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

A syndrome where the median nerve in the forearm becomes compressed, causing  numbness, tingling or pain in the hand/wrist. 

• A standard carpal tunnel release surgery involves cutting the ligament that forms the roof of the carpal tunnel to relieve pressure on the nerve 

• An endoscopic carpal tunnel is minimally invasive. A small incision is made, and an endoscope is used to release the carpal ligament 

Cubital Tunnel

A syndrome that occurs when the ulnar nerve becomes compressed, causing numbness, tingling or weakness in the elbow, forearm, hand or fingers. 

• Cubital tunnel release surgery is the most common procedure for cubital tunnel syndrome. The roof of the cubital tunnel is widened to relieve pressure on the ulnar nerve 

• Ulnar nerve transposition is a procedure used to move the ulnar nerve in front of the elbow joint, reducing pressure on the nerve

Trigger finger

Also known as stenosing tenosynovitis, this condition causes the affected finger to get stuck in a bent position and then suddenly snap straight, resembling the action of pulling and releasing a trigger 

• Steroid injections can decrease inflammation of the flexor tendon 

• Trigger finger release surgery involves releasing the tight constricted portion of the tendon sheath, allowing the tendon to move more freely and reducing pain and swelling.

Dupuytren’s Disease

This is a condition characterized by the thickening and tightening of the connective tissue (fascia) beneath the skin of the palm and fingers. This can lead to the fingers becoming bent or curled, making it difficult to straighten them fully.

• Needle aponeurotomy: This technique involves using a needle to break up the tight bands of fascia without making large incisions. This method is typically used for early stage Dupuytren’s contracture and can result in faster recovery and less scarring compared to open surgery.

• Fasciectomy: In this procedure, the surgeon removes the diseased or thickened fascia tissue from the palm and fingers. Partial fasciectomy removes only a portion of the affected tissue, while total fasciectomy removes all of the diseased tissue. Fasciectomy aims to correct finger deformities and restore hand function.

Wrist Fractures (Distal Radius/Ulna) 

Distal radius and ulna wrist fractures are common injuries that occur near the end of the forearm bones, specifically the radius and ulna, close to the wrist joint. Distal radius fractures are the most commonly encountered broken bones in the Emergency Room. These fractures can result from falls, sports injuries, or other traumatic events and can cause pain, swelling, deformity, and can limit wrist and hand function.

• Open reduction and internal fixation (ORIF): This is the most common surgical procedure for severe or displaced fractures. During ORIF, the surgeon makes an incision to realign the fractured bones (reduction) and then uses plates, screws, wires, or pins to hold the bones in place (internal fixation). This stabilizes the fracture and promotes proper healing.Percutaneous pinning: This minimally invasive technique involves using pins or wires inserted through the skin and into the fractured bones to hold them in alignment.

• Percutaneous pinning is often used for less severe fractures or as an adjunct to other surgical techniques.Bone grafting: In cases where there is significant bone loss or comminution (multiple fracture fragments), bone grafts may be used to fill in gaps and promote bone healing.

• Bone grafts can be harvested from the patient’s own body (autograft) or obtained from a donor (allograft).External fixation: In some cases, external fixation may be used as a temporary measure to stabilize the fractured bones.

• External fixation involves placing pins or screws into the bones above and below the fracture site and connecting them to an external frame outside the body. This provides stability while allowing for swelling reduction and soft tissue healing before definitive surgical treatment.