info@ogwa.com.au
(08) 9389 3800
Hand & Wrist Surgery
The Orthopaedic Group WA hand and wrist surgeons have sub-specialty knowledge of hand and wrist anatomy and pathology and are experienced in the management of both degenerative and traumatic conditions. They are fellows of the Royal Australasian College of Surgeons and the Australian Orthopaedic Association, and can advise on both surgical and non-surgical care.
Basal Thumb Arthritis
Basal Thumb Arthritis
Arthritis describes a loss of cartilage from a joint resulting in pain, stiffness and a loss of function. Arthritis involving the Carpometacarpal joint at the base of the thumb is a very common condition in women and occasionally in men.
Patients typically present with aching pain or discomfort at the base of the thumb and over the thumb muscles; they may find it difficult to pinch and grab objects, and tend to avoid use of the hand.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by compression of the median nerve at the wrist. The nerve is compressed as it passes through a ‘tunnel’ formed by the small bones of the wrist and the transverse carpal ligament. Tendons also run through the carpal tunnel and inflammation around the tendons or thickening of the ligament can contribute to compression. Carpal tunnel symptoms may also occur during pregnancy.
Compression of the nerve causes pins-and-needles, numbness, discomfort or pain in the wrist, thumb, index, middle and half of the ring finger. Patients often experience pain and numbness at night and wake to shake their hand about or hang it by the side of the bed to relieve the symptoms. During the day, they may have symptoms exacerbated by gripping or pressure on the palm of the hand, which can cause shooting electric shocks radiating to the fingers.
De Quervain’s Tenosynovitis
De Quervain’s Tenosynovitis
Tenosynovitis describes inflammation of the lining of a tendon. De Quervain was the first doctor to describe this in the tendon that extends the thumb. There is thickening of the tissue lining over the tendon and movement underneath the lining becomes limited and painful.
This causes pain over the thumb side of the wrist (first extensor tendon compartment.)
Patients may find difficulty with a dart throwing action or lifting objects. There is often a swelling noted over the adjacent bone (radial styloid) which may be very tender to touch.
Trigger Finger
Trigger Finger
Tigger finger occurs when a thickening in a tendon becomes stuck beneath a tendon pulley in the palm of the hand. Patients may initially note discomfort in the palm of the hand and then may describe a locking, triggering and grinding sensation in the fingers which can be worse at night time. The finger often becomes stuck in a flexed position (like squeezing a trigger) and to straighten the finger again they may have to use the other hand. This could be a rather painful experience.
The triggering can happen at any age. It can be seen in neonates when they are born, especially in the thumb, but it can also happen throughout their lives. It could be related to trauma, repetitive direct pressure, or there could be associations with conditions such as diabetes.
Ulnar Sided Wrist Pain
Ulnar Sided Wrist Pain
Ulnar sided wrist pain is a condition that could be quite debilitating for many patients. The pain is felt over the ulnar side of the wrist (little finger side). it can arise from numerous different causes including arthritis in the distal radioulnar joint, extensor carpi ulnaris tendinopathy, TFCC (triangular fibrocartilage complex) pathology such as tears and ulna-lunate impaction to name a few. The condition needs to be investigated and often following examination an MRI is performed to assess these structures.
Wrist Arthritis
Wrist Arthritis
Arthritis describes a loss of cartilage from a joint resulting in pain, stiffness and a loss of function. Wrist arthritis can occur due to numerous different underlying conditions; patients may have episodic pain or constant pain. Pain across the wrist may gradually get worse and limit the ability to use the wrist and hand.
Patients may, or may not, have a history of trauma to the wrist. If there was a previous injury such as a scaphoid fracture or ligament injury in the distant past, patients can develop characteristic arthritic changes referred to as either a SNAC (Scaphoid non-union advanced collapse) or a SLAC (Scapholunate advanced collapse) wrist.
Wrist Ganglions
Wrist Ganglions
A ganglion is a protrusion of fluid arising from a joint due to a defect in the joint capsule or adjacent structures. Wrist ganglions are very common and can be a source of pain or discomfort. Up to 40% of the population however have a ganglion and these are often asymptomatic and discovered incidentally. Some patients may have numerous ganglions.
Symptoms from a small ganglion may settle spontaneously. Large ganglions can rupture causing pain, though following rupture symptoms typically resolve.
Procedures
- Wrist and Thumb Arthritis
Techniques for management of wrist and base of thumb arthritis vary, reflecting the complex articulations that make up the “wrist” joint. Patients with wrist or base of thumb arthritis may present at different stages of disease and have different individual joints involved. Individual patterns of arthritis have different techniques for treatment based on both the disease state and patient needs. Some techniques include:
- Partial wrist fusion: damaged cartilage is removed and some of the small bones are joined together to limit pain, while maintaining motion in the uninvolved portions of the joint.
- Excisional arthroplasty: damaged cartilage and some of the small bones are removed and scar tissue is allowed to form in the space remaining.
- Interpositional arthroplasty: damaged cartilage is removed and a strip of tendon is divided and used as a spacer to replace the arthritic cartilage.
- Complete wrist fusion or “arthrodesis”: damaged cartilage is removed and all of small bones of the wrist are joined together to remove pain by preventing wrist motion.
The goal of all procedures is to relieve pain. Typically, motion maintaining procedures do so by sacrificing strength (causing inherent weakness arising from excision of the bone), whereas complete wrist fusion sacrifices motion to maintain strength.
- Carpal Tunnel Release (Open or Arthroscopic)
To relieve pressure on the median nerve the transverse carpal ligament is surgically divided. This surgical “release” can be performed in an open fashion or arthroscopically. The overall benefits and risks associated with each technique should be discussed on a case by case basis.
Following surgery most patients do well, however it does take time for the more severe cases to have adequate resolution of symptoms.
- Tendon Release Procedures
A release procedure may be performed to divide tissue constricting a tendon and preventing it from gliding freely. This may be used to relieve symptoms in “trigger fingers” or De Quervains syndrome, where non-operative treatments such as cortisone injection have failed to give long term relief and involves cutting the “retinaculum” or “pulley” that lies over the tendon.
- Wrist Arthroscopy
Arthroscopy describes the use of a camera and specialist tools to work inside a joint. This is done through small key-hole incisions in the skin and around the wrist, and can be used to assess and treat injuries to wrist ligaments or the TFCC (Triangular fibrocartilage complex), release the carpal tunnel, or resect some ganglions. Wrist arthroscopy may occasionally be used as an adjunct to fracture management or wrist arthritis procedures.
- Osteotomy
Osteotomy describes cutting of a bone. Around the wrist this is commonly performed to restore normal anatomy after a malunited fracture or to shorten the ulna to improve symptoms of ulnar sided wrist pain.
