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3 Common Types of Orthopaedic Hand Surgery

Trigger Finger

Trigger finger (stenosing tenosynovitis) is a condition that causes the fingers to be locked when it is bent. Tendons are bands of tissue that attaches muscles to bones. When bending and straightening the finger, the tendon slides through the tissue that covers it (sheath). Due to repetitive and forceful movements, the tendons in the finger may become inflamed. When this happens, it may be stuck in the narrow space of the sheath, causing the finger to be locked in the bent position.

Causes

  • Repetitive movements
  • Forceful movements
  • Affects women more than men
  • Commonly occur in people aged 40 – 60 years of age
  • Other diseases (rheumatoid arthritis & diabetes)

Symptoms

  • Morning finger stiffness
  • Finger momentarily stuck in the bent position and suddenly straightening itself
  • Finger locked in bent position and unable to straighten itself
  • Clicking sensation when bending and straightening the finger
  • A painful bump (nodule) at the base of the finger

Treatment

For mild cases, the surgeon may simply ask you to rest the finger and also prescribe putting on a splint to allow the affected finger to be immobilised. For moderate cases, the surgeon may prescribe some anti-inflammatory drugs to reduce the swelling and may also give steroidal injection directly into the sheath. For more severe cases, surgery may be recommended.

Surgery

The surgery is aimed to create more room within the sheath for the tendon to move through it. Basically, this is achieved by cutting the sheath. The conventional method is to cut a small incision near the base of the affected finger and cut the sheath. Another method, which does not involve cutting, uses the sharp end of an injection needle to cut the sheath open.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a hand and wrist condition where the median nerve is compressed. This results in symptoms of pain, weakness and numbness which may also radiate up to the affected arm. The carpal bones and the transverse carpal ligament creates a narrow tunnel, known as carpal tunnel. This tunnel is a small area where the median nerve and the tendons from flexor muscles of the forearm is housed. Due to its fixed area, when irritated tendons or other forms of swelling occur, the space within it becomes narrowed. This in turn compresses the median nerve, which controls sensations to the palmar aspect of the thumb and fingers, except for the little finger.

Symptoms

  • Pain of wrist and/ or hand
  • Numbness of wrist and/ or hand
  • Weakness of wrist and/ or hand
  • All three symptoms above may also radiate to the arm

Causes

  • Repetitive movements of the wrist
  • Irritated flexor tendons
  • Other existing conditions
    • rheumatoid arthritis
    • diabetes
    • hypothyroidism
    • pregnancy

Treatment

Treatment for carpal tunnel syndrome is aimed to allow you to regain the normal function in your fingers and hand. For mild cases, the surgeon might recommend resting the wrist with a splint. Physiotherapy sessions may help with range-of-motion exercises to improve your posture, flexibility and also to strengthen the muscles affected.

For pain management, the surgeon may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and also to reduce inflammation of the tendons. In more severe cases, corticosteroids may be prescribed orally or through injection directly into the carpal tunnel.

Surgery is usually for chronic cases after other treatment options have failed to yield satisfying results, or if there is a risk of nerve damage. The surgeon will cut the transverse carpal ligament for immediate relief of the symptoms.

De Quervain’s Synovitis

De Quervain’s synovitis is a painful condition affecting the thumb-side of the wrist. It is caused by the inflammation of the extensor tendons of the thumb. Tendons are bands of tissue that attaches muscles to bones. There are two extensor tendons attached to the thumb and during straightening of the thumb, these tendons slides through the tissue that covers it (sheath). Due to repetitive and forceful movements, the tendons in the thumb may become inflamed. When this happens, it swells up and take up more space than usual within the narrow space of the sheath, causing pain.

Symptoms

  • Pain felt over the thumb-side of the wrist, which can radiate up the forearm
  • A painful bump (nodule) at the thumb-side of the wrist
  • Clicking sensation when straightening the thumb

Causes

  • Repetitive extension of the thumb
  • Other existing conditions
    • rheumatoid arthritis
    • pregnancy

Treatment

Treatment for De Quervain’s tenosynovitis is aimed to reduce inflammation and to allow you to regain the normal function in your thumb and wrist. For mild cases, the surgeon might recommend resting the wrist with a splint. Physiotherapy sessions may help with range-of-motion exercises to improve your posture, flexibility and also to strengthen the muscles affected.

For pain management, the surgeon may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and also to reduce inflammation of the tendons. In more severe cases, corticosteroids may be prescribed orally or through injection directly into the tendon sheath.

Surgery is usually recommended for more serious or chronic cases. The surgery is aimed to create more room for the tendon to move through the sheath. This is achieved by cutting the sheath open to release the pressure.

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