Hand Surgery with Dr. Spiegl
Treatment of Nerve, Tendon and Connective Tissue Conditions of the Hand in Salzburg and the Tullnerfeld
Unlike aesthetic procedures, hand surgery is medically indicated: it restores function. Nerve compression syndromes such as carpal tunnel or cubital tunnel syndrome, and tendon or connective tissue conditions such as trigger finger or Dupuytren’s disease, lead if left untreated to loss of strength, permanent nerve damage or fixed flexion contractures – which is why the timing of treatment is itself part of the outcome. Dr. Matthias Spiegl is a board-certified specialist in Plastic, Reconstructive and Aesthetic Surgery with many years of experience in hand and microsurgery. A large proportion of these procedures is performed on an outpatient basis under local or regional anaesthesia and takes between twenty minutes and one hour. For carpal tunnel syndrome and trigger finger, an ultrasound-guided technique that requires virtually no skin incision is also available. The overview below introduces the conditions treated – each detail page covers diagnosis, technique, aftercare and costs.
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Carpal Tunnel Syndrome
In carpal tunnel syndrome the median nerve is compressed at the wrist. Characteristic symptoms are tingling, numbness and pain in the thumb, index and middle finger, particularly at night; at an advanced stage, loss of strength and wasting of the thenar muscles are added. A night splint and infiltration therapy usually improve the symptoms only temporarily, which is why division of the carpal ligament is recommended in most cases – preferably ultrasound-guided and with virtually no skin incision, otherwise using a mini-open technique through approximately two and a half centimetres. The procedure takes twenty to thirty minutes under local infiltration anaesthesia and is performed on an outpatient basis; sutures are removed after ten to fourteen days, whereas full recovery of the nerve may take a year or longer.
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Trigger Finger
In trigger finger (tenosynovitis stenosans) the flexor tendon no longer glides freely through its sheath, usually because of a narrowing at the A1 pulley. The movement catches and snaps, and in advanced cases the finger locks in a flexed position; the thumb, middle and ring finger are most commonly affected. Conservative treatment comes first – immobilisation, injections, anti-inflammatory measures – and if this fails or the finger remains locked, the pulley is divided in a targeted manner, in many cases ultrasound-guided and minimally invasive, alternatively as an open procedure leaving a scar of about one and a half centimetres. The procedure takes twenty to thirty minutes under local anaesthesia; the snapping usually disappears immediately, and the hand is fully load-bearing again after two to three weeks.
Dupuytren’s Disease
Dupuytren’s disease is a benign, non-inflammatory connective tissue disorder of the palm: nodules and cords form beneath the skin and can draw the fingers – most commonly the ring and little finger – permanently into flexion. The condition usually progresses slowly, though the rate is difficult to predict; left untreated it leads to fixed flexion contractures. Surgical options are selective fasciectomy, in which only the affected connective tissue is removed while healthy structures are preserved, and partial fasciectomy to release individual finger segments; in selected cases a minimally invasive approach is possible. The procedure takes 45 to 60 minutes under regional anaesthesia (brachial plexus block) or general anaesthesia; physiotherapy or occupational therapy begins in the first or second week and is essential to the result.
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Cubital Tunnel Syndrome
Cubital tunnel syndrome, also known as ulnar sulcus syndrome, is the second most common nerve compression disorder of the upper limb after carpal tunnel syndrome: the ulnar nerve is compressed at the elbow. Typical symptoms are tingling or numbness in the ring and little finger, a feeling of weakness in the hand and uncertainty when gripping or typing; in advanced cases the hand musculature wastes. Depending on the findings, the nerve is either released from the constricting tissue by neurolysis or – where compression is severe or the nerve unstable – transposed anteriorly. The procedure takes approximately one hour under regional anaesthesia, optionally with twilight sedation or under general anaesthesia; because nerves regenerate slowly, the final result only becomes apparent after six to twelve months.
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Ganglion Cyst
A ganglion cyst is a benign, fluid-filled cyst close to a joint or tendon sheath, most commonly at the wrist, on the fingers or on the dorsum of the foot. Because the finding is benign, surgery is not strictly necessary: it is recommended in cases of pain, restricted movement, recurrent swelling, or where the cause of the swelling is unclear. Decisive for a lasting result is removal of the cyst together with its stalk and its connection to the joint capsule or tendon sheath – with mere puncture, or if the stalk is incompletely removed, the risk of recurrence rises considerably. Access is through a small, precise skin incision, the procedure takes approximately 30 to 60 minutes under regional or general anaesthesia and is performed on an outpatient basis.
