Hand and wrist injuries (orthopaedics)

A carpal tunnel syndrome (CTS) is caused by increased pressure on a nerve (median nerve) in your wrist canal, also known as carpal tunnel.

A carpal tunnel syndrome is a common condition in both men and women. It is seen more in people with diabetes, thyroid disease, rheumatism. It can also occur frequently in pregnant women. However, often no underlying problems or conditions are seen.

Symptoms

The complaints are usually numbness and tingling in the hand and sometimes accompanied by pain. The complaints are usually located on the thumb, index finger, middle finger and ring finger or part of them. Over time, fine motor skills and strength may also be affected. Most complaints are often present at night and can lead to a bad night's sleep. Also certain daytime activities such as cycling, reading,... can lead to these complaints.

Diagnosis

Most often the diagnosis can be made as early as the consultation based on the patient's symptoms and the clinical examination by the doctor. If necessary, a nerve examination (EMG) may be requested to confirm the diagnosis.

G‍eneral treatment

Pain medication (anti-inflammatories), modification of activities or posture, night splint can sometimes lead to improvement of the symptoms. Especially in the early stages of the condition, symptoms may be relieved with an injection of cortisone.

In the end, an operation (Carpal Tunnel surgery) will often be necessary to be relieved of the complaints.

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A wrist cyst is a swelling at the wrist. It can occur on either the upper (dorsal) or lower (volar) side. They consist of a thin wall that is filled with fluid coming from the wrist joint.

Symptoms

A wrist cyst occurs very frequently and usually without an underlying cause. Often they cause no pain symptoms and thus do not require treatment. However, if the cyst grows larger, pain symptoms may develop.

Diagnosis

The diagnosis is usually made at consultation based on the clinical examination and the typical appearance of the wrist cyst. If necessary, additional ultrasound may be requested for confirmation.

‍General treatment

A wrist cyst should be treated only if it has become too large and is causing pain or movement restrictions. Draining the cyst is usually only a temporary solution.

Most often surgical removal of a wrist cyst is done anyway.

Dupuytren's disease is a benign condition in which nodules/lumps form in the palm of the hand, just under the skin. The nodules can connect with each other, forming strands in the palm and warping the fingers. Often this is a hereditary condition in which several people in a family suffer from the condition. The condition is much more common in men and is of northern European origin. It particularly affects the little and ring fingers. The first symptoms usually start at the age of 40 years

Symptoms

The first symptoms of the disease are, usually painless, small lumps or hardening in the palm of the hand. As the disease progresses, strands progressively form in the palm and over the fingers. Those strands will cause the fingers to become progressively more curved and, as a result, can no longer be fully extended. This, of course, will cause poorer function of the hand in day-to-day activities.

‍Diagnosis

The diagnosis of the disease is made at the consultation based on the clinical examination.

G‍eneral treatment

The disease itself cannot be cured to date. That is, preventive treatment for the disease makes no sense. Only if the fingers are crooked and this causes trouble with activities is treatment appropriate. The disease cannot be improved by medication or physiotherapy. 

Surgical treatment of Dupuytren's disease involves (partially) removing affected tissue in the palm and/or fingers.

Symptoms

This is a common disorder of the hand that involves a staggered sensation when stretching the affected finger. Sometimes the finger is blocked in a bending position and must be manually straightened back up with the other hand. This is usually accompanied by a shooting pain. Often there is also pain and a lump felt at the base of the finger, in the palm. 

The condition is caused by inflammation of the flexor tendon of the finger. It is more commonly seen in people with diabetes and rheumatoid arthritis but can occur in anyone.

Diagnosis

The diagnosis is usually made at the consultation based on the patient's symptoms and the clinical examination. If necessary, additional ultrasound may be requested to confirm the diagnosis.

‍General treatment

In the early stages of the disease, anti-inflammatories and rest can sometimes help. If insufficient, additional injections of cortisone may be given. If this is insufficient or if the symptoms return quickly, we usually proceed to surgery. For this surgery it is usually possible to go home after the surgery, so you don't have to stay overnight (day admission). The intention is to be able to move and use the finger quickly after the operation. Usually we count on about 6 weeks of rest during which no strenuous efforts should be made.

Osteoarthritis of the base of the thumb is a condition in which the cartilage a the bones at the base of the thumb has thinned or even disappeared completely. Osteoarthritis causes inflammation and especially pain.

Osteoarthritis of the base of the thumb is more common in women as early as age 40. Sometimes prolonged repetitive movements of the thumb and certain working conditions can accelerate osteoarthritis. A hereditary background may also be present.

Symptoms

Mainly the symptoms are pain a the base of the thumb and pain with certain gripping movements (opening a bottle or jar, tying a shirt,...) as well as reduced mobility of the thumb. As a result, the function of the hand deteriorates and we usually see external swelling at the base of the thumb. If the osteoarthritis worsens further, a deformity of the thumb develops.

Diagnosis

The diagnosis is made through a clinical examination and via imaging (RX or CT).

The treatment in the initial phase consists of rest, pain medication and a thumb brace. If this is insufficient, an injection of cortisone or gel may be given at the consultation to help with the pain.

If the complaints are insufficiently controlled or come back quickly, surgery is usually necessary.

There are 2 types of surgery possible, depending on the severity of the osteoarthritis. Either the bone, which is affected with osteoarthritis, is removed and replaced with its own tendon from the forearm (Burton Pellegrini surgery) or the joint at the base of the thumb is replaced with a prosthesis.

For both procedures, a one-night stay is recommended, especially to properly manage pain symptoms the first night. After the procedure, a cast is placed. After the cast, the thumb may be returned to progressively normal use, though initially with a protective brace. It is best to avoid heavier physical exertion during the first 2 months.

‍General treatment

In the early stages of the condition, anti-inflammatories and rest can sometimes help. If insufficient, additional injections of cortisone may be given. If this is insufficient or if the symptoms return quickly, we usually proceed to surgery. This surgery is possible through a day admission so you normally do not have to stay overnight. The intention is to be able to move and use the finger quickly after the operation. Usually we count about 6 weeks of rest during which no strenuous efforts should be made.

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