5 myths about hand surgery

Hand pain, stiffness or injury can disrupt even the simplest daily tasks — from buttoning a shirt to texting. When these issues persist, hand surgery might be recommended to restore comfort and mobility. But despite its potential benefits, hand surgery is often misunderstood.

To help clear up the confusion, MultiCare hand surgeons Benjamin Welling, MD, and Justin Barker, MD, address five common myths about hand surgery.

Myth: Steroid injections are temporary and unsafe.
Truth: Single steroid shots are very safe and can sometimes be curative.

Dr. Welling: People tend to have an aversion to steroid injections because they think they only temporarily relieve symptoms. But steroid injections can actually be curative in some cases.

A good example is trigger finger. This is a condition that can be really painful and greatly affect a person’s life. Some may feel strongly about having surgery, not knowing that steroid shots are oftentimes curative for trigger finger. I’ll recommend that we start off with a steroid shot and, as a result of the shot, the inflammatory process that’s producing the trigger finger will be disrupted enough that the trigger finger will go away.

That’s also true for other conditions like tendonitis, where steroid shots are not a Band-Aid treatment, but can be curative.

Not only can steroid shots help with symptoms and sometimes be curative, but they can also help clarify diagnoses and be predictive of surgical success. If we see dramatic improvement from a steroid shot and then symptoms come back, that’s actually very helpful in terms of a diagnosis because it shows surgery will be successful. If they get no response, that can suggest surgery will be less successful.

That can be surprising to people because they will think if the steroid shot didn’t work, then we should proceed straight to surgery, but it’s kind of the opposite. Usually we like to see a steroid shot work but then wear off before we proceed surgically.

Another reason people may be apprehensive of steroid shots is because they view them as potentially harmful. The data behind the harmful effects of steroid shots are largely confined to very young patients who are receiving multiple shots into a joint, causing cartilage to weaken. This is not true for single injections, even in the young, and it’s especially not true for injections around tendons. A single injection is very safe, helpful and often curative.

Myth: All post-surgical pain should be treated with narcotics.
Truth: Nonnarcotics can be much better at controlling pain after surgeries that affect soft tissue.

Dr. Welling: I’m very committed to the pain relief of my patients, but always treating pain after surgery with narcotics is not good practice and not always the right thing to do.

For instance, I do not regularly prescribe narcotics for surgeries that just affect soft tissue, like carpal tunnel surgeries or trigger-finger surgeries, because the risk is greater than the benefit. I do have a very specific regimen of nonnarcotic medications that I have patients take, particularly Tylenol and NSAIDs. A well-regimented dose of Tylenol (acetaminophen) and ibuprofen can be much better at controlling pain than something like hydrocodone or oxycodone.

Pain has always been a difficult thing to predict. Some people have zero pain after a profoundly invasive surgery, while others have severe pain even after a small, minimally invasive surgery.

I think pain is a fascinating part of human physiology because the perception of pain is as unique as the person experiencing it. I’m starting to view pain similarly to how I view individual personalities.

Myth: Hand therapy isn’t necessary after surgery.
Truth: Hand therapy is crucial after some surgeries, like tendon repairs.

Dr. Welling: It’s not needed for carpal tunnel or trigger-finger surgeries, but there are some surgeries, particularly tendon repairs, where hand therapy is not just important; it’s crucial.

People might think after surgery, once they are using their hands, that that should be therapy enough, but seeing a hand therapist is an essential component of treatment.

Hand therapists are unique in that they are actually occupational therapists, not physical therapists, with separate subspecialty training. The difference between a dentist and a chiropractor is the difference I see between a hand therapist and a physical therapist. We have such a different swath of treatment mechanisms or methods for nerve-related pain.

The magic happens when you have a good surgeon and good hand therapist. You can have an incredible outcome with that combination.

Myth: Surgery is the only option.
Truth: Many nonsurgical options can help hand pain.

Dr. Barker: People may think any time you go to a hand surgeon you have to have surgery. That’s not the case. The majority of patients we treat don’t require surgery.

When a patient comes in, we like to look at their overall health picture. What is their occupation? What are their leisure activities? What responsibilities do they have at home? Once we have a full picture of the person, we look at the problem they’re coming in with and if it can be helped by nonsurgical means, and we make the decision together.

For many conditions, time can be a very good healer. We just have to give it time and have them avoid the activity that’s aggravating the problem. Two or even four weeks might feel like a long time to deal with a problem, but in the grand scheme of things, it might not be long at all.

Trying a brace, taking a regular course of ibuprofen or Tylenol (acetaminophen), doing hand therapy or having a steroid injection are also nonsurgical methods that can help patients. It’s important to know if you step foot in a hand surgeon’s office, you’re not going to automatically be signed up for hand surgery.

Myth: Surgery is the most aggressive form of treatment.
Truth: Sometimes surgery is actually the conservative treatment.

Dr. Barker: I think people often get confused about what is considered conservative treatment and what is considered aggressive treatment. Surgery is regarded as a conservative treatment option when noninvasive methods fail to effectively manage a condition.

An example would be if someone has a finger infection that’s brewing. We could try an oral antibiotic, which would mean waiting a week or two to see if it improves. Or, we do surgery the next day that takes 15 minutes. We wash out the infection, and they start to get better in three days instead of waiting a week. Surgery would be considered the conservative method in this case because it gets them back to work and life more quickly.

Another example: Someone has a badly broken wrist that’s really crooked. We could put their wrist in a cast and hope it gets better and straightens over time. That could be seen as conservative because we’re not cutting, but they will likely end up with a crooked wrist. Whereas if we do surgery within a week, we can make the bone straight and give them a better outcome.