Hand
A variety of hand problems can present with pain and limitation in function. Frequently this can be due to nerve compression in the wrist, arthritis in the thumb or inflammation in the tendons.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition that affects the wrist and hand. It occurs when there is pressure on the median nerve, which runs through a narrow passageway called the carpal tunnel in the wrist. This nerve controls sensation and movement in the thumb, index finger, middle finger and half of the ring finger.

The carpal tunnel is a confined space formed by bones and ligaments and when the tissues within this space become inflamed or swollen, they can compress the median nerve. This compression leads to symptoms such as:

  • Numbness and tingling
    Usually in the thumb, index, middle and part of the ring fingers. This is often worse at night and when the hand is being used for prolonged periods.
  • Pain
    Often described as burning or aching, which may radiate up the forearm and again is usually worse at night.
  • Weakness
    Difficulty gripping objects or performing fine motor tasks.

Treatment for carpal tunnel syndrome can vary depending on the severity of the condition. Some common approaches include:

  • Rest and Immobilisation
    Giving the wrist and hand time to rest by avoiding activities that worsen the symptoms can help alleviate the pressure on the median nerve. Wearing a wrist splint at night can keep the wrist in a neutral position, reducing symptoms.
  • Medications
    Over-the-counter pain relievers and anti-inflammatory drugs can help manage pain and inflammation associated with CTS.
  • Ergonomic Modifications
    Making changes to your workspace or daily activities to reduce wrist strain can be beneficial. Using an ergonomic keyboard and mouse setup, maintaining proper wrist posture and taking frequent breaks can also help.
  • Corticosteroid Injections
    Injecting a corticosteroid directly into the carpal tunnel can provide temporary relief by reducing inflammation and relieving pressure on the median nerve.
  • Surgery
    In cases where symptoms are severe or don’t respond to conservative treatments, surgery is usually considered. Carpal tunnel release surgery involves cutting the ligament that forms the roof of the carpal tunnel to create more space for the median nerve. This can be done using traditional open surgery or minimally invasive endoscopic techniques.

It is important to note that early diagnosis and intervention can lead to better outcomes in managing carpal tunnel syndrome. If you suspect you have CTS or are experiencing symptoms, consult an experienced healthcare professional such as an orthopaedic surgeon or physiotherapist for an accurate diagnosis and appropriate treatment plan.

CMC Joint Arthritis

CMC joint arthritis, also known as base of thumb arthritis or basal joint arthritis, refers to the degeneration and inflammation of the Carpometacarpal (CMC) joint located at the base of the thumb. This condition can cause pain, stiffness and reduced hand function, particularly in gripping and pinching activities.

Treatment for CMC joint arthritis includes:

  • Conservative measures
    Rest and modification of activities to reduce stress on the joint.
    Hand therapy: Exercises to enhance hand strength and flexibility.
    Over-the-counter painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and swelling.
    Topical creams or gels containing NSAIDs for localised pain relief.
    Lifestyle modification i.e. using ergonomic tools and techniques for improved hand function.
  • Splinting or Bracing
    Wearing a splint or brace to stabilise the joint and relieve strain.
  • Corticosteroid Injections
    Injecting corticosteroids into the joint can provide temporary relief from pain and inflammation.
  • Surgery
    If conservative treatments fail, surgery can be considered. This usually involves removal of the arthritic trapezium bone on one side of the joint, often associated with a ligament stabilisation procedure.

If you suspect you have CMC joint arthritis, is essential to consult a healthcare professional such as an orthopaedic surgeon or physiotherapist for an accurate diagnosis and personalised treatment plan, tailored to your condition and requirements.

De Quervain's Tenosynovitis

De Quervain’s tenosynovitis, also known as De Quervain’s tendonitis, is a painful condition that affects the tendons on the thumb side of the wrist. It is characterised by inflammation of the tendons and their surrounding sheath, causing pain and discomfort during movement of the wrist and thumb. This condition primarily impacts the tendons of the abductor pollicis longus and extensor pollicis brevis muscles, which are responsible for moving the thumb away from the hand and extending it.

Causes:

The exact cause of De Quervain’s tenosynovitis isn’t always clear, but it often results from repetitive hand and wrist motions. Activities that involve repeated grasping, twisting, or lifting can strain the tendons and lead to inflammation. This is common in activities such as gardening, knitting, playing musical instruments and holding a baby.

Symptoms:

  • Typical symptoms of De Quervain’s tenosynovitis include:
  • Pain and tenderness along the thumb side of the wrist.
  • Pain that may radiate up the forearm.
  • Swelling around the base of the thumb.
  • Difficulty moving the thumb and wrist, especially during gripping or pinching motions.
  • A “creaking” sensation when moving the thumb.

