David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco



First posted January 8, 2005 Last updated January 15, 2014

Thinking About Surgery

Having surgery is a serious 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 my practice. While you are reading this page, remember Shakespeare's admonition to "know yourself," and take into consideration your own natural "worry level". Are you the type who never worries about anything, or are you a championship worrier even when things are expected to go well?

The decision to have surgery on your hand is a team effort. I need to explain it 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 enjoyment of life, and how willing you are to accept an unknown future. I want to help you make that decision, and that is what this webpage is about.

Here are some things to think about:

1. Do you understand what I have been talking about? I try very hard to talk in plain English and to make sure you understand what is going on at each visit. I have written an extensive website to empower you with information. 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.

2. 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.

3. 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 a cat bite abscess cleaned out, for instance, may cause the loss of function of part of your hand or even death. Discuss with me the possibilities that might happen if you do NOT have surgery.

4. 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.

5. Do you understand the likely, the possible and the rare complications of your particular surgery? Almost all surgeries have the risks of:

a) infection. In my practice, I have had about 8 infections in 22 years, with hundreds of surgeries, so the risk is rather small.

b) damage to local structures like nerves. This complication is very rare. I have cut three nerves in my career of hundreds of surgeries, all of them about 1 mm in size; one patient cannot even find any area of numbness, the nerve is so small. By contrast, the median nerve, the nerve in carpal tunnel syndrome, is about 10 mm. I have never cut a median nerve.

c) 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.

d) the problem recurring. This is similar to the above problem c.

e) rare problems like reflex sympathetic dystrophy (RSD). I have not had a patient develop RSD that I originally treated who needed any treatment other than hand therapy, and that has been very rare.

f) anesthesia complications are very rare. One figure cited is one death per 6 million cases. The serious risks are almost all on very sick patients with multiple medical problems. Serious anesthesia complications are very rare.

6. Are you taking blood thinner medication? If so, read this.

I will discuss with you any other complications which might be peculiar to your particular surgery. If you do not feel that I have explained them to you carefully enough, please write down your questions. I will talk to you prior to surgery.

Remember, common things happen commonly and rare things are rare. Know what the possible complication might be, but don't make them more serious than they actually are. Know yourself and act accordingly.

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 the hospital. I will talk with you prior to surgery, to answer any last minute questions.