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General Surgery

 

Most small surgery procedures can be performed on an outpatient basis. A hospital admission is not always necessary, this saves patients time and stress.  Routine surgical procedures which we perform daily are:

 

  • Hernia
  • Tennis Elbow
  • Trigger Finger
  • Tendovaginitis

 

Usually, we can find out whether a surgical procedure is suitable for you straight away during your first consultation appointment.
We will take good care of you in pleasant, comfortable surroundings, starting from your first visit to your final check, providing individual consultation, medical expertise with our dedicated, experienced medical team.

 

Trigger Finger condition

The “Trigger Finger” condition is a disease of the flexor tendons of the fingers. Due to a thickening of the tendon, it no longer slides under a ring ligament available for fixation. The tightness leads to a rubbing effect, which in turn increases the tendon sheath inflammation. There is a sudden “rapid” or “crunch” when the finger is stretched. At the beginning, this is mainly seen in the morning or after a longer rest of the hand, but later with every movement. At an advanced stage, a fixation can also occur, in which case the finger can neither be bent nor stretched.
All fingers can be affected, but the thumb, ring and middle finger are most commonly affected.
In some cases of the disease, however, the “classic” snapping does not occur. There is pronounced pain when the fist is closed or when the fingers are stretched. This symptom is also very pronounced, especially in the morning.

 

Tendovaginitis
Tendovaginitis is an inflammation of the tendons usually caused by repeated minor injury. It usually occurs at the back of the thumb and results in pain
What is Tendovaginitis de Quervain?
It is an infection of the tendon sheaths of the thumb extensor tendons of the wrist. It is caused by an overload. A is caused by scarring and consequent narrowing of the tendon sheath, resulting in considerable pain when the thumb is moved because the tendon can no longer slide freely.

 

Tennis Elbow
What is Tennis Elbow
A tennis elbow, or “epicondylitis” in technical terms, describes a painful irritation of the muscle attachments at the thumb-side bone projection of the elbow. Most affected are middle-aged men and women, i.e. 35-55 years old. As a rule, most people are not tennis players, but rather craftsmen, DIY enthusiasts, housewives, or computer operators .

 

 

Most of smaller surgeries can be done on an outpatient basis.

Hernia, Typewriter’s cramp, tennis elbow, golfer’s elbow and snap finger are treated regularly in our clinics with years of experience.

 

We will determine if an outpatient surgery is suitable for you.

We will look after you with personal attention from first symptom to final check-up.

 

“From head to toe; if something aches or bothers you, we will help!”

Snapping Finger

 

What is a snapping finger?

The “snapping finger” is a disease of  the hand and finger bend tendons. As a result of a thickening of the tendon it will no more slide smoothly underneath a ring tendon, which provides its fixation. The constriction of the tendon leads to friction, which will intensify the tendonitis. Sudden spring-like movement during stretching of the finger can be the result. This phenomenon will appear at first especially after sleep or after an extended period of hand relaxation, later on during every movement of the finger. In advanced stages of the disease the finger may be fixated, so that it can no longer be stretched or bent.

All of the fingers can be affected, although thumb, ring finger and middle finger are most commonly concerned.

In some cases the typical “snapping finger” does not occur. However, severe pain is felt, when closing the hand to a fist or stretching of the fingers.

 

What are the typical symptoms?

In early stages one commonly notices pain induced by pressure or motion located around the first ring tendon, i.e. in the palm right underneath the skin fold of the affected finger. As the disease progresses tendons can no longer slide smoothly, the “snapping finger” occurs later on. The snapping is felt in first joint of the finger, while its cause is the ring tendon in the palm. The snapping can happen without pain, which may change during the course of the disease.

 

What is the treatment of  the treatment for the “snapping finger”?

In the early phase the disease can be treated with anti-inflammatory pills (NSAR).

Often a surgery is necessary, that can be done on an outpatient basis using local anaesthesia of the hand. The procedure usually takes only several minutes. A cut in skin of about 1cm length is used to access the ring tendon, which is then split to give the surrounded tendons the appropriate space. The finger will move without inhibition shortly after surgery.

 

What is important for me to comply with after surgery?

