Specialist Hand and Wrist Treatment in London
We use our hands and wrists constantly – for work, sport and almost every aspect of everyday life. Pain, stiffness, weakness or an injury can therefore have a significant impact, even when the problem initially seems relatively minor.
At London Bridge Orthopaedics, our specialist hand and wrist consultants provide assessment and treatment for both acute injuries and longstanding conditions affecting the hand, wrist, fingers and thumb.
Wherever possible, treatment is focused on restoring function without surgery. This may involve specialist hand therapy, physiotherapy, splinting, medication, injections or changes to activity.
For conditions where surgery offers the most appropriate treatment, your consultant will explain the procedure, expected recovery and rehabilitation so that you can make an informed decision about your care.
Whether your symptoms started suddenly following an injury or have gradually become more troublesome, the aim is to establish an accurate diagnosis and help you return to the activities that matter to you.
To arrange an appointment with a London Bridge Orthopaedics hand and wrist specialist, call our dedicated booking team or book an appointment online.
Below are some of the most common hand and wrist conditions and injuries we treat.
Hand and Wrist Fractures
Hand and wrist fractures commonly occur following a fall, sporting injury or direct impact. The wrist contains several small bones as well as the ends of the radius and ulna, while fractures can also affect the bones of the hand, thumb and fingers.
Symptoms can include pain, swelling, bruising and difficulty moving or using the hand or wrist. Some fractures cause an obvious deformity, while others – particularly scaphoid fractures – can initially be less apparent.
X-rays are commonly used to diagnose a fracture, although CT or MRI may sometimes be needed for more detailed assessment.
Treatment depends on which bone has been fractured and whether it remains in a stable position. Some fractures can be treated with a splint or cast, while displaced, unstable or more complex injuries may require surgery.
Find out more about hand and wrist fractures
Carpal tunnel syndrome
Carpal tunnel syndrome occurs when the median nerve becomes compressed as it passes through a narrow space at the wrist called the carpal tunnel.
It commonly causes numbness, tingling or pins and needles in the thumb, index, middle and part of the ring finger. Symptoms are often particularly troublesome at night and some people find themselves waking and shaking their hand to relieve them. As the condition progresses, grip and fine hand movements can also be affected.
Treatment depends on the severity and duration of the symptoms. Night splints and steroid injections can be useful for some patients, while carpal tunnel release surgery may be recommended for persistent or more severe nerve compression.
Find out more about carpal tunnel syndrome
Acute Tendon and Ligament Injuries
The hand and wrist contain a complex network of tendons and ligaments that provide movement and stability. These structures can be injured during sport, falls, accidents or sudden force through the hand or fingers.
Injuries range from relatively minor sprains to complete tendon or ligament tears. Examples include finger tendon injuries, thumb ligament injuries and damage to important stabilising structures within the wrist.
Symptoms can include pain, swelling, bruising, weakness or instability. You may also notice that a finger or thumb no longer moves normally.
Early diagnosis can be particularly important with certain tendon and ligament injuries, as delayed treatment may make them more difficult to repair successfully. Treatment may involve splinting and specialist hand therapy, while significant tears or unstable injuries may require surgery.
Find out more about acute tendon and ligament injuries
Chronic Ligament Strains and Tendinopathy
Not all hand and wrist problems follow a single obvious injury.
Tendinopathy and chronic ligament problems can develop gradually through repetitive loading, sport, work or following an injury that has failed to settle completely.
Symptoms may include persistent wrist or hand pain, tenderness, swelling, weakness or discomfort during gripping, lifting or weight-bearing through the hand.
Because there are many closely positioned structures within the hand and wrist, identifying exactly where symptoms are coming from is important. Assessment may be supported by imaging such as X-ray, ultrasound or MRI when appropriate.
Treatment is usually tailored to the underlying problem and may include activity modification, splinting, hand therapy or physiotherapy and, in selected cases, injection therapy or surgery.
Find out more about chronic ligament strains and tendinopathy
Dupuytren’s contracture
Dupuytren’s contracture is a condition affecting the tissue beneath the skin of the palm and fingers.
Over time, this tissue can thicken and form nodules and cords, gradually pulling one or more fingers towards the palm.
It most commonly affects the ring and little fingers. The condition is not usually painful, but as it progresses it can become difficult to straighten the affected fingers fully. This may eventually interfere with everyday tasks such as putting your hand flat on a table, reaching into a pocket, wearing gloves or gripping larger objects.
Not everyone with Dupuytren’s disease requires treatment. When the contracture begins to significantly affect hand function, your consultant can discuss the available treatment options.
Find out more about Dupuytren’s contracture
Ganglion Cysts
A ganglion cyst is a fluid-filled swelling that develops near a joint or tendon. Ganglions are very common around the wrist and hand and may appear as a smooth lump that changes in size over time.
