Hand surgery
We specialise in hand surgery techniques to enhance mobility, restore strength, and alleviate pain. We aim to improve hand function and overall quality of life for various conditions. Whether you're facing a recent trauma or long-term challenges, our team is committed to providing optimal, personalised care tailored to your needs.
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is a condition where the median nerve is compressed at the wrist, commonly affecting middle-aged women but can occur in anyone. It can be linked to various conditions like pregnancy, diabetes, and arthritis but often has no identifiable cause. Symptoms include tingling, numbness, and weakness in the thumb, index, middle, and ring fingers, worsened by activities like gripping objects. In advanced stages, there may be continuous altered sensation, muscle weakness, and clumsiness. Diagnosis may involve nerve conduction tests and x-rays.
What is the treatment?
Non-surgical treatments for carpal tunnel syndrome (CTS) include wearing splints, particularly at night, and receiving steroid injections into the carpal tunnel. CTS during pregnancy often resolves after childbirth.
However, surgery is frequently necessary. The procedure involves opening the roof of the tunnel (known as the flexor retinaculum) to alleviate pressure on the nerve. This typically entails making an incision over the tunnel at the wrist and opening the roof under direct vision. Surgery can be performed under local or general anaesthesia.
What should I expect during a consultation for carpal tunnel syndrome?During your consultation, you should be ready to discuss your carpal tunnel symptoms and how they affect your hand function, as well as your medical history, current medications, and any previous surgeries. Your plastic surgeon will evaluate your health and examine your hand/upper limb. You will then have a discussion about investigations, treatment options and the potential outcomes and risks. It is important to understand what is required to recover from surgery and maximise the outcome. Please ask any questions you may have and address your concerns with your surgeon.
What is cubital tunnel syndrome?
Cubital tunnel syndrome is characterized by the compression or irritation of the ulnar nerve at the inside of the elbow. Symptoms typically include numbness or tingling in the little and ring fingers, often worsened by leaning on the elbow or keeping it bent, such as during sleep. In advanced stages, constant numbness and hand weakness may occur, with visible muscle loss in severe cases. Causes can include arthritis or past injuries, although many cases arise without a clear trigger.
What is the treatment?
To prevent or reduce symptoms, avoid activities that provoke the condition, such as using a headset for phone calls, avoiding pressure on the inside of the elbows, or wearing protective pads. At night, minimise elbow bending by wrapping a folded towel around the elbow or using a splint. These measures can be effective in the early stages.
Surgery may be necessary in severe cases or if non-surgical treatments are ineffective. Surgery often improves numbness and aims to prevent muscle weakness and wasting. Your surgeon can recommend the best approach for your situation.
What should I expect during a consultation for cubital tunnel syndrome?
During your consultation, be prepared to discuss your symptoms and how they affect your work and daily activities. You should also be ready to share your medical history, current medications, and any past surgeries. Your plastic surgeon will assess your health and examine your ulnar nerve and upper limb. Following this, you will have a conversation about investigations, treatment options, potential outcomes, and associated risks. It's important to fully understand the post-surgery recovery process and how to maximize the results. Please do not hesitate to ask any questions you may have and address your concerns with your surgeon.
What is de Quervain syndrome?
De Quervain's syndrome is a painful condition affecting tendons on the thumb side of the wrist, often without a clear cause. It commonly occurs in mothers of small babies and can be aggravated by repetitive activities. Symptoms include pain on the thumb side of the wrist, worsened by lifting the thumb or using scissors, tenderness and swelling at the painful site, and occasional clicking or snapping of the tendons. Though not harmful, it can be very painful.
Who is a good candidate for de Quervain surgery?
Not all cases of de Quervain syndrome require surgery, as some mild cases recover without treatment. Treatment options include avoiding activities that cause pain, using a wrist/thumb splint to immobilize the thumb and wrist, and steroid injections, which relieve pain in about 70% of cases but can occasionally cause skin changes at the injection site. Surgical decompression of the tendon tunnel is an option, typically reserved for patients who do not respond to other treatments, though it may be the most appropriate initial option for some.
What should I expect during a consultation for de Quervain syndrome?
During your consultation, be prepared to discuss your symptoms, their impact on your hand function, your medical history, current medications, and any previous surgeries. Your plastic surgeon will evaluate your health and examine your upper limb. You will then discuss investigations, treatment options, potential outcomes, and risks. Understanding the recovery process and how to maximise your outcome is crucial. Feel free to ask any questions and address any concerns with your surgeon.
What is Dupuytren's disease?
Dupuytren’s disease, or Dupuytren's contracture, is a common condition that typically arises in middle age or later, more frequently in men. It starts with firm nodules in the ligaments just beneath the skin of the palm, often in line with the ring finger. These nodules can extend to form cords that prevent the finger from straightening completely and may be associated with small pits in the skin. Some individuals also develop nodules over the back of the finger knuckles (Garrod's knuckle pads) or lumps on the soles of the feet. The condition often (but not always) progresses slowly, with affected digits potentially becoming fixed in a bent position over months or years. The cause is unknown, but it is more common in Northern Europe, often runs in families, and may be linked to diabetes, smoking, and high alcohol consumption. It is not associated with manual work but can occasionally appear after injury or surgery to the hand or wrist.What is the treatment?
