Baddow Hospital offers a range of surgical treatments to treat conditions such as arthritis, nerve compression, tendon inflammation, ganglions and Dupuytren’s contracture. All can be performed as day case procedures under local, regional or general anaesthesia, depending on the complexity.

The joints of the hand can be damaged by arthritis, causing pain and deformity. Osteoarthritis is essentially the result of wear and tear and tends to affect the small joints of the fingers and the base of the thumb. Rheumatoid arthritis is an autoimmune disorder which usually affects the knuckles, thumb and wrist. In the early stages of arthritis, treatment involves activity modification, splinting and medication. As the arthritis becomes more severe, the following treatments can be offered:

Steroid injection into joints. Performed under local anaesthetic to reduce the discomfort of the injection, steroid injections can be effective at relieving painful joints and delaying the need for surgery.

Joint replacement. In more severe cases, a painful arthritic joint can be replaced by a silicone ‘hinge’ in the fingers. A special ball and socket joint can be inserted at the base of the thumb, which has been likened to a miniature hip replacement.

Joint fusion. This may be the best option in painful joints with severe destruction and/or instability. Fusion results in complete loss of movement at that joint, but effectively treats pain and provides stability.  

Base of thumb (1st CMC joint) denervation. This operation involves removing the sensory nerve supply to the joint at the base of the thumb. This can be an effective means of treating pain caused by osteoarthritis, before the need for trapeziectomy or joint replacement arises. The nerves responsible for carrying sensory signals (and therefore pain) from the 1st CMC joint are divided via three short incisions around the wrist.

Trapeziectomy. This procedure involves removing a bone (the trapezium) from the base of the thumb when it has become worn and painful. It is often accompanied by a procedure to loop a tendon from the wrist around the base of the thumb to provide stability. The operation takes place under general or regional anaesthesia (where the arm is made numb, but you remain awake). Following the surgery, a plaster splint is worn for two weeks, after which a programme of physiotherapy is started to regain strength.

Tendon rebalancing. Rheumatoid arthritis can also affect ligaments and tendons, causing deformity. Various procedures can be performed to realign tendons to correct these deformities.

Carpal tunnel release. Carpal tunnel syndrome is a set of symptoms (eg pins and needles, numbness, weakness) that are caused by compression of the median nerve at the wrist. The median nerve supplies sensation to the thumb, index, middle and inner part of the ring finger. Early carpal tunnel syndrome may respond to activity modification, splinting or steroid injections. For more severe cases, a carpal tunnel release may be offered. This operation can be performed under local anaesthetic and involves a short incision at the base of the palm to release the ligament causing pressure on the nerve.

Cubital tunnel release. Cubital tunnel syndrome is caused by compression of the ulnar nerve at the elbow (your funny bone). This can cause tingling, pain and numbness, particularly in the little finger. Surgery for this condition is called a cubital tunnel release and involves an incision along the inside of the elbow to release the structures causing pressure on the nerve. The operation is usually performed under a general or regional anaesthetic and afterwards the elbow is kept in a bulky bandage to limit elbow movement for two weeks.  

De Quervain’s release. De Quervain’s tenosynovitis is a condition that results from inflammation of tendons in the wrist as they run towards the base of the thumb. This causes movements of the thumb and wrist, such as gripping objects, to become painful. It is common in mothers who are constantly picking up and holding their children. Surgery involves a small incision over the painful area after it has been numbed and the tight tunnel around the affected tendons is released.

Trigger finger release. Trigger finger is caused by inflammation around a tendon in the palm. The affected finger catches as you try to straighten it and it very severe cases it can become completely locked. Surgery involves a small incision in the palm under local anaesthetic to release the tunnel around the affected tendon.

Ganglion excision. A ganglion is a sac of jellylike fluid, often arising from a joint or tendon sheath. Ganglions commonly occur around the wrist and can cause unsightly and sometimes painful swellings under the skin. A ganglion may be treated by aspiration of the jellylike fluid and an injection of steroid into sac. Alternatively, the ganglion can be surgically removed by a short incision, which makes it much less likely to come back.

Mucous cyst excision. A mucous cyst is effectively a small ganglion, which arises from the distal joint of a finger or thumb, often secondary to degenerative change. It presents as a small, pearly, swelling at the base of the fingernail and is sometimes associated with ridging of the fingernail. This is caused by the mucous cyst pressing on the area where the nail grows from. Surgery involves removal of the mucous cyst, often with a small piece of overlying skin. To close the gap in the skin, the skin on the back of the finger may need to be advanced by another incision, a procedure called a “local flap”.

 

Dupuytren’s contracture is a condition in which the tissue under the skin in the palm and fingers (the fascia) becomes thickened. Nodules and bands of thickened fascia (called cords), form under the skin, eventually causing the fingers to curl in. As the contracture becomes more severe, the hand cannot be laid flat on a table. The surgery required depends upon the extent and severity of the problem.

Fasciectomy. This involves cutting out the nodules or cords from the palm and/or fingers. The size of incision required depends on the severity of the disease, ranging from a small C-shape in the palm, to longer incisions along the whole length of the finger.

Dermofasciectomy. If the skin overlying the cords is very stuck down, both the skin and the affected fascia need to be removed. The skin is replaced with a small skin graft, usually taken from the forearm.

Most procedures for Dupuytren’s Contracture require some form of splinting post-operatively, as well as physiotherapy to help regain range of movement in the hand.

 

These procedures are performed by Mr Adam Sierakowski FRCS(Plast), who is a specialist in Hand Micro-Surgery. Click here to read more about Mr Sierakowski.