Many ganglion cysts cause little or no discomfort and do not require treatment. Others can become painful, particularly during wrist movement or weight-bearing activities, and occasionally their position can interfere with movement or irritate nearby structures.
If a lump develops in the hand or wrist, it is worth having it assessed rather than assuming it is a ganglion.
Where a ganglion is confirmed, treatment depends on the symptoms it is causing. Observation may be all that is required, while aspiration or surgical removal can be considered in selected cases.
Find out more about ganglion cysts
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. It can cause pain and tenderness around the base of the thumb and wrist, particularly during gripping, lifting, twisting movements or when moving the thumb.
Symptoms may develop gradually and are often associated with repeated hand and wrist movements or changes in activity. The condition is also commonly seen during pregnancy and in the months after having a baby, when repetitive lifting and carrying can further aggravate symptoms.
Treatment usually begins with simple measures such as activity modification, splinting and hand therapy. A steroid injection can be very effective for persistent symptoms. If symptoms continue despite appropriate non-surgical treatment, a small surgical procedure to release the affected tendon sheath may be considered.
Find out more about De Quervain’s tenosynovitis
TFCC Injuries
The triangular fibrocartilage complex (TFCC) is a group of cartilage and ligaments on the little-finger side of the wrist that helps support and stabilise the joint. TFCC injuries are an important cause of ulnar-sided wrist pain and can occur following a fall or twisting injury, during sport, or develop gradually through repeated loading of the wrist.
Symptoms commonly include pain on the little-finger side of the wrist, particularly when twisting the forearm, gripping, pushing up from a chair or loading the wrist. Some people also notice clicking, weakness or a feeling of instability.
Diagnosis involves a detailed clinical assessment and may be supported by X-rays and MRI. Many TFCC injuries can be treated without surgery using activity modification, splinting and specialist hand therapy. In selected cases, injection treatment may also be helpful. Persistent symptoms, significant tears or wrist instability may require wrist arthroscopy or surgical repair, depending on the type and location of the injury.
Find out more about TFCC injuries
Rheumatoid arthritis of the hand
Rheumatoid arthritis is an inflammatory autoimmune condition that commonly affects the small joints of the hands and wrists.
Unlike osteoarthritis, rheumatoid arthritis occurs when the immune system mistakenly attacks the tissues lining the joints. This can cause pain, swelling and stiffness and, over time, may damage joints, tendons and other structures within the hand.
Medical management of rheumatoid arthritis is usually led by a rheumatology team using medication to control the underlying disease.
A hand surgeon may become involved when structural changes within the hand or wrist are causing persistent pain, tendon problems, deformity or loss of function despite appropriate medical treatment. Treatment is therefore individualised and may involve hand therapy, splinting or surgery where appropriate.
Find out more about rheumatoid arthritis of the hand
Thumb arthritis
Thumb arthritis most commonly affects the joint at the base of the thumb, known as the carpometacarpal or CMC joint.
This joint plays an important role in gripping and pinching, so arthritis here can make surprisingly simple everyday tasks difficult. Opening jars, turning keys, using scissors, fastening buttons or gripping objects can all become uncomfortable.
Symptoms typically include pain around the base of the thumb, stiffness, reduced grip or pinch strength and sometimes swelling or a change in the shape of the joint.
Treatment usually begins with non-surgical options such as activity modification, splinting, hand therapy, pain relief and injections. If symptoms become severe and continue to interfere with everyday life despite conservative treatment, surgery may be considered.
Find out more about thumb arthritis
Trigger finger
Trigger finger, medically known as steno sing tenosynovitis, occurs when a flexor tendon has difficulty gliding smoothly through its tendon sheath.
You may notice pain or tenderness at the base of the finger or thumb, together with clicking or catching when you bend and straighten it. In more established cases, the finger can temporarily become locked in a bent position and need to be straightened using the other hand.
Symptoms are often particularly noticeable first thing in the morning.
Treatment depends on the severity of the condition and may include activity modification, splinting or a steroid injection. When symptoms persist despite conservative treatment, a relatively small surgical procedure known as a trigger finger release can create more space for the tendon to move freely.
Find out more about trigger finger
Not Sure What Is Causing Your Hand or Wrist Pain?
Hand and wrist problems are not always straightforward to diagnose. A relatively small area contains numerous bones, joints, ligaments, tendons and nerves, and different conditions can produce very similar symptoms.
For example, wrist pain following a fall could be caused by a fracture, ligament injury or soft tissue problem. Numbness and tingling may suggest nerve compression, while pain during gripping or repetitive activity can have several potential causes.
A specialist assessment can help identify which structures are involved and whether further investigation is required.
Depending on your symptoms, this may include X-ray, ultrasound, CT, MRI or nerve conduction studies.
