Hand Surgery

Many hand operations take less than half an hour. The therapy afterward decides how well the hand works.

In a randomized trial of 176 patients with carpal tunnel syndrome, 90 percent of those treated with surgery counted the treatment a success at eighteen months, against 75 percent of those treated with a night splint.

What hand surgery treats

Most hand operations fall into two groups. The first is wear and pressure, which builds slowly over months or years, so carpal tunnel syndrome, trigger finger, Dupuytren disease, arthritis at the base of the thumb and ganglion cysts belong here, and almost all of them can be planned, done in a day and followed by a short trip home. The second is injury, a cut tendon, a nerve divided by glass, a broken finger or wrist bone that has healed crooked or not at all, where timing matters and some repairs work best within days of the accident. Children with a congenital difference of the hand, such as joined or extra fingers, form a third and smaller group with its own timing. Whatever the group, the aim is the same, a hand that feels, grips and opens fully, and the surgeon judges success by what you can do with it in daily life rather than by the look of the scar.

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Carpal tunnel, a splint or an operation

Night numbness in the thumb, index and middle fingers is the classic first sign.

One Dutch trial, published in JAMA in 2002, assigned 176 patients by chance with carpal tunnel syndrome to a night splint or to surgical release of the nerve, and three months later 80 percent of the surgical group counted the treatment a success against 54 percent of the splint group, a gap that held at eighteen months with 90 against 75 percent. By then 41 percent of the patients who started in a splint had chosen surgery anyway. Surgery gave better results for most patients. A splint remained a fair first step for mild symptoms, and nerve conduction tests confirm the diagnosis and show how hard the nerve has been squeezed before anyone decides.

The release itself takes ten to fifteen minutes.

Trigger finger and Dupuytren disease

Trigger finger

When a tendon catches in its tunnel, the finger clicks or locks in the palm. A steroid injection settles many cases, and when it does not, an open release of the first pulley succeeds in 90 to 100 percent of published series, takes minutes under local anesthesia, and in one large review of 795 releases led to minor complications in 9.6 percent and major ones in 2.4 percent.

Dupuytren disease

Thick cords in the palm draw one or more fingers down until the hand will not lie flat on a table. The choice lies between a needle fasciotomy, which divides the cord through the skin with a needle in a few minutes, and a limited fasciectomy, which removes the diseased tissue through an incision and needs weeks of therapy. A trial from Groningen followed 111 patients for five years and found the cords had come back in 84.9 percent after needle fasciotomy against 20.9 percent after fasciectomy, yet 53 percent of the needle group said they would choose the needle again for a recurrence, because the first recovery had been so quick.

Quick now, or lasting longer.

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Arthritis at the base of the thumb

Pain at the base of the thumb when pinching, opening jars or turning a key often comes from wear in the small joint between the thumb metacarpal and the trapezium bone. Splints, hand therapy and injections come first, and surgery waits until they no longer help.

Eleven trials with 670 patients went into a Cochrane review, updated in 2015, which compared seven operations for this joint and found that none was clearly better than another for pain or function, while simple removal of the trapezium caused 10 adverse events per 100 patients against 19 when a tendon reconstruction was added. Many surgeons therefore keep the operation simple.

The simplest operation held its own.

Awake surgery under local anesthesia

Wide awake local anesthesia with no tourniquet, known by its initials WALANT, uses lidocaine mixed with epinephrine injected around the operation site, so the hand goes numb, bleeding stays low and no arm cuff is needed. You stay awake, eat as usual beforehand and can move the finger on the table, which lets the surgeon check a tendon repair or a release while the wound is still open.

In a 2013 study of 200 carpal tunnel releases, patients treated awake spent 2.6 hours at the hospital against 4.0 hours for sedated patients, needed preoperative blood tests, heart tracings or chest X-rays in 3 percent of cases against 48 percent, and used opioid painkillers in 5 percent against 67 percent. Both groups liked the method they had received, and 93 percent of each would choose it again.

