If you’ve been experiencing discomfort or struggling with daily activities due to chronic afflictions of the hand, advancements in hand surgery have brought new outpatient treatment options to help relieve pain and restore function.
A technique known as Wide Awake Local Anesthesia No Tourniquet (WALANT) has proven transformational for my patients—previously, many procedures were difficult to do without general anesthesia but can now be done using WALANT.
Relieving Pain, Restoring Function
WALANT has grown in popularity because of the ease, comfort and convenience it offers patients, especially those whose hand function has been compromised due to stenosing tenosynovitis, also known as “trigger finger” and Dupuytren’s contracture, an abnormal thickening of tissues in the palm of the hand.
Trigger fingers have multiple symptoms, including finger stiffness, a popping or clicking sensation as the finger moves, tenderness, and one or more fingers being locked in a bent position.
The WALANT procedure to address trigger fingers is known as percutaneous trigger finger release, and is performed in the office during a routine visit with a small needle puncture. The band of tissue along the tendon sheath at the base of the finger known as the A1 pulley is divided, allowing the tendon to move freely. The procedure takes one to two minutes and return to normal activity is allowed immediately. Moreover, patients can easily receive treatment for multiple affected fingers.
Dupuytren’s contracture is believed to be hereditary, although the specific causes are not known. Symptoms can include uncomfortable lumps and pits within the palm, bending of the finger(s) towards the palm and difficulty doing daily activities, such as washing hands or putting on gloves, or shaking hands.
Similar to trigger finger, patients with Dupuytren’s contracture can also find relief for their symptoms with a short in-office WALANT procedure known as needle aponeurotomy. During the procedure, under local anesthesia, the abnormal tissue in the hand is weakened with multiple passes of a needle and then separated to open the finger from the palm. There is no open wound.
Benefits of WALANT Procedures
In addition to comfort and convenience, a key benefit of WALANT is that it makes treatment available to patients who may not be candidates for traditional surgery due to the risks that general anesthesia may pose to their health. For people suffering from asthma, chronic obstructive pulmonary disease (COPD), cardiovascular conditions, or who have had a recent heart attack or stroke, or who take blood thinners, WALANT is now the procedure of choice.
What’s more, patients who take medications to manage chronic health conditions who may have had to stop their medications in advance of a surgery can instead continue these regimens as normal.
Additionally, many patients in good health but who are unable to take time away from work and family obligations for surgery can now access treatment that fits into their lifestyle. In my practice, I am now seeing a whole new patient population get the care they need.
Many times, the consultation and procedure can be done in the same in-office visit, after which patients enjoy rapid recovery, including minimal wound care. A small adhesive bandage over the needle puncture is all that is required. Hand washing is allowed later that same day, enabling patients to feel better and get back to their lives even faster.
[White Plains Hospital Physicians Associates]
Dr. George Pianka is a board-certified orthopedic surgeon at White Plains Hospital Physician Associates. He holds a Subspecialty Certificate in Surgery of the Hand and is a member of the prestigious American Society for Surgery of the Hand.Dr. Pianka sees patients at the WPHPA offices in Hawthorne (914-631-7777) and Yonkers (914-375-7777).
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3 Jun 2024
0 Commentswide awake hand surgery
If you’ve been experiencing discomfort or struggling with daily activities due to chronic afflictions of the hand, advancements in hand surgery have brought new outpatient treatment options to help relieve pain and restore function.
A technique known as Wide Awake Local Anesthesia No Tourniquet (WALANT) has proven transformational for my patients—previously, many procedures were difficult to do without general anesthesia but can now be done using WALANT.
Relieving Pain, Restoring Function
WALANT has grown in popularity because of the ease, comfort and convenience it offers patients, especially those whose hand function has been compromised due to stenosing tenosynovitis, also known as “trigger finger” and Dupuytren’s contracture, an abnormal thickening of tissues in the palm of the hand.
Trigger fingers have multiple symptoms, including finger stiffness, a popping or clicking sensation as the finger moves, tenderness, and one or more fingers being locked in a bent position.
The WALANT procedure to address trigger fingers is known as percutaneous trigger finger release, and is performed in the office during a routine visit with a small needle puncture. The band of tissue along the tendon sheath at the base of the finger known as the A1 pulley is divided, allowing the tendon to move freely. The procedure takes one to two minutes and return to normal activity is allowed immediately. Moreover, patients can easily receive treatment for multiple affected fingers.
Dupuytren’s contracture is believed to be hereditary, although the specific causes are not known. Symptoms can include uncomfortable lumps and pits within the palm, bending of the finger(s) towards the palm and difficulty doing daily activities, such as washing hands or putting on gloves, or shaking hands.
Similar to trigger finger, patients with Dupuytren’s contracture can also find relief for their symptoms with a short in-office WALANT procedure known as needle aponeurotomy. During the procedure, under local anesthesia, the abnormal tissue in the hand is weakened with multiple passes of a needle and then separated to open the finger from the palm. There is no open wound.
Benefits of WALANT Procedures
In addition to comfort and convenience, a key benefit of WALANT is that it makes treatment available to patients who may not be candidates for traditional surgery due to the risks that general anesthesia may pose to their health. For people suffering from asthma, chronic obstructive pulmonary disease (COPD), cardiovascular conditions, or who have had a recent heart attack or stroke, or who take blood thinners, WALANT is now the procedure of choice.
What’s more, patients who take medications to manage chronic health conditions who may have had to stop their medications in advance of a surgery can instead continue these regimens as normal.
Additionally, many patients in good health but who are unable to take time away from work and family obligations for surgery can now access treatment that fits into their lifestyle. In my practice, I am now seeing a whole new patient population get the care they need.
Many times, the consultation and procedure can be done in the same in-office visit, after which patients enjoy rapid recovery, including minimal wound care. A small adhesive bandage over the needle puncture is all that is required. Hand washing is allowed later that same day, enabling patients to feel better and get back to their lives even faster.
[White Plains Hospital Physicians Associates]