- Synovial (ganglion) cysts of the wrist
- Dupuytrens disease
- 1. Enzyme (Xiaflex) injection
- 2. Removal of the diseased tissue. Also called Aponeurectomy.
- 3. Percutaneous needle aponeurotomy
- De Quervain's disease
- Trigger finger (stenosing tenosynovitis)
- Arthritis of the thumb
- Tumor of the Wrist & Fingers
- Ulnar (cubital) nerve compression at the elbow or wrist
- Tennis Elbow (lateral epicondylitis)
- Repair of hand & wrist bone fractures
- Repair of ligaments, tendons and nerves
SYNOVIAL (ganglion) CYSTS OF THE WRIST
The synovial cyst is the second most common problem that is encountered in the hand. This consists of a balloon like swelling, or bump, they can either be located on the front or on the back of the wrist (please see diagram).
Most cases of synovial cysts (also called ganglion cysts) do not have any associated symptoms, pain or weaknesses. However, in certain cases this large bump can cause localized pain with movement of the wrist because it pushes on adjacent structures which normally aren’t supposed to be pushed on (see diagram).
These synovial cysts in the wrist are most often diagnosed by history and clinical examination: occasionally an X-rated can be useful in order to rule out other problems.
The treatment of a synovial cyst in the wrist can include prescription orthotics (or splinting), as well as temporary decompression by aspiration. However these are often measures which offer temporary relief.
More often, patients will choose to have the bump removed with minor surgery for both functional as well as aesthetic reasons.
Surgery for a synovial (ganglion) cyst of the wrist is usually done as an outpatient procedure under local or regional block anaesthesia. The surgery lasts between 20 and 30 minutes; following which a dressing is applied, and the patient is allowed to go home. Use of the hand after surgery is allowed with some modifications. Basically we ask that you not use the hand forcefully for 2 to 3 weeks after surgery. Judicious use of the end is allowed within the first week after the procedure.
Dupuytren’s disease is a fibrous and nodular thickening of the tissue on the palm side of the hand which is genetically determined.
It is named see diagram in 1816 after dr Guillume dupuytren Who was the surgeon and personal physician of king Louis XVIII of France in 1816. Dr. Dupuytren was the first to correctly recognize that the thickening of the tissue under skin in the palm (with associated chords and flexion deformity of the finger) was caused by an inherent natural process owing to hereditary factors.
This disease affects both hands in 45% of cases, and affects men three times as often as it affects women. Most commonly the fourth finger is involved followed in frequency by the fifth finger and the third finger.
There are four possible treatments for Dupuytren’s disease.
1. Enzyme (Xiaflex) injection
This injection applies to people who have very EARLY disease and very small nodules in the palm of the hand. This is a very good treatment for EARLY stage Dupuytren’s disease. Injections cannot be performed for advanced, or severe Dupuytren’s disease.
Although that this is an excellent form of treatment for early stage disease most government sponsored medical programs (like RAMQ in Quebec, Canada) do not cover the cost of this type of treatment. And often times, the injection needs to be repeated two or even three times in order to complete the therapeutic program.
2. Removal of the diseased tissue. Also called Aponeurectomy
For disease where it is not possible to undergo Xiaflex treatment with enzyme infiltration, the open approach leads to the highest permanent cure rates with minimal complications. This procedure is done as an outpatient basis under regional or local block anesthesia. Surgery typically lasts 30 to 40 minutes, after which a dressing is applied and the patient can return home.
3. Percutaneous needle aponeurotomy
Although superficially this seems like a good idea because it is performed with minimal down-time, most experienced and certified hand surgeons will also tell you that this is the most dangerous procedure possible. The reason is because this is done without any visualization of associated anatomic structures: thus, there’s a very high level of associated tendon nerve and vessel injury in the hand with this technique. Also, this technique has the highest incidence of recurrent disease of all treatments possible. The very high associated complication rate, and the highest incidence of recurrent disease make this procedure the least desirable of all treatment options.
DE QUERVAIN’S DISEASE
This is a painful condition which causes pain due to swollen tendons in the wrist just before the thumb.
When recognized and treated early, this is a condition which responds very well to either an injection of cortisone, which reduces the swelling. When the situation is allowed to progress, then, occasionally, minor surgery is required in order to decompress and clean the swelling around the tendons. This procedure is done as an out patient and typically takes approximately 15 minutes to perform.
TRIGGER FINGER (stenosing tenosynovitis)
In this condition, any of the fingers can be involved, and symptoms relate to a clicking (or triggering) of the finger upon trying to open the finger.
This is caused by a swollen tendon at the base of the finger (see diagram) which gets intermittently stuck as it tries to enter the finger with normal motion.
When treated early, this condition can be addressed with a simple cortisone injection, which causes the swelling of the tendon to resorb. Occasionally, the swelling may require a 5 minute surgical procedure in order to decompress and clean the swollen tendon. Recovery is usually reasonable within the first week after treatment.
ARTHRITIS OF THE THUMB (trapezio-metacarpal joint)
This condition relates the the premature “wear and tear” of the cartilage forming the joint between the thumb and the wrist.
Pain is centered around this joint (see diagram), and is made worse with forceful and repeated use of the hand.
This Condition occurs in women much more than it does in men, and often, although this premature degradation of the joint is usually present in both wrists, it is often MORE pronounced in the NON-DOMINANT hand !
