Hand and Wrist Treatments
At London Bridge Orthopaedics we use the latest surgical and non-surgical treatments to manage an individuals specific problems.
These services include but are not limited to the following:
Ganglion cyst removal
A ganglion cyst can be drained to reduce the swelling in a local procedure called aspiration. This uses a hypodermic needle to puncture the cyst, and drain the fluid. Although this treatment removes the fluid, it still leaves the cyst lining behind, and the ganglion cyst will return about 50% of the time.
Surgery is a more effective way of removing a ganglion cyst. In surgery, the wrist ganglion is “shelled out,” to remove the fluid and the sac, and the connection to the joint or tendon sheath that supplied the fluid can be addressed. Although this treatment is usually effective, a small percentage of removed wrist ganglia will still return.
If the problem of deQuervain’s tenosynovitis persists, despite wrist splinting and a cortisone injection treatment, then surgery can be performed. This surgery is performed under local or general anaesthetic and aims to create more room for the tendons. During the procedure, the tight tissue around the tendons is released to remove the restriction on tendon motion. After surgery, a splint is worn for a few weeks.
Dupuytren’s contracture may be treated using a minimally invasive procedure called needle aponeurotomy under local anaesthesia. In needle aponeurotomy, the surgeon uses the tip of a needle to divide the contracted fibrous skin tissue beneath the palm of the hand. Unlike open surgery, the hand is not widely opened, which reduces tissue scarring.
Tendon transfer surgery can improve lost hand function, when a muscle or nerve has been injured and cannot be repaired. In tendon transfer surgery, the working tendon is shifted and reattached in a different part of the hand. This restores the hand action that has been lost. This surgery is commonly used to treat muscle or tendon injuries caused by rheumatoid arthritis, or fractures.
Joint replacement surgery is an effective option in painful arthritis that does not respond to other treatments. Wrist joint replacement surgery removes the damaged joint and replaces it with a metal and plastic implant. This can be carried out as an outpatient procedure. Wrist replacement surgery is often combined with other procedures to correct problems in the tendons, nerves, and small joints of the fingers, and thumb. Although wrist replacement surgery is not as common as hip or knee replacements, its use is growing.
Internal wrist fixation is a surgical procedure can be used to immobilise wrist fractures to enable the bone to heal. Internal fixation involves inserting implants, which are called ‘internal fixators’, into the wrist bone. These internal fixators can include bone screws and metal plates, pins and rods. This procedure is performed as open surgery, under general anaesthetic.
External wrist fixation is used for treating fractures that have significant swelling or soft-tissue damage. In external fixation, pins or screws are surgically placed into the bone on both sides of the fracture, without damaging the tissue. The pins are then secured together outside the skin with clamps and rods, which are known as the ‘external frame.’ This immobilises the bone while it heals. Compared to internal fixation, external fixation is quicker to apply, and the risk of infection at the site of the fracture is minimal.
Wrist arthroscopy is a treatment option for some types of wrist pain. Arthroscopic surgery (keyhole surgery) involves inserting a small camera through an incision (about 1 cm) in the skin. Other small incisions are made to insert instruments that can diagnose, repair or remove damaged joint problems. This procedure is usually performed as day surgery, carried out under local anaesthetic. Afterwards, wrist splints and physiotherapy are then used to regain wrist motion.
Wrist arthroscopy can be also used for treatment of:
- Ligament injuries/instability
- Ganglion cysts
- Specific types of wrist fractures
Release trigger finger
If trigger finger does not resolve after steroid injections, then surgery to release the tendon may be necessary. This procedure is a same day surgery that can be done under local anaesthetic or regional nerve block. A small (less than 2 cm) incision is made in the skin, and the tight portion of the flexor tendon sheath is released to allow the finger full flexibility. This surgery has a high success rate, and patients regain full use of the finger relatively quickly.
Physiotherapy for hand and wrist problems is an important part of our treatment services at London Bridge Orthopaedics. Inpatient and outpatient physiotherapy services are available on-site. Our chartered physiotherapists work with our consultants and patients to develop customised rehabilitation and exercise routines. This quickens recovery, flexibility and motion – both before and after surgery.
Our physiotherapists also work and liaise with many independent physiotherapists specialising in the treatment of hand and wrist problems. They will also be happy to work with a patient’s existing physiotherapist, and forward all details of post-operative physiotherapy care.