There is currently no cure for Dupuytren's disease. Surgery can often help straighten bent fingers, but it cannot eliminate the disease, and it may recur in areas that have been operated on or were previously unaffected. Many patients may require only one operation, while others may need multiple operations in their lifetime. Collagenase injections can be beneficial.
Surgery is unnecessary if fingers can be fully straightened but may be considered when it becomes impossible to lay the hand flat on a table. The surgeon will advise on the appropriate type and timing of surgery, which can be performed under local, regional, or general anaesthesia. Surgical options include:
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Fasciotomy: Cutting the contracted cord in the palm or finger.
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Segmental Fasciectomy: Removing short segments of the cord through small incisions.
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Regional Fasciectomy: Removing the entire cord through a longer incision.
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Dermofasciectomy: Removing the cord and overlying skin, replaced with a skin graft, usually for recurrent or extensive disease in younger individuals.
After surgery, a splint may be used at night, and hand therapy is crucial for regaining movement and function. Recovery varies depending on the disease's extent and behaviour and the type of surgery performed.
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What is terminal finger joint arthritis?
The distal interphalangeal joint (DIPJ) and the joint at the base of the thumb are commonly affected by osteoarthritis. Osteoarthritis typically occurs after age 45 and may have a genetic component. It involves the thinning and roughening of cartilage, which leads to the rubbing together of bone ends. Symptoms include small bony bumps (osteophytes or Heberden's Nodes), swelling, deformity, stiffness, and loss of function. However, despite these changes, many people experience minimal pain and maintain good hand function.
What is the treatment?
Episodes of pain, redness, and swelling from osteoarthritis often resolve on their own over weeks or months. Management includes avoiding painful activities, using simple painkillers, anti-inflammatory gels or medications, and sometimes steroid injections. Surgery can fuse a persistently painful joint, trading pain relief for loss of movement. Various fusion techniques exist, and post-surgery, a splint may be needed for several weeks. Your surgeon can provide guidance on its indications and potential complications.
What are ganglion cysts?
Ganglion cysts are the most common type of swelling in the hand and wrist, containing a thick clear fluid and originating from various structures. Common locations include the back of the wrist, base of the thumb, base of a finger on the palm side, and back of a finger end joint. They result from a leak of joint lubricating fluid, forming a round collection within nearby tissues. While typically painless, they may become painful with certain activities. Finger ganglions can cause nail grooving or skin thinning with fluid discharge. Most arise spontaneously, but sometimes follow injury or joint arthritis. Diagnosis is usually straightforward due to their smooth, round appearance, fluctuating size, and characteristic locations, though scans may be needed if uncertain.
What is the treatment?
Ganglion cysts are generally harmless and can often disappear on their own. Treatment options include observation, aspiration of the cyst's contents, or surgical removal. The choice of treatment depends on the cyst's location and the symptoms it causes. It's important to note that even with successful surgery, there is a small risk of the ganglion returning in the future.
What is basal thumb arthritis?
The joint at the base of the thumb commonly develops osteoarthritis with age, characterized by thinning and roughening of the cartilage covering bone ends, leading to pain, tenderness, and difficulty with thumb use. Tasks like opening jars or turning keys become challenging, and stiffness and limited thumb movement may occur. In advanced cases, a bump at the base of the thumb and hyperextension of the middle thumb joint may be noticeable. Osteoarthritis can occur at any age but typically appears after 45, sometimes runs in families, and may follow a previous joint fracture.
What is the treatment?
Treatment options for thumb osteoarthritis include avoiding painful activities, analgesic and/or anti-inflammatory medication, and using a splint for support. Steroid injections can provide pain relief, though effects may wear off over time and can occasionally cause skin changes at the injection site. Improvement may take weeks to occur and injections can be repeated if needed. Surgery is a last resort and may involve various operations, with trapezium removal being common. Your surgeon will advise on the best option for your thumb.
Trigger finger/thumb
Trigger finger is a painful condition where a finger or thumb clicks or locks when bent towards the palm. It is caused by thickening of a tendon tunnel mouth, leading to roughness of the tendon surface and catching in the tunnel. While more common in people with insulin-dependent diabetes, it can occur in those without diabetes, sometimes starting after an injury. Work activities may aggravate the pain. Symptoms include pain, tenderness, clicking or locking during movement (often worse in the morning), and stiffness, especially in the thumb. It is not caused by osteoarthritis but can be related to tendon nodules in rheumatoid arthritis.
What is the treatment?
Trigger finger and trigger thumb, although not harmful, can be very painful. Some mild cases can recover without treatment over a few weeks. Treatment options include avoiding painful activities, using a small splint to hold the finger or thumb straight at night, and steroid injections. Steroid injections can relieve pain and triggering in about 70% of cases. If other treatments fail, surgery may be needed, which includes percutaneous trigger finger release with a needle or surgical decompression of the tendon tunnel. Surgery is typically considered when other options have been unsuccessful or when it is deemed the most appropriate initial option.
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