Treatment:

Treatment for De Quervain’s tenosynovitis aims to reduce pain and inflammation, improve wrist and thumb mobility and prevent recurrence. Common treatment approaches include:

Conservative Measures

  • Rest: Avoiding activities that exacerbate the pain can help give the inflammation time to settle down.
  • Ergonomic Changes: Adjusting your hand and wrist positioning during repetitive activities can help prevent strain and recurrence.
  • Immobilisation: Wearing a splint or brace that immobilizes the wrist and thumb can help relieve strain on the tendons and promote healing.
  • Ice: Applying ice to the affected area can help reduce inflammation and alleviate pain.
  • Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain and inflammation.
  • Corticosteroid Injections: Occasionally a corticosteroid injection into the sheath surrounding the affected tendons may be recommended to reduce inflammation and provide relief.
  • Physiotherapy: Specific exercises and stretches may be recommended by a physical therapist to help improve wrist and thumb mobility and strengthen the surrounding muscles.
  • Ergonomic Changes: Adjusting your hand and wrist positioning during repetitive activities can help prevent strain and recurrence.

Surgery

In severe cases where conservative treatments do not provide relief, surgery may be considered to release the constricted tendons and alleviate pressure. This is usually performed as a day case procedure.

If you suspect you have De Quervain’s tenosynovitis or are experiencing persistent wrist and thumb pain, it’s important to consult an orthopaedic surgeon or physiotherapist to obtain a correct diagnosis and treatment plan tailored to your specific condition.

Ganglion Cyst

A wrist ganglion, also known as a ganglion cyst, is a non-cancerous lump or bump that typically forms around a joint or tendon in the wrist or hand. It is filled with a thick, jelly-like fluid and is often located just beneath the skin, giving it a soft and movable feel when touched. Ganglion cysts are the most common type of soft tissue mass found in the hand and wrist.

The exact cause of ganglion cysts is not always clear, but they often develop near joints or tendons due to the accumulation of synovial fluid, which lubricates and cushions joints. The cysts can vary in size and may change in size over time, sometimes even disappearing on their own.

Treatment options for wrist ganglions include:

  • Observation
    Small, painless ganglion cysts that do not cause any discomfort or functional issues may be simply observed. Some cysts may shrink or disappear on their own without any intervention.
  • Immobilization
    Wearing a splint or brace to immobilize the affected joint may help reduce the size of the cyst and relieve symptoms, especially if the cyst is located in a location where movement exacerbates the pain.
  • Aspiration
    Aspiration involves using a needle and syringe to drain the fluid from the cyst. However, this method is often not a long-term solution as the cyst usually refills with fluid and returns.
  • Cortisone Injection
    After aspiration, some medical professionals might inject a corticosteroid medication into the cyst to help reduce inflammation and prevent the cyst from reoccurring.
  • Surgical Excision
    If the ganglion cyst is causing pain, discomfort or functional impairment, or if it’s large and not responding to other treatments, surgical removal may be considered. During the procedure, the cyst and its associated stalk or connection to the joint or tendon are removed. This can typically be done as an outpatient procedure.

It is important to note that even after surgical removal, there is a small chance of recurrence. Recovery time following surgery varies, but many people can resume normal activities relatively quickly.

If you have a wrist ganglion or suspect you might have one, it is advisable to consult a medical professional such an orthopaedic surgeon. They can provide an accurate diagnosis and recommend the most appropriate treatment based on the size, location and symptoms associated with the ganglion cyst.

Trigger Finger

Trigger finger, also known as stenosing tenosynovitis, is a condition that affects the tendons in the fingers or thumb. The tendons are responsible for connecting the muscles in the  forearm to the fingers and allowing them to move. In trigger finger, the affected tendon becomes inflamed, causing it to become thicker and making it difficult for it to glide smoothly through the tunnel-like sheath (called the tendon sheath) that surrounds it. This results in pain, stiffness and a sensation of “catching” or “locking” when the finger is moved.

The main symptom of trigger finger is the finger getting stuck in a bent position and then suddenly popping straight, as if triggered. It can be painful and make it challenging to perform everyday tasks.

Treatment options for trigger finger include:

  • Rest and Activity Modification
    Initially, resting the affected finger and avoiding activities that worsen the symptoms can help alleviate the inflammation and irritation.
  • Splinting
    Wearing a splint or brace to keep the affected finger in an extended position can help rest the tendon and reduce inflammation.
  • Medications
    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation.
  • Hand Exercises
    Gentle hand exercises and stretches can help improve the flexibility and strength of the affected finger.
  • Corticosteroid Injections
    In some cases, a corticosteroid injection may be administered into the affected area to reduce inflammation and provide relief. This can often provide a temporary improvement in symptoms and occasionally long-term relief.
  • Physiotherapy
    A hand therapist can provide a structured exercises programme and techniques to improve finger mobility and reduce symptoms.
  • **Surgery**
    If conservative treatments don’t provide relief, your doctor may recommend a surgical procedure called a “trigger finger release.” During this procedure, the constricted portion of the tendon sheath is opened to allow the tendon to move freely. It’s usually a minor surgery and can often be done on an outpatient basis.

