Hand Surgery Procedures:

Dr. Iyengar has completed a fellowship in hand and upper extremity surgery, and is able to offer expertise in the follow procedures: 

Carpal Tunnel Syndrome and Surgery

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes compressed as it passes through the narrow carpal tunnel at the wrist. This condition often causes numbness, tingling, or pain in the thumb, index, and middle fingers, and can lead to weakness in grip strength if left untreated.

Standard Carpal Tunnel Release:
This traditional surgery involves making an incision in the palm to access the carpal ligament. The ligament is carefully cut to relieve pressure on the median nerve, alleviating symptoms and preventing further nerve damage. Over time, the ligament heals, allowing the space within the carpal tunnel to expand.

Endoscopic Carpal Tunnel Release:
This minimally invasive approach involves a small incision, typically in the wrist or palm. Using an endoscope—a thin, flexible tube with a camera—Dr. Iyengar releases the carpal ligament with precision, minimizing trauma to surrounding tissues. This technique generally results in less post-operative pain, faster recovery, and smaller scars.

Cubital Tunnel Syndrome and Surgery

Cubital tunnel syndrome occurs when the ulnar nerve, which passes along the inside of the elbow (the "funny bone"), becomes compressed. Symptoms include numbness, tingling, or weakness in the ring and little fingers, as well as discomfort in the elbow or forearm.

Cubital Tunnel Release:
This common procedure relieves pressure on the ulnar nerve by opening or expanding the roof of the cubital tunnel. This allows the nerve more room to move and reduces irritation.

Ulnar Nerve Transposition:
In more advanced cases, the ulnar nerve is repositioned from behind the elbow to the front, preventing it from getting pinched when the elbow is bent. This approach reduces symptoms, improves function, and lowers the risk of further compression.

Trigger Finger Treatment

Trigger finger, or stenosing tenosynovitis, occurs when the flexor tendon in the finger or thumb becomes inflamed and catches within its sheath, causing the finger to get stuck in a bent position. It may straighten with a sudden "snap," similar to pulling and releasing a trigger.

Steroid Injections:
For mild cases, corticosteroid injections into the tendon sheath can reduce inflammation, allowing the tendon to glide smoothly. This treatment can provide relief for several months, though symptoms may recur.

Trigger Finger Release Surgery:
For persistent or severe cases, Dr. Iyengar performs a trigger finger release. A small incision is made to open the tendon sheath, allowing the tendon to move freely without catching. This straightforward surgery provides lasting relief and restores full finger function.

Dupuytren’s Disease and Treatment

Dupuytren’s disease causes the connective tissue under the skin of the palm to thicken and form cords, gradually pulling the fingers into a bent position. As the condition progresses, it can interfere with daily activities like grasping objects or shaking hands.

Needle Aponeurotomy:
This minimally invasive technique uses a fine needle to break the thickened bands of fascia, releasing the contracted fingers. Needle aponeurotomy is often recommended for early-stage disease and offers a faster recovery with minimal scarring.

Fasciectomy (Partial or Total):
In more advanced cases, a fasciectomy may be performed to remove the diseased fascia. A partial fasciectomy removes only the affected tissue, while a total fasciectomy removes all thickened tissue. This surgery corrects finger deformities, restores hand function, and offers a longer-lasting solution.

Wrist Fractures (Distal Radius/Ulna) and Treatment

Wrist fractures, particularly of the distal radius or ulna, are common injuries caused by falls or trauma. Symptoms include pain, swelling, bruising, and difficulty moving the wrist. Proper treatment is essential to restore wrist function and prevent long-term complications.

Open Reduction and Internal Fixation (ORIF):
ORIF is the standard treatment for severe or displaced fractures. Dr. Iyengar realigns the bones through an incision and stabilizes them using plates, screws, or wires. This ensures proper healing and restores function.

Percutaneous Pinning:
For less severe fractures, small pins or wires are inserted through the skin to hold the bones in place without the need for large incisions. This technique is often used in conjunction with other procedures to maintain alignment during healing.

Bone Grafting:
In cases where bone loss or multiple fracture fragments are present, bone grafts are used to fill in gaps and promote healing. The graft can come from the patient’s own body (autograft) or a donor (allograft).

External Fixation:
For complex fractures with significant soft tissue damage, external fixation may be used temporarily. Pins or screws are inserted into the bones and attached to an external frame, providing stability while soft tissue healing occurs before definitive surgery.