De Quervain’s Tendonitis
De Quervain’s Tendonitis (also known as ‘first dorsal compartment tendonitis’) is a condition brought on by irritation of tendons across the wrist at the base of the thumb. This irritation causes pain on movement of the thumb and wrist. Common painful movements include making a fist and grasping or holding objects.
The main symptom is pain over the thumb-side of the wrist. The pain may come on gradually or suddenly and may radiate down the thumb or up the forearm. There may be increased pain with hand and thumb motion, leading to difficulty with pinch activities. Other symptoms include swelling at the site of pain, ‘clicking’ or ‘snapping’ and numbness on the back of the thumb and index finger.
Non-surgical treatment options include:
Wearing a splint to rest the thumb and wrist
Oral anti-inflammatory medication
Cortisone injections around the tendons
These treatments help reduce the swelling, which can relieve pain over time. In some cases, simply stopping the aggravating activities may relieve symptoms. When symptoms are severe or do not improve, plastic surgery is often recommended. The tight fibrous tissue around the tendons is released to make room for the irritated tendons, which prevents irritation occurring.
Normal use of the hand can usually be resumed within a few weeks. Surgery has a low complication rate and is usually performed as day surgery. There is some pain during the recovery period. No splint is required.
Trigger Thumb (Children)
Trigger thumb refers to a thumb that clicks, catches, or locks as it is bent or straightened. At times, the thumb may become “locked” in a flexed position.
Most often, the child does not complain of any pain. The thumb may click or get stuck. The child may be unable to fully straighten the thumb. Often a palpable node or lump is felt at the base of the thumb.
Trigger thumb may resolve spontaneously but this is very unusual after one year of age. Surgery is usually recommended for children over the age of one year. This involves release of the A1 pulley.
A bulky dressing is applied. This is usually left intact for up to 2 weeks. No splints are required. The vast majority of patients make a quick recovery and complications are unusual. A resumption of triggering after surgery is very unusual.
In plastic surgery osteoarthritis (degenerative or “wear-and-tear” arthritis) is a condition that occurs when the smooth cartilage at the end of bones wear away, resulting in increased friction as the bones rub against each other during hand movements. There is further joint damage over time and there is pain from the irritation of the joint.
Osteoarthritis is a common problem, however, the cause is largely unknown. The condition tends to affect middle-aged women. There may be a previous history of injury. Sometimes, there is a family history of osteoarthritis.
Types of Osteoarthritis
It is common to experience osteoarthritis in the fingers and wrist or at the base of the thumb:
Fingers and Wrist.
Ganglion cysts are common lumps that appear on the hand and wrist. They typically occur at 4 sites:
the back of the wrist
the front of the wrist
the base of the finger
the end joint of the finger.
These lumps are generally not painful but may be of concern due to their appearance. They may fluctuate in size and may disappear spontaneously.
Some ganglions may disappear spontaneously and require no treatment. Sometimes, reassurance is all that is required if the ganglion is not causing problems. If the ganglion persists and is troublesome, then injection with steroid may help.
Ultimately, removal may be required or requested. This is generally performed as a day surgery in hospital under general or local anaesthetic. Surgery aims to remove the ganglion and a small cuff of joint capsule from which the ganglion arises. This is performed through an incision directly over the swelling.
A splint may be used after excision of wrist ganglions for a few weeks. There is up to a 10% chance of recurrence with any ganglion.
The back of the hand is the most visible unclothed area of the body other than the head and neck. It is also subject to the same changes of ageing as the face with a change in skin quality, pigmentation, wrinkles and loss of volume in the tissues under the skin. Patients who undergo facial cosmetic surgery often complain that the appearance of their hands “gives away” their age.
Few plastic surgeons undertake cosmetic hand surgery because of the difficulties in obtaining reliable results comparable with those seen in facial cosmetic surgery. In recent years there have been reports of reliable techniques to improve the appearance of the aging hand.
Fat grafts, usually taken from the abdomen can improve the loss of fullness in the back of the hand ie visible veins, wrinkling and a “bony” appearance. The fat is “sucked” from the abdomen and injected beneath the skin in the hand. (Other fillers can be used, but experience with the use of these in the hand is limited).
The pigmentation in the hand can be improved with the use of resurfacing techniques such as laser or chemical peels. This is done separately to the fat grafting to ensure safe healing.
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