The treatment approach depends on the severity of your symptoms, how long you’ve had them, and your overall health. It’s important to consult a medical professional for a proper diagnosis and personalized treatment plan if you suspect you have trigger finger. They can help determine the best course of action based on your individual circumstances.

Wrist Arthroscopy

A wrist arthroscopy is a minimally invasive surgical procedure that involves the use of a tiny camera, called an arthroscope, to visualize and diagnose conditions inside the wrist joint. This procedure allows an orthopaedic surgeon to examine the structures within the wrist, including bones, cartilage, ligaments, and tendons and if necessary, perform surgical interventions to treat various wrist problems. Wrist arthroscopy is performed using small incisions and specialised instruments, which can result in less tissue damage, quicker recovery times and reduced post-operative pain compared to traditional open surgery.

The procedure is typically done as an outpatient surgery under local or general anaesthesia.

Wrist arthroscopy is performed for various reasons:

  • Diagnostic
    When the exact cause of wrist pain or dysfunction is not clear, arthroscopy can help identify the problem by directly visualising the internal structures in the joint. 
  • Treatment
    The procedure can be used to treat several wrist conditions, such as carpal tunnel syndrome, ligament injuries (like triangular fibrocartilage complex tears), ganglion cysts, and certain fractures.
  • Synovectomy
    Inflammatory conditions like rheumatoid arthritis can cause excessive growth of the synovial tissue lining the joint. Arthroscopy can be used to remove this excess tissue.
  • Debridement
    Damaged or worn cartilage and bone fragments can be removed to alleviate pain and improve joint function.
  • Ligament Repair
    Tears or injuries to wrist ligaments can be repaired or reconstructed using arthroscopic techniques.
  • Biopsies
    Tissue samples can be obtained during arthroscopy to aid in diagnosing joint diseases or other conditions.

Here is how wrist arthroscopy is performed: 

  • Incisions
    Small incisions, often less than a centimetre in size, are made around the wrist joint.
  • Arthroscope Insertion
    The arthroscope, a thin tube with a light and camera on one end, is inserted through one of the incisions. This allows the surgeon to view the interior of the joint on a monitor.
  • Visualisation and Diagnosis
    The surgeon uses the images from the arthroscope to examine the structures within the wrist joint, identifying any issues, such as cartilage damage, ligament injuries, or other abnormalities.
  • Treatment
    Depending on the findings, the surgeon may use specialised instruments inserted through the other incisions to perform necessary procedures. This could include removing damaged tissue, repairing ligaments, or addressing other problems.
  • Closure
    After the procedure is complete, the instruments are removed and the incisions are closed with stitches or small adhesive strips.

Wrist arthroscopy offers several advantages over traditional open surgery, including smaller incisions, reduced scarring, quicker recovery times and potentially less post-operative pain. However, not all wrist conditions can be treated with arthroscopy, so it is important to consult with an orthopaedic surgeon to determine the most suitable treatment approach for your specific wrist problem.

Wrist Fracture

A wrist fracture, also known as a distal radius fracture, is a break in one or both of the two bones in the forearm (radius and ulna) near the wrist joint. This type of fracture is relatively common and can occur due to a variety of causes, such as falls onto an outstretched hand, a direct blow to the wrist, or sports-related injuries.

Wrist fractures can vary in severity and they may be categorised based on factors like the location of the fracture, the degree of displacement (how much the bone fragments have moved out of their normal alignment) and the presence of associated injuries.

Treatment for wrist fractures depends on the type of fracture, how severe it is and the overall health of the patient. Common treatment options include:

  • Casting or Splinting
    For less severe fractures where the bones are still in good alignment, a cast or splint may be applied to immobilize the wrist and allow the bones to heal. The cast/splint helps prevent movement that could hinder the healing process.
  • Closed Reduction and Casting
    In some cases, if the fracture is slightly displaced, a medical professional may perform a closed reduction. This involves manipulating the bone fragments back into their proper alignment without the need for surgery, followed by immobilisation with a cast or splint.
  • Open Reduction and Internal Fixation (ORIF)
    If the fracture is significantly displaced or if the bones have broken through the skin (an open fracture), surgery may be necessary. During ORIF, the bone fragments are realigned surgically, and they are held in place using screws, plates, or other fixation devices to ensure proper healing. This procedure helps maintain stable alignment of the bones while they heal.
  • External Fixation
    In complex fractures or cases where there is significant soft tissue damage, an external fixation device may be used. This involves the placement of pins or wires outside the body, attached to a frame that holds the bones in proper alignment.
  • Rehabilitation and Physiotherapy
    Following immobilisation or surgery, rehabilitation and physiotherapy are essential to regain strength, flexibility and function in the wrist and hand. A structured program of exercises can help prevent stiffness and improve overall wrist function.

Fractures around the wrist can be life changing injuries. It is crucial to obtain a thorough evaluation by a medical professional such as an orthopaedic surgeon or emergency doctor, in order to determine the most appropriate treatment plan for a wrist fracture. Appropriate treatment can help minimise complications and facilitate a successful recovery.