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Hand & Wrist Surgery

Hand Surgery - ZNG Plastic Surgery, Singapore

The hand is not simply a collection of bones and joints. It is an integrated structure of nerves, tendons, vessels, skin, and bony architecture, all of which must work together to produce movement, sensation, and strength. A problem in one component almost always has consequences for the others, and getting the management right requires a surgeon trained to assess and treat the hand as a whole.

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Hand and wrist surgery thus requires both plastic reconstructive and orthopaedic expertise to achieve restoration of movement, sensation, and strength after injury or in chronic conditions. I manage the complete pathway as a dual-accredited (UK & Singapore) plastic surgeon, with a subspecialty interest in hand surgery. From clinical assessment with point-of-care ultrasound through to surgical treatment and rehabilitation, I follow BSSH and FESSH standards throughout.

​My Approach

​I trained in the UK and hold the European Board of Hand Surgery (FEBHS) qualification alongside my plastic surgery qualifications (FRCS Plast, FEBOPRAS). Hand surgery in the UK is not a separate speciality but a subspecialty entered through plastic surgery or orthopaedic training. Hand surgery in Singapore by contrast, is a recognised standalone speciality, although it is one in which the training pathway and clinical workload are predominantly orthopaedic in origin, similar to Switzerland and the Scandinavian countries of Sweden and Finland.

 

The soft tissue, nerve, and reconstructive aspects of hand pathology, which are integral to a good functional outcome and which form the core of plastic surgical training, may be approached differently as a result. My dual background in plastic surgery and hand surgery means I am able to manage the full spectrum of hand and wrist problems, with particular emphasis on the soft tissue, nerve, and reconstructive components alongside the bony work.

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For straightforward cases such as trigger finger release, ganglion or small lump excision, and minor hand lacerations, same-day management under WALANT is available through my other practice, Doctor Stitch. Cases requiring more extensive surgery, formal nerve or tendon reconstruction, complex fracture fixation, or structured rehabilitation are managed here at ZNG Plastic Surgery, with me as the same surgeon throughout.

Planning & Technique

My approach begins with an accurate diagnosis. Many hand conditions present with overlapping symptoms, and many do not require surgery. A focused clinical assessment, supported by point-of-care ultrasound (POCUS) where appropriate, allows real-time evaluation of tendon glide, nerve compression, and soft tissue masses without waiting for separate imaging appointments. Of course, when necessary, more detailed scans such as CT, MRI or PET, and nerve conduction studies, EMG will be requested as indicated. Once the diagnosis is confirmed, the surgical plan is tailored to the condition, the patient's hand demands, and their occupational and recreational needs.

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The majority of cases can be performed under WALANT (Wide Awake Local Anaesthesia No Tourniquet), which avoids the risks and recovery burden of  regional and general anaesthesia, allows intra-operative movement testing, and supports a faster return to normal activity.

Nerve Compression

Carpal tunnel syndrome and cubital tunnel syndrome are the most common nerve compression problems I treat. Early or mild cases may respond to splinting, activity modification, or steroid injection. Surgical decompression is indicated where symptoms persist, where there is muscle wasting or sensory loss, or where nerve conduction studies confirm significant compression. Carpal tunnel release and cubital tunnel decompression are routinely performed under WALANT through small incisions, with same-day discharge. Painful neuromas, peripheral nerve entrapments, and nerve-related migraine can also be addressed through targeted nerve surgery.

Tendon Conditions

Trigger finger and De Quervain's tenosynovitis are managed with a graduated approach: splinting, ultrasound-guided steroid injection, and surgical release where conservative measures fail or recur. Surgical release is performed through a small incision under WALANT, with immediate active movement encouraged to ensure adequate release.

Trauma

Cut tendons, divided nerves, and injured blood vessels require timely repair to restore function. Repair is undertaken using microsurgical technique where indicated, with the rehabilitation programme planned from the day of surgery. Early protected motion protocols, supervised by a hand therapist, optimise tendon glide and reduce stiffness compared with traditional immobilisation.

Fractures of the metacarpals, phalanges, and distal radius are common. Many can be managed non-operatively with a well-fitted splint, but displaced or unstable fractures require surgical fixation to restore alignment and allow early movement. Fixation is selected to match the fracture pattern, ranging from percutaneous K-wires for simple metacarpal fractures to plate fixation for more complex injuries with displacement and instability.

For non-displaced distal radius fractures suitable for conservative management, a custom 3D-printed splint is often a more practical alternative to a traditional plaster cast, particularly in Singapore's climate, where comfort and skin integrity over six weeks of immobilisation can otherwise become a real problem with ensuing issues such as complex regional pain syndrome (CRPS). This was demonstrated in a retrospective case control study, whereby prolonged immobilisation > 5 weeks markedly increased the risk of developing CRPS in non-operatively managed distal radius fractures.

Lumps and Growths

Ganglion cysts, giant cell tumours of the tendon sheath, glomus tumours, mucous cysts and skin cancer are the most common hand lumps I manage. Ultrasound assessment in clinic confirms the diagnosis in most cases. Excision is undertaken with attention to the underlying functional anatomy, removing the lesion while preserving tendon glide, nerve continuity, and skin sensibility. Histological confirmation is obtained for all excised lesions.

Dupuytren's Disease

Early Dupuytren's contracture may be suitable for needle aponeurotomy, a minimally invasive technique performed under local anaesthesia. Established contracture with significant joint involvement is managed with limited fasciectomy, occasionally with full thickness skin grafting in advanced or recurrent disease. Recurrence patterns and patient hand demands are taken into account when selecting the approach.

