Hand & Wrist
Select a treatment from the list below.
Consultant – Gavin Brigstocke
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a condition when the median nerve is compressed as it passes through a short tunnel at the wrist resulting in pain, tingling and numbness in the hand. CTS most commonly affects middle aged women but can occur in anyone. Symptoms are often worse at night or first thing in the morning. It may be provoked by activities that involve gripping an object. In the early stages numbness and tingling are intermittent and sensation does return to normal. As the condition worsens altered sensation may become permanent and wasting of the muscles at the base of the thumb may occur.
The diagnosis of CTS is usually clear from symptoms and signs alone. Nerve conduction studies may be used to confirm the diagnosis if the clinical findings are equivocal.
Carpal tunnel syndrome (CTS) is a condition when the median nerve is compressed as it passes through a short tunnel at the wrist resulting in pain, tingling and numbness in the hand. CTS most commonly affects middle aged women but can occur in anyone. Symptoms are often worse at night or first thing in the morning. It may be provoked by activities that involve gripping an object. In the early stages numbness and tingling are intermittent and sensation does return to normal. As the condition worsens altered sensation may become permanent and wasting of the muscles at the base of the thumb may occur.
The diagnosis of CTS is usually clear from symptoms and signs alone. Nerve conduction studies may be used to confirm the diagnosis if the clinical findings are equivocal.
What treatments are available?
Non-operative measures including exercises, night splints and steroid injections may be beneficial with mild or moderate CTS. If the symptoms progress surgery is usually required. The short procedure involves opening the roof of the tunnel to release the pressure on the nerve. The surgery is usually performed under local anaesthetic.
Non-operative measures including exercises, night splints and steroid injections may be beneficial with mild or moderate CTS. If the symptoms progress surgery is usually required. The short procedure involves opening the roof of the tunnel to release the pressure on the nerve. The surgery is usually performed under local anaesthetic.
What are the outcomes?
Surgery usually results in a satisfactory resolution of symptoms. Night pain and tingling disappear within days. In severe cases improvement of the constant numbness and muscle weakness may be slow or incomplete. The scar in the palm will be firm to touch and sometimes tender for 3-6 months after surgery. This will routinely settle with time and can often be aided by massaging the scar.
Surgery usually results in a satisfactory resolution of symptoms. Night pain and tingling disappear within days. In severe cases improvement of the constant numbness and muscle weakness may be slow or incomplete. The scar in the palm will be firm to touch and sometimes tender for 3-6 months after surgery. This will routinely settle with time and can often be aided by massaging the scar.
Further information:
http://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome
http://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome
Consultant – Gavin Brigstocke
What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is compression of the ulnar nerve in a tunnel at the inside of the elbow. The ulnar nerve provides sensation to the little and part of the ring finger and power to several of the small muscles in the hand. In the early stages you may experience intermittent numbness of the little and ring fingers that can be provoked by leaning on the elbow or holding it in a flexed position. Over time as the compression worsens the numbness may become constant and the hand weak.
Cubital tunnel syndrome is compression of the ulnar nerve in a tunnel at the inside of the elbow. The ulnar nerve provides sensation to the little and part of the ring finger and power to several of the small muscles in the hand. In the early stages you may experience intermittent numbness of the little and ring fingers that can be provoked by leaning on the elbow or holding it in a flexed position. Over time as the compression worsens the numbness may become constant and the hand weak.
What treatments are available?
Simple non-operative measures include avoiding provocative activities, anti-inflammatory medications and wearing protective pads. A night time splint can be used to prevent excessive elbow flexion. Should symptoms persist despite such measures, surgery to decompress the nerve may be required. Decompressive surgery involves releasing all the tight structures that may be restricting the nerve. Once released the elbow is flexed and if the nerve is found to be unstable it is moved to a stable position at the front of the elbow.
Simple non-operative measures include avoiding provocative activities, anti-inflammatory medications and wearing protective pads. A night time splint can be used to prevent excessive elbow flexion. Should symptoms persist despite such measures, surgery to decompress the nerve may be required. Decompressive surgery involves releasing all the tight structures that may be restricting the nerve. Once released the elbow is flexed and if the nerve is found to be unstable it is moved to a stable position at the front of the elbow.
What are the outcomes?