After surgery the patient leaves the practice with a light bandage. After 2-3 days a simple plaster is sufficient. It is important to exercise the finger with movements starting the day after surgery to prevent the resulting scar from clogging the bend tendon. Initially burdensome tasks have to be avoided to prevent distinctive swelling. Fitness for work will be restored after 10-20 days (depending on your profession). Sometimes swellings and problems related to the scar persist until up to 6 weeks after surgery.

Tendovaginitis stenosans de Quervain

 

What is Tendovaginitis de Quervain?

It describes an inflammation of the tendon sheaths of the thumb stretching tendons at the wrist. Overexertion is the cause for this disease. If chronification occurs scarring and as a result tightening of the tendon sheath lead to distinct pain, as the tendon can no longer slide smoothly.

 

How do I recognise Tendovaginitis?

Movement of the thumb results in heavy pain. Gripping objects tight is painful as well. The pain may radiate into the lower arm. A knotty thickening of the tendons at the wrist is common. In later stages the tendons can be totally blocked in their movement.

 

What is the therapy?

In the early phase conservative therapy may lead to success. Anti-inflammatory pills (NSAR), application of ointment and fixation with a plaster splint can alleviate the symptoms.

In chronic stage surgery is the only option, which is done on an outpatient basis using local anaesthesia and will only take several minutes. A 1,5-2 cm cut in the skin is made and then the stretch tendon section is split, so that the tendons can once again slide smoothly and without pain.

 

What is important for me to comply with after surgery?

After surgery the patient leaves the practice with a light bandage. After 2-3 days a simple plaster is sufficient. It is important to exercise the thumb with movements starting the day after surgery to prevent the resulting scar from clogging the bend tendon. Initially burdensome tasks have to be avoided to prevent distinctive swelling. Fitness for work will be restored after 10-20 days (depending on your profession).

Tennis Elbow (Epicondylitis humeri radialis)

 

What is a tennis elbow?

A tennis elbow, or “Epicondylitis” in professional terminology, describes a painful state of irritation of the muscle insertions at the thumb-sided bony protrusion of the elbow. Middle-aged men and women are mostly affected (35-55 years). Usually people who suffer from tennis elbow are not actually tennis players, but craftsmen, handymen, housewives, computer workers and others.

 

How does a tennis elbow develop?

The cause is a regular overexertion of radius-sided lower arm muscles through one-sided exercise or malposition. The resulting tension of the musculature leads to overstress of the muscle insertion at the elbow. An inflammatory irritation emerges, which manifests itself during movement or under applied pressure.

 

How do I recognise the symptoms?

At first one feels a painful tension of the lower arm muscles. Later on stinging and burning sensations can be felt at the elbow upon closing the hand to a fist, stretching the hand away from the lower arm or rotary motions, especially if these motions recur. As the disease progresses a loss of power can be noticed during certain activities.

 

What is the therapy?

In 90% of the cases the symptoms can be alleviated through conservative therapy. The first measure will be to avoid pain-inducing activities. Ointment application and anti-inflammatory pills (NSAR) relieve the acute pain and the inflammatory irritation. Injections of cortisone compounds can also be used to reduce the pain. Fixation with a plaster splint to treat the acute inflammation is a short-term procedure. Special tapes, so-called “Kinesiotapes” are often applied to support arm-movement. Wearing an orthosis and its measured pressure on muscle insertion has also a pain reducing effect. Physiotherapy and manual therapy stretch the tense muscles, exercises for self-therapy can be learned.

 

In 10% of the cases conservative therapy does not lead to success. In this case a surgery is indicated as the only remaining option. The muscle insertions will be notched, which results in a relief of muscle tension. By sclerosing the nerves atop of the bone in indicated areas the pain can be alleviated.

By using the “Wilhelm-method” our success rate is 90%, i.e. nine out of ten of our patients are permanently relieved from pain after surgery.

“Wilhelm-method” means that the surgery is done on an outpatient basis during anaesthesia. After surgery the concerning arm has to be fixated with an orthopedic splint for the period of wound healing, i.e. 10-14 days. Simultaneously exercises begin under professional physiotherapeutical instruction . Depending on your profession the estimated time until return to the workplace is possible is 4-6 weeks.