Hand & Wrist Treatments
The human hand is an intricate instrument that is both tough and delicate. Its functions of sensations and motion allow us to experience and control the world around us.
One in three industrial or home accidents involves injury to the hand. The restoration of hand function after injury or disease is a gratifying experience for the hand surgeon.
The following links provide a brief description of some common hand conditions. There are numerous other conditions that relate to the injury, disease and deformity of the wrist and hand.
Dr Wheatley offers surgery for many common hand conditions.
The tendons of the thumb and each of the fingers pass through a sheath on the palm side of the hand. Certain diseases and overuse activities can cause a thickening of this sheath. As the tendon passes through a thickened sheath, the tendon eventually becomes irritated and swells. Pain, catching and eventually locking of the finger will occur. Early treatment consists of anti-inflammatory medication or Cortisone injection. If these fail to provide relief, the sheath is opened surgically through a small incision at the base of the finger.
De Quervain’s Tenosynovitis
Tendonitis on the thumb side of the wrist can be a very painful and disabling condition. Simple pinching and twisting activities can be almost impossible. The tendons to the thumb become inflamed as they pass under a ligament and the slightest motion of the wrist can cause pain.
Treatment consists of rest, medication and occasionally the use of a steroid injection. If these treatments do not provide relief over time, the tendons can be surgically released.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common hand problem resulting from pressure on the median nerve at the wrist. Symptoms, which are often worse at night, consist of numbness and/or pain in the wrist and fingers. Eventually there is loss of strength, fine motor control and sensation.
Early treatment consists of splinting and anti-inflammatory medication. If symptoms do not improve, a day surgery procedure to relieve the pressure on the nerve is suggested.
Following surgery, early gentle use is encouraged. The hand is kept dry for the first 3 days. On day 4 after surgery, the hand can be wet in the shower and a small dressing can then be applied. Sutures are removed at 7 to 10 days. People commonly have both hands released at the same time and cope well with self-care.
A ganglion rises out of a joint, like a balloon on a stalk. It grows out of the tissues surrounding a joint, such as ligaments, tendon sheaths, and joint linings. Inside the balloon is a thick, slippery fluid, similar to the fluid that lubricates your joints.
The most common location of a ganglion cyst is on the back of the wrist.
Ganglion cysts can develop in several of the joints in the hand and wrist, including both the top and underside of the wrist, as well as the end joint of a finger, and at the base of a finger. They vary in size, and in many cases, grow larger with increased wrist activity. With rest, the lump typically becomes smaller.
It is not known what triggers the formation of a ganglion. They are most common in younger people between the ages of 15 and 40 years, and women are more likely to be affected than men. These cysts are also common among gymnasts, who repeatedly apply stress to the wrist. Ganglion cysts that develop at the end joint of a finger - also known as mucous cysts - are typically associated with arthritis in the finger joint, and are more common in women between the ages of 40 and 70 years.
Most ganglions form a visible lump, however, smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms, if a cyst puts pressure on the nerves that pass through the joint, it can cause pain, tingling, and muscle weakness. Large cysts, even if they are not painful, can cause concerns about appearance. Although x-rays will not show a ganglion cyst, they can be used to rule out other conditions, such as arthritis or a bone tumour. Magnetic resonance imaging (MRI) scans can be useful prior to surgery to identify the extent and origin of the cyst.
Treatment ranges from observation, to aspiration to surgery.
Aspiration frequently fails to eliminate the ganglion because the "root" or connection to the joint or tendon sheath is not removed.
Surgical excision is typically a day-case procedure, performed under general anaesthesia. This has the highest success rate. Despite well-performed surgery, one in twenty ganglia still recur.
Arthritis Surgery for Thumb
Arthritis is an inflammatory condition of joints. There are several types of arthritis; the most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years. This may cause swelling, pain, stiffness, and malformation all of which interfere with use of the hand.
The diagnosis of thumb arthritis is made by examining the thumb. X-rays of the joint are usually taken to know the severity of the disease and to determine any bone spurs or calcium deposits.
Nonsurgical treatment methods for relieving pain in an arthritic joint include activity modification, pain medications, use of splints, and occasionally steroid injections. Surgery is usually considered if nonsurgical treatment fails to give relief. There are different surgical procedures that can be used and may include:
Excision arthroplasty: In this procedure, a bone at the base of the thumb is removed. Ligaments around the joint are reinforced. After eight weeks in a plaster the local tissues have healed to allow comfortable movement and a stable joint.
Arthrodesis: A fusion, also called an arthrodesis involves fusing two the bones of the joint together using metal wires or screws. It is also a reasonable operation, depending on the pattern of arthritis.
Both of these options will usually improve the comfort of the thumb. They do not restore full range of motion or full power.