Conditions Treated by Hand Surgery
There are a wide range of hand, wrist and elbow conditions that can be treated by hand surgery or other methods at The Hand Clinic. Details of some of these conditions along with some of the remedial treatment may be offered, can be found below:
Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve is squashed (compressed) at the wrist. This compression causes pins and needles in the hand, a loss of feeling and can make your grip weaker. You may tend to drop things. Your symptoms may also be worse at night.
Initially you may be treated using a splint and rest but you may need injections or surgery if this does not improve.
A splint can be prescribed, which will lift your wrist and let you use your fingers and thumb. This aims to widen the carpal tunnel and reduce your symptoms. The splint should be worn for most of the day and definitely at night. You may need to wear it for up to 3 months.
Steroid injections are performed with a little local anaesthetic. You will then be reviewed in a few weeks to assess the response to treatment. This can be an effective treatment for symptoms of carpal tunnel syndrome.
Thumb Joint Arthritis
The trapezium is one of your wrist bones that lie at the base of your thumb. Arthritis in this joint is common. It is a progressive condition and can lead to pain, stiffness and deformity of your thumb.
Initially you may be treated with splints and activity modification but may need injections or surgery if this does not improve.
Splints can be fashioned from either soft neoprene or hard thermoplastic and worn at certain times of the day or night.
A qualified Hand Therapist can advise on joint protection, activity modification and energy conservation.
Steroid with local anaesthetic is injected into the joint. You will then be reviewed in a few weeks to assess the response to treatment. The Steroid injection can certainly help with the pain of thumb based arthritis.
The tendons that bend your fingers run through a tunnel or sheath. Sometimes the tendon can develop a thickened part which catches on the edge of the tunnel as the tendon glides in and out.
In later stages of trigger finger, the tendon can get stuck in the tunnel and the finger ‘locks’ down into a bent position
The treatment is usually a steroid injection, unless the patient has a locked trigger finger, in which case the injection may be unsuccessful. The success rate of an injection is around 60% unless the digit is a thumb or in diabetic patients. If the injection is ineffective, surgery may be offered.
This is a very common condition amongst Anglo-Saxon people. Although there are various risk factors, being male, less than 50 years of age and having a family history of the disease tends to put you at higher risk. Rates of recurrence of the disease are higher, the longer you live.
The skin of the palm and underlying tissue thickens, so pulling down the finger. The tendon is not affected, although the rope like cord can feel similar to a tendon.
There are many treatment options, from no treatment, radiotherapy, minimally invasive release of the cord, chemical release of the cord and surgery. Your surgeon will guide you through the possible treatment options (see teaching section) and also useful information can be found on www.dupuytren-online.info
Fractures and sprains around the hand
Fractures and sprains around the hand are common and rarely require surgery. If they are diagnosed early and the appropriate rehabilitation is applied, the functional outcome is usually good.
Delayed presentation and inadequate therapy sometimes result in stiff and painful fingers which occasionally require surgical procedures. These surgical procedures are never as successful as early recognition and treatment.
Tendons allow our finger joints to straighten and to close like a fist. Any disruption to this system may stop or limit these movements. The two broad categories of tendon injury are closed and open injuries. Open injuries imply a laceration of some sort and usually require surgical exploration.
Closed tendon injuries, in some areas of the body, can be managed non-operatively with splints and rehabilitation. Some closed tendon injuries, especially those that cause the finger tips to bend, may require surgical treatment.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is a compression of the ulna nerve as it runs around the medial epicondyle (“funny bone”).
The little and ring fingers can have numbness and pins and needles, especially related to certain positions of the elbow. If the compression should progress, pain, loss of movement, reduced grip and wasting of the muscles, could ensue.
Nerve tests and clinical examination can diagnose the problem, which sometimes requires surgical decompression.
There are eight small bones within the wrist. A commonly broken bone is the scaphoid bone, which is shaped like a kidney bean and can be tricky to heal.
Young males tend to get this injury and the injury is associated with a fall on an outstretched hand.
Presenting late, smoking and fractures close to the radius (proximal pole fractures) have a higher incidence of not healing (non-union). Sometimes, if left untreated chronic injury can lead to arthritis of the wrist.
Early identification and cast treatment can lead to good results in 85% of fractures at the waist (middle) of the bone. Some will still require surgery and a small portion would require immediate surgery.
Nerves originate from the spinal cord and have a variety of functions. They supply the muscles and conduct sensory impulses. If a nerve in a finger is injured, the patient may lose sensation to the digit. If the nerve is injured in the arm, the muscles may waste and the hand may become weak. The area of loss of sensation in the hand depends on which nerves are injured.
A strange and potentially devastating problem is a partial nerve injury causing pain, stiffness, swelling and skin changes know as chronic regional pain syndrome. This syndrome can occur without nerve injury and also after trivial trauma. Early identification and treatment can prevent permanent loss of function.
Wrist Fractures & Sprains
Wrist fractures & sprains are common and tend to happen by two distinct mechanisms. The first being a fall from standing, (due to trying to put your hand out to prevent injury) and the second being high energy trauma.
Most fractures can be managed in a cast but some do require surgery.
Sprains tend to settle down but if they don’t, further investigations are required.
Arthritis in the Hand and Wrist
Finger and wrist joints can wear out in the same way as hip or a knee joints. Arthritic joints can be painful and can interfere with function. Non-operative treatments range from simple pain relief, activity modification and steroid injections.
Key hole surgery can help ‘wash out’ joints and also help diagnose the severity of the arthritis.
Procedures can also be targeted at removing the pain nerves supplying a joint.
In the severe cases, either the joint is prevented from moving (fused) or the joint can be replaced.
Tennis & Golfer’s Elbow
Elbow tendons coalesce on either side of the elbow joint, to insert into bone. These tendons can be injured by trauma or overuse. Failure to diagnose the condition early may lead to restricted use and chronic pain.
A multitude of treatments and treatment combinations are available, such as:
2. Plasma rich protein (your own blood removed and spun in a centrifuge and the serum injected into the painful spot)
3. An Elbow clasp