The outcome of surgery depends upon the severity of the nerve compression. In mild cases one would expect a full resolution of symptoms. With more severe cases surgery prevents worsening of muscle weakness and sensation but is less predictable in regard to the nerve function fully recovering.
The outcome of surgery depends upon the severity of the nerve compression. In mild cases one would expect a full resolution of symptoms. With more severe cases surgery prevents worsening of muscle weakness and sensation but is less predictable in regard to the nerve function fully recovering.
Further information:
http://www.bssh.ac.uk/patients/conditions/22/cubital_tunnel_syndrome
http://www.bssh.ac.uk/patients/conditions/22/cubital_tunnel_syndrome
Consultant – Gavin Brigstocke
What is De Quervain’s Syndrome?
De Quervain’s syndrome is a painful condition affecting the tendons attached to the base of the thumb as they run through a tunnel at the wrist. Symptoms may include pain at the thumb side of the wrist, swelling, tenderness and clicking of the tendons.
De Quervain’s syndrome is a painful condition affecting the tendons attached to the base of the thumb as they run through a tunnel at the wrist. Symptoms may include pain at the thumb side of the wrist, swelling, tenderness and clicking of the tendons.
What treatments are available?
De Quervain’s syndrome is not harmful but can cause troublesome symptoms. Mild cases will frequently recover with no intervention. If symptoms persist non-operative measures include avoidance of provocative activities, the use of a splint to immobilise the thumb and wrist or a steroid injection may be employed. Surgery may be considered if non-operative measures fail to control your symptoms. Surgery involves slitting the roof of the tendon tunnel to decompress the tendons and provide sufficient space for them to move without irritation.
De Quervain’s syndrome is not harmful but can cause troublesome symptoms. Mild cases will frequently recover with no intervention. If symptoms persist non-operative measures include avoidance of provocative activities, the use of a splint to immobilise the thumb and wrist or a steroid injection may be employed. Surgery may be considered if non-operative measures fail to control your symptoms. Surgery involves slitting the roof of the tendon tunnel to decompress the tendons and provide sufficient space for them to move without irritation.
What are the outcomes?
Steroid injection will successfully relieve the pain in approximately 70% of cases. The risks of injection are small but it may lead to thinning or discolouration of the overlying skin. Surgery will usually result in rapid pain relief, however the scar is sometimes sore and temporary numbness on the back of the hand may be present as small nerve branches are moved to adequately visualise the tunnel.
Steroid injection will successfully relieve the pain in approximately 70% of cases. The risks of injection are small but it may lead to thinning or discolouration of the overlying skin. Surgery will usually result in rapid pain relief, however the scar is sometimes sore and temporary numbness on the back of the hand may be present as small nerve branches are moved to adequately visualise the tunnel.
Further information:
http://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome
http://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome
Consultant – Gavin Brigstocke
What is Dupuytren’s Disease?
Dupuytren’s disease is a progressive thickening of the deep tissue of the palm and fingers. Small benign nodules grow in the palm of the hand which over time may progress to thickened cords extending into the digits forcing the fingers to contract.
Dupuytren’s disease is not a serious condition and most cases are painless. Treatment is not always necessary but if the contracture affects the hand’s function the contracture may be surgically released. The severity of the condition will determine the type of procedure required. Even after treatment, Dupuytren’s can recur in which case more extensive surgery may be required.
Dupuytren’s disease is a progressive thickening of the deep tissue of the palm and fingers. Small benign nodules grow in the palm of the hand which over time may progress to thickened cords extending into the digits forcing the fingers to contract.
Dupuytren’s disease is not a serious condition and most cases are painless. Treatment is not always necessary but if the contracture affects the hand’s function the contracture may be surgically released. The severity of the condition will determine the type of procedure required. Even after treatment, Dupuytren’s can recur in which case more extensive surgery may be required.
What treatments are available?
There is no cure for Dupuytren’s disease. Surgery can correct contractures of the digits but cannot eradicate the disease.
Non-operative treatments are available in the out-patient department and often very successful. The cord may be released by needling through the skin or alternatively by the injection of enzymes. Once disrupted the cord is snapped with a manipulation procedure. These treatments are suitable for some patients with disease limited to the palm.
Surgical options include segmental fasciectomy when a short segment of the cord is removed, regional fasciectomy when the entire cord is removed and dermofasciectomy when the cord and overlying skin is removed and replaced by a skin graft from the upper arm. Following surgery the hand is fitted with a splint and hand therapy is essential in recovering movement and function of the hand.
