Having surgery is a major consideration, and you should think about it seriously. Keep in mind, at the same time, that while surgery may be rather strange and unusual to you, it is actually very common in our practice. The decision to have surgery on your hand is a team effort. It should be explained clearly to you, and you need to have a good understanding about what we are talking about. We both need to consider all the options, and then together come to a reasonable conclusion that surgery is better for you than not having surgery. In the end, the decision to have surgery is up to you, because only you know how much your hand problem is interfering with your quality of life.
Here are some things to think about:
- Do you understand why you are having surgery and what is involved? You should not have surgery if you don't know what we have been talking about. If you have questions, please, write them down and bring them with you to your next visit or to the operating room.
- Do you feel that you have tried all the appropriate non-operative possibilities? In some cases, like an infection or an open fracture, there may not be any reasonable alternatives besides surgery, but most of the time there are non-operative alternatives that are reasonable. You should not have surgery until you understand and have considered the non-operative possibilities and decided that they are not a reasonable option for you. Discuss this with me if you are unsure.
- Have you considered the possibilities if you do NOT have surgery? I will try to tell you what you can expect if you do not have surgery. Sometimes, the problems of NOT having surgery are close to zero (for example, living with your arthritis for a bit more), but sometimes they are serious: not having an infection cleaned out, for instance, may pose more risk than having surgery. Discuss with me the possibilities that might happen if you do NOT have surgery.
- Do you understand the expected, possible, as well as the unlikely outcomes of your particular surgery? Unrealistic expectations will make both you and me unhappy. For instance, the pain of arthritis in your hand will not be cured by surgery for carpal tunnel. Know exactly what your diagnosis is, what the surgery is intended to treat, and what results you can expect. For example, arthritis surgery is generally designed to DECREASE your pain, NOT ELIMINATE IT, and a fracture fixation is designed to IMPROVE YOUR BONE POSITION and INCREASE YOUR CHANCES FOR GOOD FUNCTION, it is not designed to MAKE YOUR HAND NORMAL (that is, run the clock back in time to before you had your fracture). Understand the expected, possible, and unlikely outcomes of your particular surgery. If you are not sure, write down your questions and ask me for more information.
- Do you understand the likely, the possible, and the rare complications of your particular surgery? Almost all surgeries have the risks of:
- Infection. Although rare, any cut in the skin, may predispose you to an infection. Most infections can be successfully treated with oral antibiotics (by mouth), but rarely intravenous (IV) antibiotics or even additional procedures may be needed.
- Injury to local structures like nerves, blood vessels, or tendons. This complication is very rare as well, but may rarely occur.
- Failure to completely cure the problem. This would relate to things like getting all of a mass out, removing all the Dupuytren's tissue, completely put the fracture back into place, etc. Patients with severe carpal tunnel syndrome may have persistent problems as there may be permanent nerve damage. The goal of surgery may at times be to make things better or prevent them from getting worse, not to make things “normal.” Realistic expectations are important.
- Recurrence. This is similar to the above problem of not completely curing a problem. Certain conditions such as carpal tunnel syndrome or ganglion cysts have realistic, documented recurrence rates even with the best of surgery.
- Rare problems like reflex sympathetic dystrophy (RSD) or Complex regional pain syndrome (CRPS). This is a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems. The condition is characterized by pain, swelling and stiffness in the affected hand or extremity. The pain may be out of proportion to the injury that triggered it.
- Anesthesia complications are rare. You should meet with your anesthesiologist on the day of surgery and discuss anesthetic options with him/her. If you have any concerns regarding your anesthetic (such as a history of nausea/vomiting or other complications from an anesthetic) you must inform your doctor and the anesthesiologist.
- Scar. This is not really a complication, but rather a normal process following surgery. Most scars on the hand and wrist heal quite nicely without significant cosmetic issues. Some people have a tendency to form more or thicker scar than others. Occasionally scars may be tender, but this usually resolves with time and scar massage.
I will discuss with you any other complications which might be peculiar to your particular surgery.
It is important to understand that significant complications are rare. If you have any questions, please, write them down and bring them into the office for your next appointment. If you have questions after we have decided to perform surgery, either call me or write them down and bring them with you to surgery. I will talk with you prior to surgery, to answer any last minute questions.
* Modified from Dr. David Nelson, MD