For this month’s Q&A, we are joined by Mr James Nicholl, a Consultant Orthopaedic Surgeon who specialises in hand and wrist surgery.
In this video, he provides an overview of non-invasive and surgical treatments for carpal tunnel syndrome, Dupuytren’s contracture, and hand arthritis. Whether symptoms are mild or advanced, Mr Nicholl offers valuable insights into how to determine the most suitable treatment to restore function and improve quality of life.
Q1. What are the symptoms of carpal tunnel syndrome and what is the treatment?
A. Carpal tunnel syndrome is a trapped nerve in the wrist and patients experience numbness and tingling going into their fingers. Typically, it's the thumb, index and middle fingers, and often. Initially it's a problem at night - people are woken up with painful pins and needles. Symptoms may occur when they're sitting reading holding a book or when they're driving or holding their phone. If the condition progresses, then you can actually lose feeling in the fingers, they go numb, and then you find you're dropping things and you struggle with sort of fiddly tasks, perhaps picking up small objects.
The treatment options are that if it's predominantly at night and waking you up, wearing a splint to hold the wrist straight can be helpful. A cortisone injection into the carpal tunnel will often settle the symptoms if they're intermittent ones, but this may only work temporarily. And the definitive treatment is to have an operation to release the nerve, which is done under local anaesthetic. It takes about 15 minutes, and the recovery is usually fairly quick and easy. If a patient has got permanent numbness in their fingers, or if they've started losing the strength of the muscle that moves the thumb, then surgery is the only option which is likely to reverse that.
Q2. When should I have Dupuytren’s contracture treated?
A. Dupuytren's contracture is a condition that affects the hand where there's a buildup of the fibrous tissue underneath the skin, and over time, the fingers gradually bend down. The speed with which this happens is very variable. Usually when the lumps first appear and the fingers still straighten, we would recommend that there isn't any treatment and that we just monitor things and advise patients to keep an eye on it. If the fingers bend over such that the patient can no longer get their hand down flat, then this is the time we would treat it. So from the point of view of degrees, if the first knuckle nearest the hand bends to 30 degrees or more, or if the middle knuckle in the finger bends to 10 degrees or more, this is when we would recommend treating it. If the fingers have bent right down into a severe contracture, then it can still be treated, but it becomes more difficult, and the likelihood of a good result becomes less.
Q3. What can be done for painful hand arthritis?
A. Arthritis can affect almost any of the joints of the hand and wrist. Often this will occur spontaneously, but it can be following an episode of trauma which has damaged the joint. Initially, the pain is controlled with simple measures such as using painkillers and rubbing in anti-inflammatory creams, and perhaps wearing a splint beyond this. Steroid injections into the joints can give good pain relief for a prolonged period, but they're not going to cure the arthritis.
Ultimately, if any joint remains very painful and the patient needs more definitive treatment, then there are a whole variety of operations that can be done to relieve the pain, ranging from fusing bones together, taking out the arthritic bone, and even putting in artificial joints made of metal or plastic, which are very good at relieving the pain for some of the affected joints.
Book a consultation with The Horder Centre
If you are experiencing significant hand pain and want to discover the treatment options available to you, book a consultation with The Horder Centre. Our team is on hand to support you through the treatment process, from your initial consultation to any aftercare you may need.
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