There is no cure for Dupuytren’s disease. Surgery can correct contractures of the digits but cannot eradicate the disease.
Non-operative treatments are available in the out-patient department and often very successful. The cord may be released by needling through the skin or alternatively by the injection of enzymes. Once disrupted the cord is snapped with a manipulation procedure. These treatments are suitable for some patients with disease limited to the palm.
Surgical options include segmental fasciectomy when a short segment of the cord is removed, regional fasciectomy when the entire cord is removed and dermofasciectomy when the cord and overlying skin is removed and replaced by a skin graft from the upper arm. Following surgery the hand is fitted with a splint and hand therapy is essential in recovering movement and function of the hand.
What are the outcomes?
The final outcome of surgery is dependent upon the extent and behaviour of the disease and the type of surgery required. The vast majority of patients are very happy with the result of their surgery, however complications can occur. Recurrence over a life time is almost inevitable. Incomplete correction of finger contractures may occur particularly with longstanding severe deformities. Infections as well as injuries to the blood vessels and nerves may occur.
The final outcome of surgery is dependent upon the extent and behaviour of the disease and the type of surgery required. The vast majority of patients are very happy with the result of their surgery, however complications can occur. Recurrence over a life time is almost inevitable. Incomplete correction of finger contractures may occur particularly with longstanding severe deformities. Infections as well as injuries to the blood vessels and nerves may occur.
Further information:
http://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease
http://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease
Consultant – Gavin Brigstocke
What is Finger Arthritis?
Osteoarthritis is the loss of the smooth cartilage surfaces lining the ends of bones in the joints. In the fingers this is typically seen at the terminal joint called the distal interphalangeal joint (DIPJ) and less frequently at either the middle joint called the proximal interphalangeal joint (PIPJ) or the most proximal joint called the metacarpo-phalangeal joint (MCPJ). Arthritis will present with a combination of pain, swelling, deformity and loss of motion of the affected joint
Osteoarthritis is the loss of the smooth cartilage surfaces lining the ends of bones in the joints. In the fingers this is typically seen at the terminal joint called the distal interphalangeal joint (DIPJ) and less frequently at either the middle joint called the proximal interphalangeal joint (PIPJ) or the most proximal joint called the metacarpo-phalangeal joint (MCPJ). Arthritis will present with a combination of pain, swelling, deformity and loss of motion of the affected joint
What treatments are available?
Many people have deformed arthritic finger joints but experience very little pain and maintain good hand function. With this scenario very little treatment is required. Should the joints become painful a range of non-operative and operative interventions may be appropriate. Non-operative measures include activity modification, painkillers, anti-inflammatory medication and targeted steroid injections into the arthritic joints. Surgery may be employed to either fuse or replace the joint.
Many people have deformed arthritic finger joints but experience very little pain and maintain good hand function. With this scenario very little treatment is required. Should the joints become painful a range of non-operative and operative interventions may be appropriate. Non-operative measures include activity modification, painkillers, anti-inflammatory medication and targeted steroid injections into the arthritic joints. Surgery may be employed to either fuse or replace the joint.
What are the outcomes?
Joint fusion is a reliable pain relieving procedure, however the potential benefit does come at the cost of permanently stiffening the joint. Joint replacement with either a flexible silastic hinge joint or pyrocarbon prosthesis may provide reliable pain relief and preserve motion. Joint replacement has well documented complications and the risks and benefits will be discussed with the patient prior to contemplating surgery.
Joint fusion is a reliable pain relieving procedure, however the potential benefit does come at the cost of permanently stiffening the joint. Joint replacement with either a flexible silastic hinge joint or pyrocarbon prosthesis may provide reliable pain relief and preserve motion. Joint replacement has well documented complications and the risks and benefits will be discussed with the patient prior to contemplating surgery.
Further information:
http://www.bssh.ac.uk/patients/conditions/23/terminal_finger_joint_arthritis
http://www.bssh.ac.uk/patients/conditions/23/terminal_finger_joint_arthritis
Consultant – Gavin Brigstocke
What are Ganglion Cysts?
