Hand and Wrist Treatment

Dr Pretorius is an experienced orthopaedic surgeon. He treats the following conditions of the hand and wrist:

  • Carpal tunnel surgery.
  • Trigger fingers.
  • De Quervain’s tenosynovitis.
  • Dupuytren’s contracture.
  • Arthritis of the base of the thumb.
  • Arthritis of the fingers.
  • Hand trauma including fractures, nerve and tendon injuries.
  • Removal of ganglia.


As many conditions affect the hand and wrist, Dr. Pretorius will take a thorough history, including your medical history. Examination may include examining your upper limb including range of motion of joints, stability of joints (ligaments) and tendons as well as neurovascular examination.

You might need to have further tests done to confirm the diagnosis.

These tests may include:

  • Blood tests.
  • X-rays.
  • CT (Computed tomography) scan.
  • Magnetic resonance imaging (MRI).
  • EMG (Electromyography) and NCS (Nerve conduction studies)

Once a diagnosis has been established, Dr. Pretorius will discuss the proposed treatment in detail

One of the most common conditions:

Carpal tunnel Syndrome:

The carpal tunnel is a formed by the wrist bones and a ligament called the transvers carpal ligament. The carpal tunnel forms a narrow passage through which one of the major nerves to the hand (median nerve) and 9 tendons pass.

Carpal tunnel is a very common condition causing pain, numbness and tingling in the hand and sometimes in the arm. This is typically worse at night, when reading a book, or driving a car. It normally worsens over time and can lead to loss of motor skills like writing and dropping objects. It can eventually lead to permanent nerve damage.

Non-operative treatment:

Non-operative can be done early in the disease and in carpal tunnel syndrome caused by fluid retention, often seen in pregnancy. Non-operative treatment involves splinting the hand at night in a removable splint. Sometimes cortisone injection in the carpal tunnel using ultrasound guidance can improve symptoms.

Surgical treatment:

With surgical treatment, the tight band called the transverse carpal ligament, is released to relieve pressure on the median nerve.

Serious complications following surgery are very uncommon, but surgical procedures carry some risks. Although extreme care is always taken to minimise any complications, there’s always a chance that it can occur and may have permanent effects.

General risks of surgery:

  • Risk of the anaesthetic.
  • Antibiotics are routinely used during surgery to prevent infection – some patients may have an allergic reaction or anaphylaxis.
  • Wound infection.
  • Bleeding in the wound with haematoma (big collection of blood) formation.
  • Pain / numbness around the incision site.
  • Allergies to antiseptic solutions used to clean the surgical site.
  • Allergies to sutures and / or dressings.
  • Nausea and vomiting after surgery.

Specific Risks with Hand and Wrist Surgery

Specific risks with surgery for the condition mentioned above will be discussed with you in detail by Dr Pretorius.

The risks may include the following:

  • Wound infection.
  • Injury to nerves.
  • Injury to tendons.
  • Painful scars.
  • Ongoing symptoms.
  • Recurrence of the condition.


Recovery after fracture surgery:

Following your hand / wrist surgery you will wake up in the recovery room. The nurses in the recovery room will monitor your recovery by doing the vital signs (pulse, blood pressure etc).

The hand may be numb from a nerve block / injection of local anaesthetic. It may take 12-16 hours for the feeling to return.

It is better to stay in control of the pain by taking the prescribed pain medication as soon as the feeling returns before the local anesthetic wears off completely.

If you are allowed to go home, it is important to arrange for somebody collect to from the hospital and drive you home.

If your surgery is overnight however, you will be transferred to the ward.

It is important to keep the limb elevated and to apply cold / ice packs to help for pain and swelling.

A follow-up appointment will be arranged for you normally around 10 days after the surgery.

Try to use the stronger pain medication only if normal pain medication like paracetamol is not effective.

It is important to keep the surgical area clean and dry and to keep the wound dressings intact.

Normally an appointment will be scheduled with a hand therapist to assist you with splint, scar treatment and rehabilitation.

Recovery after surgery is different for every patient. Your cooperation and motivation are important to ensure effective recovery and a good outcome.

Please contact the surgery immediately if you have any of the following:

  • Any redness, swelling, bleeding or drainage from your incision site.
  • Any fever or chills.
  • Any increase in pain around the incision site.
  • Any pain in your calf or thigh with swelling in the leg.
  • Loss of movement.
  • Any other concerns you may have.


Please find links to useful information regarding some surgeries:


And also, a link to a wonderful website with great animation videos and information on some of the procedures that are done: