Hand Procedures

Procedures outlined on this page include:

Carpal tunnel syndrome / Cubital tunnel syndrome

DeQuervains tenosynovitis

Dupuytren's disease

Ganglions

Osteoarthrits (OA)

Trigger digit (Trigger finger).

 

Carpal tunnel syndrome / Cubital tunnel syndrome

Carpal tunnel syndrome involves compression of the median nerve at the wrist (the carpal tunnel) and is the most common nerve entrapment. Less frequently the ulnar nerve can become squashed at the elbow (the cubital tunnel).

Compressed nerves can produce tingling, pain and sometimes numbness in different fingers. When severe, this condition can affect muscle power and dexterity.

Nerve entrapment can be treated with rest, splints, injections or surgery, depending on the degree of compression.

Most symptoms can improve with treatment.

Recovery is influenced by the length and severity of symptoms before treatment and age at onset. Affected muscle may never recover completely.

Surgery for both carpal tunnel syndrome and cubital tunnel syndrome is generally under local anaesthetic and takes 30 to 45 minutes.

After surgery for carpal tunnel syndrome, patients will need to wear a simple splint to support the wrist for one week. Both types of surgery require patients to wear a sling for around three days (the fingers are left free to move).

A follow up review at 48 hours will check the extent of swelling, bruising and movement of the fingers. In most cases, any tingling or pain present before surgery will have already improved. It should be possible to shower four to five days after surgery.

Find out more about nerve entrapment on the BSSH (British Society for Surgery of the Hand) website or the ASSH (American Society for Surgery of the Hand) website.

 

DeQuervains Tenosynovitis

DeQuervains tenosynovitis is an inflammatory condition involving tendons on the back of the thumb, which can sometimes be related to overuse. This condition can be treated with rest, splintage or steroid injections.

However, some cases will require surgery to release the compressed tendons and allow them to glide. Surgery is a day case under local anaesthetic. Recovery is relatively quick and patients should able to use their hand within a few days.

Find out more about deQuervains tenosynovitis on the BSSH website or the ASSH website.

 

Dupuytren's Disease

Dupuytren's disease is a progressive contracture of tissue which builds up in the palm (or sometimes the sole of the foot). The onset is variable - it sometimes starts in the teenage years if there is a strong family history but usually people are in their 50's. The rate of progression varies.

Dupuytren's disease cannot be cured but it can be treated. Surgery is considered when hand function is impaired. Surgery is performed as a day case procedure under local anaesthetic. The patient’s hand will be reviewed 48 hours after surgery to start mobilization. The patient will also see a physiotherpist and an occupational therapist following surgery. A small plastic splint at night is likely to be used to maintain the release of the contracture.

Find out more about dupuytren's disease on the BSSH website or the ASSH website.

 

Ganglions

Ganglions are a fluid filled sac, usually located near a joint or tendon sheath. They can cause an aching discomfort.

They may be degenerative and cannot always be cured depending on the location. However, up to 60 percent of ganglions on the back of the wrist resolve spontaneously within two to three years.

Ganglions are especially common in young women. They are also associated with increasing age, especially if they involve the thumb or finger joints as part of osteoarthritis (for more about osteoarthritis, please read below).

Ganglions can be managed in a variety of ways including: surgery under local anaesthetic as a day case, decompression under ultrasound imaging, with aspiration (suction via a needle), a steroid injection, splintage and resting the hand. Recovery is relatively quick and patients should able to use their hand within a few days.

Some patients may also require an operative procedure on the joint itself to prevent recurrence.

Find out more about ganglions on the BSSH website or the ASSH website.


Osteoarthrits (OA)

The thumb is probably the most common joint to be affected by osteoarthrits in the body. Joints in the fingers may also be affected, producing pain and stiffness. Sometimes the joints can become deformed and poorly aligned (known as subluxation), which may affect pinch, grip and power in the hand.

Degenerative arthritis is a treatable condition. Patients who are experiencing persistent pain, deformity and loss of power in their hand may need surgery. The procedure required will be matched to the stage of the osteoarthrits.

An x-ray is required to determine the extent of the condition. This may be followed by steroid injections into the joint, anti-inflammatory medication and splintage.

Alternatively surgery may be necessary. The type of procedure can vary and includes techniques to realign the forces acting on the joint (an osteotomy), removal of the bone (a trapeziectomy) or to replace the joint (an arthroplasty) or to permanently stiffen the joint (a fusion).

Find out more about osteoarthrits on the BSSH website or the ASSH website.

 

Trigger Digit (Trigger Finger)

A small nodule can sometimes develop on a tendon resulting in the finger getting stuck in certain positions. When it suddenly releases, the sensation is known as triggering. The cause is unknown, although it may relate to a minor injury.

Steroid injections can be used to treat intermittent clicking of the fingers. In about 60 percent of cases this will resolve the problem permanently and, when successful, will occur around a week after treatment. In about 20 percent of cases, the inflammatory nodule is too large and will not shrink so the triggering continues. In other cases, improvement is only temporary.

If the steroid injection is unsuccessful, the trigger may need to be released under local anaesthetic as a 30 minute day case procedure.

The fingers are left free to move following surgery. You should elevate your hand for two to three days depending on the degree of any swelling. Most patients should be able to shower after around four days.

Find out more about trigger digits on the BSSH website or the ASSH website.