Summer 2024

Innovative Hand Surgery Technique Offers Comfort and Convenience

As we get older, chronic afflictions of the hand can develop, causing discomfort or making daily activities a challenge. The condition known as stenosing tenosynovitis, or “trigger finger,” disproportionately impacts women over 50, especially those who have diabetes, low thyroid function, or rheumatoid arthritis. Symptoms can include finger stiffness, a popping or clicking sensation as the finger moves, tenderness, and one or more fingers being locked in a bent position.

Thanks to advancements in hand surgery, new treatment options are available to help relieve pain and restore function in a convenient outpatient setting – sometimes in as little as one short office visit. 

A technique known as Wide Awake Local Anesthesia No Tourniquet (WALANT) has proven transformational for patients, says Dr. George Pianka, a board-certified orthopedic surgeon at White Plains Hospital Physician Associates. 

“Many procedures that were previously difficult to do without general anesthesia can now be done using WALANT,” explains Dr Pianka, who has been at the forefront of the specialty for nearly 35 years. In addition to his board certification, Dr. Pianka holds a Subspecialty Certificate in Surgery of the Hand and is a member of the prestigious American Society for Surgery of the Hand. 

Relieving Pain, Restoring Function
Dr. Pianka attributes the growing popularity of WALANT procedures to the ease, comfort, and convenience they offer patients, especially those whose hand function has been compromised due to trigger finger and Dupuytren’s contracture, an abnormal thickening of tissues in the palm of the hand.

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 a return to normal activity is allowed immediately. Patients can easily receive treatment for multiple fingers affected over time.

Dupuytren’s contracture, which is more common in men than in women, 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, 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 for Patients
In addition to comfort and convenience, a key benefit that WALANT procedures offer is making treatment available to patients who may not be candidates for traditional surgery due to the risks that general anesthesia may pose to their health, such as those with conditions such as asthma, chronic obstructive pulmonary disease (COPD); cardiovascular conditions; those who have had a recent heart attack or stroke; or who take blood thinners. 

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. As a result, “a whole new patient population can get the care they need,” explains Dr. Pianka. 

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,” shares Dr. Pianka, emphasizing that patients can feel better and get back to their lives even faster. 

Dr. George Pianka sees patients at White Plains Hospital Physician Associates in Hawthorne and Yonkers. To make an appointment, call (914) 631-7777 (Hawthorne) or (914) 375-7777 (Yonkers).