Treatment of hand deformation and limited mobility
OSTEOARTHRITIS OF THE BASAL JOINT
Osteoarthritis of the basal joint is the most common form of osteoarthritis of the hand. In the basal joint of the thumb, where the swivel and pivoting motions of the thumb are performed, the condition may cause severe, variable pain at the base of the thumb – typically when simple hand movements are made, such as using a key, opening a door or gripping small to medium-sized objects. The pain can be quite sharp and very unpleasant.
The treatment options include splinting the hand to stabilise the thumb, although this affects the mobility and the usability of the thumb. Other options include cortisone injections or deep x-ray therapy, which can also be used to relieve the symptoms. However, this will not stop the condition from progressing. Once all non-surgical options have been exhausted, surgical treatment may be considered with good prospects of success. Well-established techniques from plastic surgery and hand surgery are available for this.
The procedure is performed under regional or general anaesthetic and involves a stay at the clinic (for one night). The bones that form the basal joint (multangular bones) are removed. A new joint is then constructed with the help of tendon fibres from the patient’s own tissue.
After immobilising the joint for four weeks in a plaster cast, the hand may be used again. An additional period of several weeks is also required before the thumb will regain its full range of movement. The end result can be expected after about a year.
CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome, also known as CTS, is a common condition of the hand, whereby, for reasons not yet fully understood, the median nerve of the hand becomes increasingly compressed and limited in its function.
The symptoms of carpal tunnel syndrome are pain in the hand during the night, accompanied by a feeling of numbness in the thumb, index and middle fingers. The problem may be initially relieved by non-surgical treatments such as exercises that involve shaking the hand, a splint to immobilise the wrist or cortisone injections into the carpal tunnel. If symptoms persist, a neurological examination will be undertaken to assess nerve conduction velocity. Then, depending on the outcome of this test, surgical intervention may also be considered as an option. Well-established techniques from plastic surgery and hand surgery are available for this.
The procedure can be performed under regional anaesthetic. The compressed nerve is released via a five-centimetre-long incision made between the thumb and the base of the little finger.
We recommend spending a night in the clinic after carpal tunnel surgery. The hand should also be rested for about four weeks following surgery. Post-operative pain usually improves quickly, although a feeling of numbness in the fingers may persist for a while, depending on how long the individual has had the condition.
Dupuytren’s contracture is a disease of the connective tissue in the palm and fingers. It involves a progressive thickening and shrinking of the tissue; lumps may develop, and the fingers become bent. Patients lose the ability to stretch their fingers and, if the condition worsens, also lose their ability to grip objects. The ring finger and little finger are the most commonly affected.
Dupuytren’s contracture progresses in stages, but may also stabilise at a certain point for many years. Treatment is by injection of medications that loosen the tissue, making it easy to straighten the crooked finger again. If one or more fingers become so bent that there is a significant loss of hand function, surgical treatment is recommended.
The procedure may be performed under general or regional anaesthetic with a short stay in hospital (one night). The operation involves isolating and removing the strands of connective tissue responsible for the contracture.
In most cases, patients are able to stretch their fingers again after surgery. However, to achieve long-term improvement, post-operative treatment with a hand splint or traction brace is frequently required. Even after surgery has proved effective, renewed contracture may develop over time, which in some circumstances will require further surgery.
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