Hand surgery

Arthritis of the hand affects the base of the thumb and finger tip joints most often. Both these conditions can be treated successfully. Splinting for a short period and cortisone injections will be the first line of treatment. Surgery is a good option if conservative management fails. Surgery gives lasting pain relief and can be done as a day case procedure mostly under local anaesthetic depending on patient preference and the planned procedure.

Carpometacarpal Arthritis of the thumb (Base of thumb arthritis) is associated with pain at the base of the thumb. This is activity related often very painful during and after the forceful use of the thumb such as wringing out of a cloth or opening tight taps or jars. This can be treated by splinting, anti-inflammatories and cortisone injection depending on the degree of arthritis and pain. If conservative treatment fails then surgery is very successful. This is done by excision of the trapezium and a ligament reconstruction.

Carpal Tunnel Syndrome is intermittent loss of sensation in the thumb, index and middle fingers and pain mostly at night or early morning. This is due to compression of the median nerve. If symptoms persist for more than 4 weeks then an assessment is recommended. Splinting may help for minor cases of short duration. Prolonged compression of the median nerve can lead to nerve damage that may not be reversable. Carpal tunnel surgery is a minor procedure that can be done under local aneasthetic with good outcome and pain relief.

Trigger Finger is the feeling of the finger that gets stuck in flexed position in the palm of the hand and a click to get it straight. This is due to swelling of the tendon system and responds well to a cortisone injection if treated early in the onset of the condition. Some tendons may not respond to the injections and this may require surgery.

Dupuytren’s Contracture is a condition that results in nodules of fibrous tissue in the palm of the hand and strands into the fingers. This may cause a contracture of the finger into a flexed position. Splinting is of no use in this condition and management should be planned in conjunction with a hand surgeon. This is a genetic condition and may affect multiple fingers and both hands and feet.

De Quervain’s Tenosynovitis is a condition that is due to inflammation of the tendons of the wrist and thumb on the thumb side of your wrist and activity related. Often seen in mothers with babies that have to be lifted multiple times a day but common at any age. The wrist and thumb can be splinted but it must include the thumb in the splint. A cortisone injection is the quickest way to get relief . In some patients surgery may be indicated if conservative management is not successful.

Finger joint dislocation is often under treated by relocation and strapping of the finger. Strapping in the wrong position can lead to longstanding deformity, instability and contractures. Professional management is recommended. X-rays are required to assess for fractures but more importantly if nothing is seen on the X-rays then there should still be specific treatment of the finger by dedicated hand therapists and specialists to prevent long term disability.

Tennis elbow or lateral epicondylitis is a disabling, painful problem which presents with pain on the outside of the elbow, which is exacerbated by resisted extension of the wrist. Contrary to popular belief, this does not just happen to tennis players. Treatment of this condition rests on confirmation of the diagnosis, because other problems such as radial nerve entrapment around the elbow may seem similar first glance. Initial treatment is always non-surgical with local injection, pain medication, activity modification and bracing. I offer 2-3 injections with cortisone and most of the elbows will respond well. If conservative treatment fails, a minor surgical release of the extensor origin may be required.

Acute injuries with open wounds should report to the nearest emergency treatment centre for treatment and evaluation. Should specialist hand surgeon management deemed necessary then the emergency doctor will refer you for further management. Most fractures and closed tendon or nerve injuries can be assessed at the first available appointment. The management options can then be discussed and planned.