A ganglion cyst is caused by synovial fluid that has leaked from a joint. It is the most common type of swelling seen in the hand and wrist. The common locations include the terminal joint of the finger (mucous cyst), the back of the wrist (dorsal wrist ganglion), the base of the thumb (volar wrist ganglion) and the base of the finger from the tendon sheath (pearl seed ganglion). Ganglion cysts often arise spontaneously but may occur following injury or because the joint is starting to develop arthritis.
A ganglion cyst is caused by synovial fluid that has leaked from a joint. It is the most common type of swelling seen in the hand and wrist. The common locations include the terminal joint of the finger (mucous cyst), the back of the wrist (dorsal wrist ganglion), the base of the thumb (volar wrist ganglion) and the base of the finger from the tendon sheath (pearl seed ganglion). Ganglion cysts often arise spontaneously but may occur following injury or because the joint is starting to develop arthritis.
What treatments are available?
Ganglion cyst are harmless and can be safely left alone. Many will disappear spontaneously and others will cause no trouble. For cysts that are troublesome, persistent or recurrent they may be drained with a needle under local anaesthetic or surgically excised.
Ganglion cyst are harmless and can be safely left alone. Many will disappear spontaneously and others will cause no trouble. For cysts that are troublesome, persistent or recurrent they may be drained with a needle under local anaesthetic or surgically excised.
What are the outcomes?
The success of either simple aspiration or surgical excision is dependent upon the cyst location. Unfortunately both of these procedures are associated with a reasonable chance of recurrence. Surgery at the wrist can result in loss of movement and painful trapping of nerve branches in the scar tissue.
The success of either simple aspiration or surgical excision is dependent upon the cyst location. Unfortunately both of these procedures are associated with a reasonable chance of recurrence. Surgery at the wrist can result in loss of movement and painful trapping of nerve branches in the scar tissue.
Further information:
http://www.bssh.ac.uk/patients/conditions/20/ganglion_cysts
http://www.bssh.ac.uk/patients/conditions/20/ganglion_cysts
Consultant – Gavin Brigstocke
What is Basal Thumb Arthritis?
Osteoarthritis is the loss of cartilage between bones and commonly occurs in the joint at the base of the thumb. This is a common site for osteoarthritis as the joint moves in several planes and transmits high forces during pinch grip. The lack of cartilage means the exposed bone surfaces of the trapezium and metacarpal can rub together resulting in pain, swelling, stiffness and deformity.
Osteoarthritis is the loss of cartilage between bones and commonly occurs in the joint at the base of the thumb. This is a common site for osteoarthritis as the joint moves in several planes and transmits high forces during pinch grip. The lack of cartilage means the exposed bone surfaces of the trapezium and metacarpal can rub together resulting in pain, swelling, stiffness and deformity.
What treatments are available?
The methods for relieving discomfort in any arthritic joint include activity modification, analgesic and anti-inflammatory medications, splints, targeted steroid injections and finally surgery. With basal thumb arthritis flexible neoprene splints can be both effective and practical. Injections can be very effective at relieving pain as the steroid works as a powerful anti-inflammatory.
Surgery is considered when other measures have failed and the pain is affecting activities of daily living. Trapeziumectomy, when the trapezium bone is removed, remains the gold-standard surgical option for base of thumb arthritis. This procedure can result in some weakness of pinch grip and there are several other surgical options including tendon interposition, fusion and joint replacement. The type of operation depends upon the extent of the arthritis, your age and activity level and your surgeon will be able to advise the best way forward.
The methods for relieving discomfort in any arthritic joint include activity modification, analgesic and anti-inflammatory medications, splints, targeted steroid injections and finally surgery. With basal thumb arthritis flexible neoprene splints can be both effective and practical. Injections can be very effective at relieving pain as the steroid works as a powerful anti-inflammatory.
Surgery is considered when other measures have failed and the pain is affecting activities of daily living. Trapeziumectomy, when the trapezium bone is removed, remains the gold-standard surgical option for base of thumb arthritis. This procedure can result in some weakness of pinch grip and there are several other surgical options including tendon interposition, fusion and joint replacement. The type of operation depends upon the extent of the arthritis, your age and activity level and your surgeon will be able to advise the best way forward.
What are the outcomes?
Surgery is very effective form of pain relief, however it is associated with a loss power in the thumb which can take up to a year to gain maximal improvement. Complications are rare and will be discussed with you prior to surgery.
