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Orthopaedic Surgery

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- Ganglions
- Dupuytren's Disease
- Osteoarthritis
- Trigger Finger
- Rheumatoid Arthritis
- CTS
- Wrist Hand and
   Finger Injuries




Hand and Wrist Problems

Ganglions

They are most often found around the wrist joint, which accounts for 80% of all ganglion cysts, but may arise in the fingers or in relation to any joint or tendon. The cyst contains clear gelatinous fluid.

If the ganglion is painful or the lump is in such a position that it gets in the way, surgical excision can be performed. If it is not symptomatic it is safe to leave these lumps alone as long as the diagnosis is confirmed. Aspiration usually fails with recurrence of the cyst within days.




Ganglions
Ganglions

Contact

Spire Yale (Private Only)
Anna Gizzi
01978 268 065

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Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH), Oswestry (private and nhs)
Hayley Higgins
01691 404 099

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Wrexham maelor (NHS Only)
Anne fisher
01978 725720

Dupuytren's Disease

Dupuytren's contracture is caused by underlying contractures of the palmar fascia. It is is usually painless, however in its early stages some nodules may be tender. The rate of progression is very variable. Features that predict more rapid progression are disease in both hands, multiple fingers, young age at onset, strong family history. Males are more at risk.

Treatment
Surgery is not necessary until the fingers are contracted. A simple guide is can you put your hand flat on the table, if not surgery may be advisable. Surgical management consists of opening the skin over the affected cords and excising (removing) the fibrous tissue. The fingers may then be brought out straight and this correction maintained with the help of postoperative therapy.

Tender nodules can be treated with steroid injection, but surgery for these nodules has very poor published results, and is best avoided. Needle aponeurotomy is a minimally invasive technique where the cords are weakened through the insertion and manipulation of a small needle. Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight. The advantage claimed for needle aponeurotomy is the very small amount of surgery required and the very rapid return to normal activities, but the nodules are not removed and often the skin splits with the manipulation which then takes as long as surgery to heal.

Collagenase injection has some supporters but is not routinely offered in the UK and not by myself.



Dupuytrens Disease Dupuytren's Disease

 

Osteoarthritis of the Hand

Osteoarthritis or degenerative joint disease affects about 8 million people in the UK.

Symptoms include pain, tenderness, swelling, stiffness and later muscle weakness and loss of grip.

Treatment is aimed at the relief of pain and restoration of function and includes analgesia, physiotherapy, splintage, activity modification and surgery.

The type of surgery may include joint replacement, arthrodesis (stiffening a joint) or excision arthroplasty (taking away an affected joint) and is a personal decision made between the patient and the surgeon depending on symptoms and lifestyle demands.

Surgery may not be necessary, but a discussion with an expert about how to manage symptoms, of what is likely to happen over time and reassurance that arthritis doesn't spread from joint to joint often allays individuals fears and gives patients control over their disease.



Osteoarthritis of the Hand Osteoarthritis of the Hand

 

Trigger Finger

Trigger finger, trigger thumb, or trigger digit, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain.

Injection of the tendon sheath with a steroid is effective over weeks to months in 80% of patients.

When corticosteroid injection fails, the problem is predictably resolved by a relatively simple surgical procedure under local anaesthetic to release the constriction in the tendon sheath. If the finger has become stiff prior to surgery some physiotherapy and splintage may be necessary.



Trigger Finger Trigger Finger

 

Rheumatoid Arthritis of the Hand

This is an inflammatory arthritis which affects joints, nerves, tendons and other soft tissues.

Symptoms include swelling, pain, warm and tender joints with stiffness deformity and loss of function. The hands and wrist are very commonly involved and I am now the lead surgeon in North Wales for rheumatoid hand and wrist surgery.

A multidisciplinary approach is vital. The patient is central to a team of surgeons, rheumatologists, physio and occupational therapists.

Surgery is aimed at relieving pain, restoring function and correcting deformity.

Nerve decompression, tendon reconstruction, joint surgery (arthrodesis or stiffening procedures, arthroplasty and synovectomy) are all available to help patients.



Rheumatoid Arthritis of the Hand Rheumatoid Arthritis

 

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) is caused by compression of the median nerve travelling through the carpal tunnel at the wrist. Most cases are idiopathic, that is without cause. Examples of related conditions are rheumatoid arthritis, pregnancy, hypothyroidism and following wrist fracture.

Carpal tunnel syndrome produces a series of symptoms from mild to extreme and include numbness, tingling, or burning sensations in the thumb and fingers, particularly the index and middle fingers. Individuals also experience pain in the hands , wrists or arm and some report to have lost gripping strength.

It is important these symptoms are treated before they become constant as weakness of the muscles and permanent loss of feeling in the fingertips cannot be reversed even with surgery.

Diagnosis is usually made by clinical assessment. However if the history and physical examination is inconclusive, patients will sometimes be tested with nerve conduction studies.

Treatments include:

Splinting or bracing (at night to help sleep).

Steroid injection This can be quite effective for temporary relief from symptoms of CTS. In certain patients, an injection may also be of diagnostic value. This treatment is not appropriate for extended periods. For most patients, surgery is the only option that will provide permanent relief.

Nerve and tendon gliding exercises.

Surgical release of the transverse carpal ligament. This is usually performed as a day case under local anaesthetic. It is the commonest operation I perform with close to 200 decompressions per year.




Wrist Hand and Finger Injuries

An early diagnosis by an expert is the best way of limiting stiffness and making a rapid and full recovery.

Even when no bones are broken soft tissue injuries can lead to pain, stiffness and longer term problems if not appropriately splinted and rehabilitated. An opinion within a few weeks is ideal but problems can be reversed even months following an injury that hasn't settled.

 


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