiffness and altered sensation. It generally improves after injury but symptoms after 18 months may be permanent. 

Non union / Mal union

Bones usually heal without problems.

Bones need to heal in a variety of situations including

• after a fracture
• after an operation designed to fuse a joint
• or after an osteotomy (intentional operation to cut a bone to improve its shape)

Some bones are prone to not healing either as a result of an injury or after an operation. If a bone fails to heal it is called a non union and if it heals in an abnormal position it is called a mal union. Non unions can be either painful or painless. If a painful non union it usually needs further intervention to get the bone to heal.

If after a joint fusion operation, the bone does not heal and is painful, this may need further surgery.

If a non union is painless it may be stable and not require intervention.

Smoking is known to affect bone healing and should be stopped several moths before surgery if outcome is to be optimised.