Diagnostics of carpal tunnel syndrome in University Hospital Greifswald

About the department

The Department of Hand Surgery at the University Hospital Greifswald offers the full range of services in its area of specialization. The medical facility provides modern diagnostics and treatment for all hand diseases. Replantation surgery is available 24 hours a day. The department's surgeons demonstrate excellent results in plastic surgery to close skin and soft tissue defects using microsurgical transplants. Reconstructive microsurgical interventions on the peripheral nerves are successfully performed in the operating rooms of the medical facility. Depending on the clinical indications, operations can be performed on an inpatient or outpatient basis. Since 2013, the department has been a certified Hand Trauma Center (certificate of the Federation of European Societies for Surgery of the Hand, FESSH). The department's specialists work in operating rooms equipped with state-of-the-art technology. Advanced surgical microscopes, monitoring devices, and computer technology provide the most accurate interventions with minimal trauma rates. The professionalism of the department's doctors also plays a decisive role in hand surgery because such operations require deep expert knowledge and experience. The department is headed by Prof. Dr. med. Andreas Eisenschenk.

For many years, the department has been successfully performing surgery to replant the whole hand and individual fingers. Such interventions are classified as complex operations because they require the restoration of the integrity of blood vessels, nerve endings, tendons, bones, and muscle tissue with further normalization of blood circulation. Thus, replantation surgery can be compared with the filigree work of a jeweler. The success of the intervention is determined by the complete restoration of sensation and movement in the amputated limb. A replantation procedure lasts about 4-6 hours, and in some cases even longer. The operation can be conditionally divided into the following five stages: primary wound treatment, matching bone fragments with the help of fixing structures, suturing of blood vessels (often with artery and vein plastic repair), restoration of the integrity of nerves and tendons, and skin grafting to restore the skin. Following the surgical intervention, the department's surgeons apply a sterile bandage with special fixation systems to the operated hand. A patient is under constant medical supervision. The final stage of treatment is complex rehabilitation activities, including massage, therapeutic exercises, physiotherapy, and drug therapy.

The department's surgical team often treats patients with wrist arthritis and rheumatic lesions of the hand joints. The first-line treatment is usually conservative therapy, including the application of gels and ointments individually prescribed by the attending physician, drug therapy, therapeutic exercises, and physiotherapeutic procedures (acupuncture, massage, magnetotherapy, electrophoresis, etc.). The department's specialists recommend that patients reconsider their diet, excluding fried, smoked, and pickled meat and fish dishes, fatty dairy products, pastries, and high-calorie cream confectionery. Severe hand pain caused by arthritis or rheumatism can be treated with intra-articular injections of drugs. If the above-mentioned therapeutic measures do not give the desired result and a patient cannot get rid of the pain syndrome, the next treatment option is surgery. Depending on the severity of the clinical case, the department's surgeons offer reconstructive hand surgery, arthrodesis (immobilization of the affected joint), or hand joint replacement surgery.

The department's therapeutic options are complemented by the treatment of Dupuytren's contracture. The disease is associated with pathological changes in the connective tissue of the palm and shortening of the tendons, due to which movement disorders of the fingers develop. The ring finger and little finger are most often affected, as a result of which a person cannot fully straighten them. The exact causes of the development of the disease have not been established, but presumably they may be associated with a genetic predisposition, smoking, excessive consumption of alcoholic beverages, heavy physical work, or hand injuries. Men are more at risk of developing Dupuytren's contracture. As for the treatment of the disease, the department uses conservative and surgical methods. Pathology has 4 stages, and in the early stages of its development, doctors use only conservative therapy, including physiotherapy, therapeutic exercises, massage, warm baths, wearing special splints, and plaster bandages. Good results can also be achieved with the injections of corticosteroids and collagenase clostridium. In some cases, radiation therapy may be recommended for patients. The last-line therapy is surgery. The main surgical procedure for Dupuytren's contracture is needle aponeurotomy, during which the department's surgeons separate the connective tissue strands that prevent the normal extension of the fingers. The operation is performed using a minimally invasive approach, so there is no recovery period after the surgical intervention.

The department's main clinical focuses include the following:

• Upper limb replantation surgery (24-hour emergency service)
• Conservative and surgical treatment of degenerative joint diseases (arthrosis) and rheumatic hand lesions
• Conservative and surgical treatment of Dupuytren's contracture
• Conservative and surgical treatment of hand and wrist fractures, including highly severe injuries
• Conservative and surgical treatment of tendon injuries and tendon diseases, including reconstructive surgery on hand tendons
• Conservative and surgical treatment of peripheral nerve injuries and nerve compression syndromes in the upper limbs
• Conservative and surgical treatment of inflammatory processes in the hand
• Surgical repair of bone and joint defects (for example, after fractures)
• Surgical removal of benign and malignant hand tumors
• Reconstruction and closure of soft tissue defects of the upper limbs using tissue transplant procedures
• Surgical treatment of paralysis of the upper limb
• Other therapeutic options