The hand

A further focus of ambulatory operations is hand surgery. All hand surgery is ambulatory and a local or regional anaesthesia is given whenever possible. Below are some frequent hand disorders that may require surgery due to their duration and the failure of orthodox treatment.

Patients with a carpal tunnel syndrome have no feeling in the fingers, usually during the night. Over time, fine motoric disturbances arise and there may be loss of strength. This is caused by restriction of the median nerve in the area of the carpal bones. The overlying ligament is split in an operation, allowing the nerve more space. The symptoms should already have disappeared by the first night after the operation.

Trigger finger syndrome: whereby one finger cannot be extended again after bending. The tendon becomes trapped in the tendon sheath at the base of the finger, causing pain and inhibiting movement. The condition ceases when the tendon sheath is surgically split.

Dupuytren´s contracture: the subcutaneous layer of tissue (fascia) in the hand becomes hardened or shrinks and progressively pulls the fingers into the palm of the hand. This usually affects the ring and small finger.

Although this disease should not be operated on in the early stage (formation of small lumps in the palm)

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.

The foot

According to statistics, about 50% of the adult population of Central Europe have painful or deformed feet or toes.
The main deformities are hallux valgus (bunions), hallux rigidus (pain and stiffness and of the big toe), claw toe and hammertoe. A common complaint is metatarsalgy, which is the occurrence of foot pain without visible changes. A lot of these complaints can be treated with shoe inlays and relieved, not least, by changing e.g., footwear, living or eating habits and reducing weight. If, however, these measures do not result in long-term improvements, surgical pain management may be the only alternative. But, a lot of patients are afraid of foot surgery; whether due to their own negative past experience or to accounts they have heard from others. This is understandable considering that legitimate methods of treatment in the past included ‘disfiguring operations’ such as removal of a joint and even amputation. The results were often unsatisfactory, both from their aesthetic as well as their functional aspect. Over the past years a number of entirely new operating techniques have been developed -particularly in the USA and France- that have a number of decisive advantages:

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.