Hand and Wrist Arthritis

Painful arthritis at the base of the thumb (CMC joint), the small finger joints, or the wrist is managed with injections and splinting in early stages, progressing to surgical options where conservative care no longer provides relief. Procedures range from joint fusion (arthrodesis) for stable, pain-free function to joint replacement or excisional arthroplasty depending on the joint and the patient's demands.

Hand Rejuvenation

For patients seeking improvement in the appearance of the hands, options include fat grafting to restore volume, laser treatment for pigmentation, and adjunctive non-surgical measures such as fillers. These are discussed alongside any functional concerns at consultation.

Every patient’s anatomy and goals are different. Dr Ng will discuss the best approach for you during your consultation.

Recovery & Expectations

Recovery depends on the procedure. Simple soft tissue surgery such as trigger finger release or carpal tunnel decompression allows light hand use within days, with full activity resumed over two to four weeks. Tendon and nerve repairs require a structured rehabilitation programme over six to twelve weeks, supervised by an experienced hand therapist. Fracture fixation typically allows protected movement from the first week, with bony healing over six to eight weeks and full strength returning over three to six months. Where conservative management of a non-displaced fracture is appropriate, a custom 3D-printed splint may be used instead of a traditional plaster cast for improved comfort and compliance during the immobilisation period.

I work closely with experienced hand therapists who take patients through the rehabilitation programme appropriate to their procedure. Where indicated, splinting and the therapy referral are provided as part of a coordinated plan, rather than as separate services. Scar management is also important as it can limit functional outcomes.

Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch, an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng for attentive, discreet, and consistent care throughout the recovery journey.​

Frequently Asked Questions

 

1. Do I need a referral to see you for a hand or wrist problem?

No referral is required. You can contact me directly via WhatsApp. Sending a brief description of your symptoms, the duration, and any imaging or photographs in advance allows me to give a preliminary view before your appointment.

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2. What is the difference between Doctor Stitch and ZNG Plastic Surgery for hand surgery?

Doctor Stitch handles same-day management of straightforward conditions such as trigger finger release, ganglion excision, and minor hand lacerations under WALANT. ZNG Plastic Surgery manages more complex cases requiring tendon or nerve reconstruction, fracture fixation, joint surgery, or structured rehabilitation. The same surgeon manages both, so there is full continuity of care regardless of where treatment begins.
 

3. What is WALANT, and why might it be used for my procedure?

WALANT (Wide Awake Local Anaesthesia No Tourniquet) allows many hand procedures to be performed safely without general anaesthesia or a tourniquet. You remain comfortable and awake, which permits intra-operative movement testing, reduces anaesthetic risks, and supports a smoother recovery. Not every procedure is suitable for WALANT, but where it is, it is often the most efficient and patient-friendly option.
 

4. Will I need imaging such as ultrasound, X-rays, CT, or MRI?

In clinic, I use point-of-care ultrasound (POCUS) to assess tendon movement, nerve compression, and soft tissue masses in real time. This often resolves the diagnosis at the first appointment without further imaging. X-rays, CT, or MRI scans may be required for fractures, joint problems, or complex soft tissue cases, and are arranged where indicated.

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5. How long is recovery after hand surgery?

Recovery varies widely depending on the condition and the procedure. Simple releases allow light functional use within days. Tendon and nerve repairs require structured rehabilitation over weeks to months. Fracture fixation generally allows protected movement early, with bony healing over six to eight weeks. I will guide you through the expected timeline at consultation, including splinting, movement progression, and return to work or sport.

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6. Will I need hand therapy after my operation?

Most hand procedures benefit from early, guided therapy to restore motion, reduce stiffness, and optimise outcomes. I work closely with experienced hand therapists, and where appropriate provide custom 3D-printed splints to support the rehabilitation programme.

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7. Is hand surgery painful?

Most hand operations are well tolerated. WALANT provides excellent intra-operative comfort, and postoperative pain is usually controlled with simple analgesia. My aim is to ensure comfort, maintain circulation, and promote early gentle movement where safe.

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8. When can I return to work or sport?

This depends on the procedure and your job demands. Light desk work may resume within days for simpler conditions. Manual work, gripping, lifting, and contact sports require a more gradual return. Personalised timelines are provided so you can plan appropriately.

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9. I had hand surgery overseas. Can you provide follow-up care in Singapore?

Yes. I regularly see patients who had hand surgery managed in the UK, Australia, or elsewhere and require ongoing rehabilitation or surveillance in Singapore. I am familiar with the protocols used in these settings and can continue care within the same framework.

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10. Is hand surgery claimable under insurance or Medisave?

Yes. Hand surgery for medical indications is generally claimable under medical insurance policies and Medisave for surgical procedures, guided by the Ministry of Health Table of Surgical Procedures (TOSP) where applicable. I can provide documentation to support your claim.

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Related Reading​

References

Contact Dr Ng Zhi Yang via WhatsApp

​Next Steps:

  1. Private consultation

  2. Personalised treatment plan 

  3. Aftercare

Consultations:

 

Private consultations are by appointment at XD Aesthetic Clinic, 9 Scotts Road, Pacific Plaza, #06-07 Scotts Medical Centre, Singapore 228210.

 

Teleconsultations may be arranged where appropriate.

Surgery:

Operations are performed at Paragon Medical Centre and other MOH-accredited private day surgery facilities in Singapore.

Disclaimer:

Individual healing responses and results naturally vary. While the utmost care and expertise are applied in every treatment, specific outcomes cannot be guaranteed.

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