Surgery is very effective form of pain relief, however it is associated with a loss power in the thumb which can take up to a year to gain maximal improvement. Complications are rare and will be discussed with you prior to surgery.
Further information:
http://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis
http://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis
Consultant – Gavin Brigstocke
What is a Skier’s Thumb Injury?
This is an injury to the ulnar collateral ligament (UCL) of the metacarpo-phalangeal joint of the thumb. The ligament acts to stabilise the thumb during pinching and provide a rigid pillar to push against. An acute injury (skier’s thumb) to the UCL may occur due to a fall on a hyper-extended thumb. A chronic injury (gamekeeper’s thumb) may occur during repetitive stretching of the ligament over time.
This is an injury to the ulnar collateral ligament (UCL) of the metacarpo-phalangeal joint of the thumb. The ligament acts to stabilise the thumb during pinching and provide a rigid pillar to push against. An acute injury (skier’s thumb) to the UCL may occur due to a fall on a hyper-extended thumb. A chronic injury (gamekeeper’s thumb) may occur during repetitive stretching of the ligament over time.
What treatments are available?
The treatment of acute UCL injuries consists of either splintage or surgical repair. The decision of the best treatment option for your injury is made upon whether the ligament is partially or completely torn. A partially torn ligament is protected in a cast or splint for a period of six weeks prior to mobilisation. A complete ligament injury requires an operation to repair the ligament followed by a period of splintage and subsequent mobilisation.
The treatment of acute UCL injuries consists of either splintage or surgical repair. The decision of the best treatment option for your injury is made upon whether the ligament is partially or completely torn. A partially torn ligament is protected in a cast or splint for a period of six weeks prior to mobilisation. A complete ligament injury requires an operation to repair the ligament followed by a period of splintage and subsequent mobilisation.
What are the outcomes?
The outcome of a correctly treated injury with no significant time delay should result in a return to normal function. Should the ligament fail to heal and the thumb become unstable further surgery to reconstruct the ligament or fuse the joint might be indicated.
The outcome of a correctly treated injury with no significant time delay should result in a return to normal function. Should the ligament fail to heal and the thumb become unstable further surgery to reconstruct the ligament or fuse the joint might be indicated.
Further information:
http://www.bssh.ac.uk/patients/conditions/32/skiers_thumb
http://www.bssh.ac.uk/patients/conditions/32/skiers_thumb
Consultant – Gavin Brigstocke
What is a Trigger Digit?
Trigger digit is a painful condition in which the finger or thumb locks as it is bent in towards the palm. It is the result of thickening of the mouth of the tendon tunnel which results in wear and tear of the tendon and catching of the tendon as it is unable to glide through the mouth of the tunnel. Trigger digit may present with pain in the palm at the site of the triggering, clicking of the digit upon movement or locking of the digit in a flexed position, often worse in the morning. The digit may need to be straightened
Trigger digit is a painful condition in which the finger or thumb locks as it is bent in towards the palm. It is the result of thickening of the mouth of the tendon tunnel which results in wear and tear of the tendon and catching of the tendon as it is unable to glide through the mouth of the tunnel. Trigger digit may present with pain in the palm at the site of the triggering, clicking of the digit upon movement or locking of the digit in a flexed position, often worse in the morning. The digit may need to be straightened
What treatments are available?
Non-operative measures include activity avoidance, the use of a small splint at night to hold the finger straight and administering a steroid injection. If non-operative measures fail and troublesome symptoms persist a surgical decompression of the tendon tunnel can be performed under local anaesthetic.
Non-operative measures include activity avoidance, the use of a small splint at night to hold the finger straight and administering a steroid injection. If non-operative measures fail and troublesome symptoms persist a surgical decompression of the tendon tunnel can be performed under local anaesthetic.
What are the outcomes?
A steroid injection relieves the pain and triggering in approximately 70% of cases. There are few risks associated with such an injection, but it may occasionally result in thinning or discolouration of the overlying skin. Surgery usually results in a rapid resolution of pain and triggering. The scar in the palm may be tender for several weeks and although uncommon triggering may recur.
A steroid injection relieves the pain and triggering in approximately 70% of cases. There are few risks associated with such an injection, but it may occasionally result in thinning or discolouration of the overlying skin. Surgery usually results in a rapid resolution of pain and triggering. The scar in the palm may be tender for several weeks and although uncommon triggering may recur.
Further information:
http://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb
http://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb
