Diseases & injuries of the hand

Carpal tunnel syndrome is a common condition where one of the major nerves to the hand, the median nerve, is compressed as it travels through the wrist. It causes numbness, pain and tingling in the hand and arm.

Early levels can be treated non-operative  with a brace or splint and anti-inflammatory drugs.

In severe cases a small surgical procedure is necessary to relieve pressure on the median nerve. Over a small skin incision in the wrist, the ligament that forms the roof of the carpal tunnel is cut and the nerve carefully inspected. The procedure increases the size of the carpal tunnel and decreases pressure on the nerve. After surgery, the wrist is immobilized in a splint for 10-14 days.

Dupuytren’s contracture is a thickening of the fibrous tissue in the palm of the hand. It forms palpable tender lumps and bands under the skin. This leads to progressive bending of the fingers to the palm and restricted straightening of the affected finger.

The common surgical procedure consists of removal of the thickened bands to restore finger motion.

Needle aponeurotomy is a new less invasive procedure. No incision is required and the risks of open surgery are minimized. Patients experience less pain or swelling after surgery and the postoperative rehabilitation is much shorter.

The trapeziometacarpal joint is located where the thumb metacarpal articulates with one of the wrist or carpal bones called the trapezium. This saddle joint allows the great mobility of the thumb.

Osteoarthritis leads to painful restricted motion of the thumb and loss of stability while grabbing.

Treatment consists of splinting and anti-inflammatory drugs.

In severe cases, operative resection arthroplasty may be helpful. The principle of this procedure is the removal of the trapezium bone. After resection, a tendon interposition is performed to stabilize the thumb. The joint must be immobilized in a splint for 6 weeks after surgery to gain satisfactory results.

Flexor tendons control the movements of the fingers. While moving the tendons slide through a snug tunnel that keeps them in place next to the bones.

Thickening of the tendon itself or the tendon sheath tunnel cause difficulties moving the tendon through the tunnel. Typically, patients feel a pop when straightening the finger as the tendon slips through the tight area.

In surgery, the sheath of the tunnel is cut to allow the tendon to move smoothly, while bending or straightening the finger.

The triangular fibrocartilage complex (TFCC) is a fibrous structure that lies on the pole of the ulna in the wrist joint. Its function is like that of a meniscus in the knee joint.

Injuries or overuse can damage the TFCC. Patients complain about pain in the wrist especially while rotating motions.

Arthroscopic TFCC surgery is indicated when conservative treatment proves insufficient. In this procedure, damaged tissue is removed or torn parts are reconstructed by sutures.