A combination of physical examination and x-ray evaluation will enable the hand surgeon to tell how worn out the cartilage has become; and depending on the severity of the condition, treatment can include a simple steroid injection into the area (in early cases), and in more severe presentations surgery may be required.
The end result is that patients after treatment are pain-free and are able to return to their usual daily activities in a comfortable manner.
TUMORS OF THE WRIST & FINGERS
AS with all living tissue, the wrist, hand and finger can exhibit the formation, of lumps and bumps, most of which are benign or not dangerous.
However, even though these bumps or growths may not pose a risk to your health, their inconvenient location in your hand will often impair the normal and comfortable way in which your hand is supposed to function in daily interaction with your immediate environment.
It is suggested that any mass which is growing on your wrist, hand or tigers lasting more than a month: should be promptly brought to the attention of a hand surgeon for evaluation. This will ensure that these conditions will be treated earlier rather than later, and will benefit you with the shortest possible recovery time after treatment.
ULNAR (CUBITAL) NERVE COMPRESSION at the elbow or wrist
Aside from carpal tunnel syndrome (a compression of a nerve in the wrist which represents THE SINGLE MOST COMMON HAND PROBLEM (click here), there is a 2nd nerve which may cause problems and pain if it becomes compressed. This is the ulnar nerve (see diagram). This ulnar nerve goes through 2 very tight anatomic spaces: one at the elbow, and one at the side of the wrist.
Compression of this nerve in either location causes pain and numbness of the little and ring fingers, and over time can even lead to weakness of hand function. This condition is diagnosed by the physical examination of your arm by a certified hand surgeon and is confirmed with a lab test called an electromyogram (EMG).
TENNIS ELBOW (lateral epicondylitis)
Repeated forced extension and flexion of the forearm can lead to damage of some of the tendons and muscles at the lower part of the elbow. This condition which is commonly referred to as tennis elbow, causes increasing pain at the lower elbow area (see diagram) with forceful activation of the forearm.
This condition is diagnosed with a proper history and physical examination, and when properly recognized can be treated with a combination of steroid injections, rest and musculature reinforcement.
However, in a minority of cases, occasionally, the process is either too evolved, or if conservative treatment is not enough, then surgery may be necessary to in order to fix the issue. Once, again they to treatment here is to treat this problem EARLY: thus significantly decreasing you chances of requiring surgery.
REPAIR OF HAND & WRIST BONE FRACTURES
Fractures of the bones of the hand and the wrist constitute an emergency situation.
After trauma results in a suspected fracture of the hand or wrist, urgent evaluation, x-ray examination, and directed treatment must be carried out as soon as possible.
Problems in return of function to the hand and wrist after a fracture are directly proportional and usually related to :
a) delayed diagnosis and treatment,
b) non-specific treatment given by someone other than a board certified hand surgeon.
Treatment involves assessing the injury to the surrounding tissues, and replacing the bones to their anatomic positions. This may be accomplished with manipulation and casting; and sometimes surgery is necessary in order to restore the bones to their normal position.
Repair of Hand and wrist ligaments, tendons or nerve injuries Muscles, ligaments, tendons and nerves all combine to control and move joints. Tissues can be damaged through overloading. Lifting too much cutting or crushing, or detaching can cause painful damage. Muscle, ligament and tendon injuries are often obvious because they cause local pain and swelling. Initially the injury may be underestimated as patients are often reluctant to move local joints when they are sore from injury. A hand specialist like Dr. Daniel Durand who sees the patient on a daily basis, can accurately determine the cause of local pain. For milder injuries comparing passive and active movement of a particular joint can determine a course of action to take to remedy the problem. For most of the rest of the injuries X-rays will be performed. Other tests such as a CT scan may be ordered to assess the bones and joints if there are concerns about associated injuries at the same site. If ligament, tendon or nerve injuries or damage are minor then rest and supervised movement are often sufficient for a proper recovery. If the damage is more severe, surgery may be recommended to avoid long-term disability. All our surgeries are performed under in a state-of-the-art operating theatre. For injuries to the hand and fingers surgery can often be performed under local anesthetic. Recovery times can range from a few short weeks up to 12 weeks for severe tendon or ligament damage.
Repair of Hand and wrist ligaments, tendons or nerve injuries
Muscles, ligaments, tendons and nerves all combine to control and move joints. Tissues can be damaged through overloading. Lifting too much cutting or crushing, or detaching can cause painful damage.
Muscle, ligament and tendon injuries are often obvious because they cause local pain and swelling. Initially the injury may be underestimated as patients are often reluctant to move local joints when they are sore from injury.
A hand specialist like Dr. Daniel Durand who sees the patient on a daily basis, can accurately determine the cause of local pain. For milder injuries comparing passive and active movement of a particular joint can determine a course of action to take to remedy the problem.
For most of the rest of the injuries X-rays will be performed. Other tests such as a CT scan may be ordered to assess the bones and joints if there are concerns about associated injuries at the same site.
If ligament, tendon or nerve injuries or damage are minor then rest and supervised movement are often sufficient for a proper recovery. If the damage is more severe, surgery may be recommended to avoid long-term disability.
All our surgeries are performed under in a state-of-the-art operating theatre. For injuries to the hand and fingers surgery can often be performed under local anesthetic. Recovery times can range from a few short weeks up to 12 weeks for severe tendon or ligament damage.