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The Most Common Hand Conditions
Wednesday 21 September 2016

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome causes numbness, pins and needles and pain in the hand, most commonly in the thumb, index and middle fingers. It can often feel like the whole hand is affected, and symptoms are mostly felt at night, and/or during specific activities such as driving or typing. The condition also occurs during and sometimes after pregnancy. Patients often complain of dropping items, difficulty gripping small things or opening jars and bottles.

The symptoms are caused by compression on one of the main nerves supplying the hand, where it passes through a small tunnel in the wrist.

The limited space in this area leaves little tolerance for change, and any inflammation or swelling in the other structures passing through the tunnel can cause the nerve to be compressed and lead to these symptoms.

Hand Therapy for Carpal Tunnel Syndrome

This uses a combination of splints and exercises and results are normally seen within 6 weeks. Hand Therapy treatment is most effective in the early stages (within the first 3 months of symptoms starting).

In more established cases, a local anaesthetic surgical procedure is needed to release the ligament across the wrist that forms the ‘roof’ of the carpal tunnel.

Importantly, this condition will respond best to early management to help prevent permanent damage to the nerve and give the best chance of a good outcome.

Dupuytren’s contracture

Dupuytren’s contracture affects mostly males over the age of 40, and most commonly over the age of 60. There is a strong hereditary link, and some say related to Viking ancestry. The condition affects the digits in the hand, most often the ring and little finger, causing them to bend permanently towards the palm. It is not normally painful.

Stretching and exercise will not prevent the condition from worsening, and in cases where the contracture is causing difficulties with daily tasks; a consultation with a hand surgeon is strongly recommended.

Depending on the nature of the contracture, different interventions are available, ranging from relatively minor local anaesthetic procedures to surgery under general anaesthetic or regional block anaesthesia where the whole arm is numbed. Our hand surgeons at Duchy Hospital are skilled in treating this condition and liaise closely with hand therapists who provide the postoperative care and rehabilitation. One of our hand surgeons, Mr Poulter, has participated in a large international conference on Dupuytren’s disease. Trigger finger occurs when the tendon that bends the finger into the palm gets stuck in its tunnel, causing the finger to remain stuck in the palm.

Patients often have to pull the finger straight which can be painful. It also affects the thumb, where it is more likely to feel like a clicking sensation in the tip joint of the thumb. In the early stages, trigger finger can be managed conservatively using hand therapy techniques including splinting, stretching and massage, or in more stubborn cases it will often respond to a localised steroid injection or minor surgery to release the tight part of the tunnel.

Hand Imaging

X-Rays remain the most common and important imaging tool for hand conditions, and although their quality has improved somewhat from these first images, they have some limitations. Significant advances in imaging technology mean it is now possible to identify soft tissue and bony abnormalities that are not obvious, or cannot be seen, on X-Ray.

MRI (Magnetic Resonance Imaging) scans are most commonly performed to help diagnose conditions where X-Rays are not sensitive enough to pick up subtle changes to soft tissues and bones, such as ligament injuries affecting the wrist and some complex bony conditions.

CT (Computerised Tomography) scans are used by hand surgeons to reconstruct an image of an area, so that bony abnormalities can be seen in far greater detail and even in three dimensions.

These detailed images can help identify progress of bony healing in more complex fractures, and help hand surgeons to plan bone and joint surgery such as joint replacement or bone reconstruction.

Ultrasound Scanning, more commonly associated with maternity care, is used to identify soft tissue problems such as tendon rupture or the nature of nerve compression, and joint problems such as the extent of joint damage in Rheumatoid Arthritis. Ultrasound

Scanning can be used to guide the administration of steroid (cortisone) joint injections, which are often used to treat Osteoarthritis affecting the thumb, Trigger Finger and Tendonitis in the wrist.

Hand Injuries are very common - twenty percent of patients attending Accident and Emergency departments do so with a hand injury. When injuries are minor, patients are normally treated and discharged to their GP for future management. In some cases complications (such as joint stiffness) can occur. Hand Therapists are ideally skilled to assess, diagnose and treat patients needing help to regain hand function following injury.

Fractures, small joint dislocations, tendon lacerations, nerve injuries, burns and crush injuries are common hand injuries. Early intervention is vital to ensure the best outcome, ideally within a week of injury. Treatment includes:

Customised splints to protect injured parts and mobilise stiff joints Wound care Help to reduce swelling Exercise prescription

The goal of hand therapy is to facilitate the patient’s successful return to work, leisure and daily activities. The Hand Therapist at Duchy Hospital is able to accept referrals for hand trauma directly from the patient or GP, but will always recommend a referral to a hand surgeon if it is needed.

Case study

John, a keen golfer, was having difficulty with pain and stiffness in his fingers which was affecting his game and ability to use his hands in daily tasks. The Hand Therapist was able to request an x-ray which confirmed the presence of osteoarthritis in his fingers and thumbs.

Hand Therapy treatment included teaching John specific exercises to help his joints get moving, strengthening techniques so his grip improved and make a customised soft support for some of his fingers, which helped reduce his pain and allowed him to return to playing golf.

If you are concerned about a hand or wrist condition you may wish to seek advice from Mr Rob Poulter, Consultant Orthopaedic Surgeon by either enquiring online or contacting us on 0800 9170022.