Awake surgery has limits. Long reconstructions, large bone work and very anxious patients still suit a regional block or general anesthesia.

Tendon, nerve and bone injuries

Act fast after a cut.

Surgeons repair a flexor tendon cut in the finger within the first days, before the ends pull back and stiffen, and a divided nerve is joined under magnification, with recovery of feeling creeping forward at roughly a millimeter a day. Fractures of the fingers and wrist are held with wires, screws or small plates when they are unstable or the joint surface is broken, and a fracture that healed crooked or never healed can be corrected later with an osteotomy or a bone graft. Reattachment of an amputated finger and free tissue transfer belong to microsurgery and are covered on that page.

Getting ready for surgery

Risks and how they are kept low

Serious complications are uncommon after planned hand operations.

Most problems come down to a tender scar, stiffness or swelling that settle with therapy over weeks.

Hand therapy and recovery

Therapy decides half the result.

After a carpal tunnel or trigger finger release, most people bend and straighten the fingers the same day, use the hand for light tasks such as eating and typing within days, and wait two to four weeks before heavy gripping, and night numbness often eases within the first nights, while long-standing numbness and lost thumb strength can take months to return and sometimes never fully do. A fasciectomy or a tendon repair is different, because a therapist makes a custom splint in the first days, teaches a precise exercise program that protects the repair while keeping it gliding, and checks progress over the following six to twelve weeks, because a repaired tendon left still sticks to its surroundings and a repaired tendon pulled too hard can snap. Hand therapy lives in the balance between those two dangers, and patients who keep to the program at home, several short sessions a day rather than one long one, regain the most movement. Stitches come out at ten to fourteen days.

A nurse at home can remove them.

How long to stay in Istanbul

Plan for three to seven days.

Istanbul carpal tunnel packages published online include one night in hospital, and a release under local anesthesia often needs none at all, so a short trip covers the consultation, the operation and a wound check before you fly. Fasciectomy, trapeziectomy and tendon repair call for a week so that the therapist can fit the splint and teach the exercises, and a longer reconstruction or a complex injury can need more. Flying is fine within a day or two of a small operation, with the hand raised on a cushion.

What decides the cost

The type of operation, local or general anesthesia, any implant or graft, a hospital night and the number of therapy sessions set most of the figure.

Published carpal tunnel packages in Istanbul list the operation with anesthesia, one night in hospital, the consultation before surgery, transfers and an interpreter, and leave out flights and hotel nights, while some add an imaging test only when the surgeon asks for it. Take-home medicines, a ready-made brace and therapy sessions after discharge sit outside several of them, so ask what happens if you need one more wound check or session before you fly. A quote you can compare names the operation, the anesthesia, the nights in hospital and the therapy sessions. That figure comes only from a hand surgeon reading your records. Thumb base surgery and tendon repairs add a custom splint and more therapy sessions, an injury repaired weeks late may need a graft and a longer operation, and when both hands need a carpal tunnel release, doing them in one sitting or on separate days changes both the plan and the figure. The review costs nothing.

Arranging the trip

Your coordinator answers the first WhatsApp message, stays with you until you fly home and keeps the same number afterward, and the team speaks English, Arabic, French, Russian, Serbian, Romanian and Spanish, with an interpreter for any other language. One person can stay in your room on a companion bed, and the international patients office books the hotel, sends the invitation letter for a medical visa ten days before travel and arranges transfers. Halal, vegetarian and diabetic meals come from the hospital kitchen, a prayer room sits on site, and a request for a female physician goes to the department with your first message.

Bring loose clothes with wide sleeves.

Once you are back home

Keep the hand raised for the first days and the dressing dry. A local therapist can continue the program the team in Istanbul wrote, and photos or videos of the finger moving reach the surgeon through the coordinator on WhatsApp.

Spreading redness, fever, a wound that opens or leaks, or a sudden loss of movement after a tendon repair. Each needs a doctor the same day.

Hand surgery FAQ