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Hand & wrist surgery

Expert care for hand & wrist concerns

Woman-with-pain-in-her-wrist
If you've ever felt pain in your hands or wrist with pins and needles and some numbness, there's a good chance you have one of the most common ailments of the hand and wrist. It's called carpal tunnel syndrome.

Carpal tunnel syndrome is also called median nerve compression because the main nerve (the median) that travels along your wrist through an aperture a few centimetres wide and into your hands becomes squeezed due to inflammation of soft tissues (the synovium) that surrounds the flexor tendons.

The narrowing of the tunnel through which the tendons move puts pressure on the median nerve, which results in the pain you feel, and can worsen and even become permanent if left untreated.

This is one of many common issues people have, and is also easily remedied by the specialist hand and wrist clinic at Werndale Hospital.

In most cases, patients are referred to us by their GPs, but you are welcome to call us direct on 01267 225600 if you'd like to talk to us about carpal tunnel syndrome or any other treatments concerning hand and wrist ailments. 

But that's only one of a series of conditions people can experience that affect their ability to use their hands that can also be treated effectively at Werndale.

The next most common ailment is called trigger finger. If you find one of your fingers getting locked, so you cannot bend it (or unbend it), there's a good chance you're suffering from trigger finger.

Other symptoms include a clicking sensation when you try to bend or unbend your fingers (it can also affect your thumb as well as multiple fingers and even both hands at the same time).

Its medical name is stenosing tenosynovitis, and in the worst case can lock a finger completely.

Dupuytren's contracture is a disease of the hands, where the ring or little finger can be permanently pulled in towards the palm of the hand. If left untreated, it can become increasingly difficult to unbend your fingers as time goes on and the disease worsens.

A simple test is to try to place your hand down flat. If you have difficulty doing that (because a finger refuses to straighten out), it's a strong signal that you may have dupuytrens.

It's not painful in any way, but obviously restricts the use of your hands, which can have a serious effect on the quality of life.

It's medical name is palmar fibromatosis and can also affect other fingers and even thumbs in rare cases. 

Ganglion cysts are fluid filled soft lumps that can occur on the wrists, hands, and fingers. They are caused by a leakage of fluid from a joint and are more common in women (especially those between 20 and 40) than men.

In many cases, the only obvious symptom is the lump formed by the cyst, but they can be painful too.

Ganglion cysts can vary in size and many disappear without any treatment, however, if a cyst persists for many months, your GP may well refer you to a specialist consultant to have it surgically removed. 

The final most common complaint of the hands and wrists is osteoarthritis. This is a degenerative disease most associated with aging although it can occur at any age.

The joints in the hands are prone to arthritis as the cartilage begins to break down and causes the bones to change with greater friction occurring when moving the fingers (this can be very painful).

The main joint in our fingers is called the proximal interphalangeal joint (PIP) and is responsible for our ability to grip. For this reason it is often prone to osteoarthritis as it naturally gets more pressure and use during our lives and day to day activities. 

Although tremors do occur in the hands, this is rarely to do with the more usual problems associated with the wrist or hands, and is more usually down to a neurological issue, so patients will be referred in most cases to a neurologist. 

The best way to cure carpal tunnel syndrome is surgery, although occasionally relief can be had using steroid injections.

The operation is called carpal tunnel release surgery. This releases the tension caused by the squeezing of the median nerve.

The carpal tunnel itself is released by cutting the transverse carpal ligament, which is the tissue that wraps around the tendons and median nerve in the wrist.

This is often carried out through open surgery, where an incision is made in the palm to reveal the ligament, which is then widened to release the tension on the nerve. With that achieved, the wound is then closed with stitches and bandaged.

The operation is usually done under a local anaesthetic, so you will be awake during the operation, and once done and when you feel comfortable enough, you will be able to return home.

You may need pain relief as the wound heals and you will be advised of this as well as any other aftercare. A follow up appointment will also be made to check everything is healing as expected. 

A liquid corticosteroid injection is commonly used to treat trigger finger. This is injected into the sheath surrounding the tendon at the base of the affected finger. After a period varying from a few days to a few weeks, your finger should make a more or less full recovery as the steroid does its work in reducing the inflammation in the sheath surrounding the tendon.

The procedure is very quick and is usually done at the same time as the initial consultation, meaning you can be in and out in less than half an hour.

The longer a trigger finger remains untreated, the more chances it has of worsening (even resulting in a locked finger), at which point surgery may be the only option (this may also be recommended if steroids fail to work).

Surgery is a straightforward operation with an incision made to release the tension allowing the finger to move freely once again (a procedure known as percutaneous trigger finger release surgery). 

The main way to treat dupuytren's contracture is with open surgery where a cut is made in the hand so the surgeon can straighten the finger (this is called a fasciectomy).

The operation is usually straightforward and you'll be able to return home the same day. 

As well as parking available during your visit, Werndale Hospital has 17 en-suite private rooms should you need to stay overnight (or longer) and medical officers available at all times to ensure your comfort.

We have state of the art equipment including an MRI scanner, X-ray, ultrasound, and mobile CT unit.

Should an operation be required, our state of the art operating theatres have laminar flow air control to ensure your environment is kept bacteria free.

Please don't hesitate to call Werndale Hospital on 01267 225600 if you would like to discuss your next steps. If you wish to book an appointment, please speak to our out-patient department on 01267 225644. 

Specialists offering Hand & wrist surgery

Mr John Black

Consultant Orthopaedic Surgeon

LRCP&SI, FRCSI, Orthopaedic Specialist Register

BMI Werndale Hospital

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Mr Owain Ennis

Consultant Orthopaedic Surgeon

MB BCh (Wales) FRCS Trauma and Orthopaedics (Edinburgh)

BMI Werndale Hospital

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Mr Andrew Bebbington

Consultant Orthopaedic & Hand Surgeon

MBBCh, MRCS, FRCS(Tr&Orth)

BMI Werndale Hospital

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