Hand Conditions

• Pain at the base of the thumb or in the finger joints, which may be constant or only present during use
• Swelling and tenderness in the affected areas
• Stiffness, particularly noticeable in the mornings or after periods of inactivity
• Reduced ability to grip or pinch objects
• A sensation of grinding or clicking in the joints during movement
• Visible joint deformity or change in hand shape in more advanced cases

Our clinic specializes in the treatment of hand arthritis, with a focus on individualized care. Depending on the severity and type of arthritis, treatment may include:

Conservative Management: Options like splinting, anti-inflammatory medications, or corticosteroid injections can help manage pain and inflammation. Occupational Therapy: Customized exercises and strategies to maintain joint function and improve the ability to carry out daily tasks. Surgical Intervention: For those who do not respond to conservative treatments, surgical procedures such as joint fusion or joint replacement may offer pain relief and restore function.

• Nodules: Small, tender lumps in the palm or on the back of the knuckles that are the early signs of the disease.

• Pitted or thickened skin: The skin on the palm may appear puckered or dimpled.

• Cord development: Tough band-like cords of tissue can form, extending from the palm to the fingers. Due to the appearance of these cords, many people (including some medical personnel) incorrectly attribute these cords to the tendons. Tendons are unaffected by Dupuytren's Disease.

• Finger contracture: One or more fingers or thumbs may begin to bend towards the palm, and this can interfere with everyday activities. This may progress rapidly over 6 months, or more slowly over 20 years or more. Progression rate is different between patients, and even in different digits of the same patient.

• Contractures elsewhere in the body: Dupuytren's disease can occasionally be associated with similar contractures in the feet (Ledderhosen's Disease), penis (Peyronie's disease) or shoulder (frozen shoulder).

• Functional problems: As Dupuytren’s Disease progresses, the affected fingers may become more difficult to straighten which can complicate tasks such as typing, wearing gloves and shaking hands. Simple daily activities may also become difficult such as using utensils or washing yourself without poking yourself in the eye.

Treatment for Dupuytren’s Disease at The Hand and Wrist Clinic is tailored to the severity of the condition and the impact on the patient’s life:

• Non-surgical treatments: Hand therapy and splinting have been proven to be of little benefit to preventing contracture in Dupuytren's Disease. However, for those wishing to avoid surgery, the expert team of Hand Therapists at The Hand and Wrist Clinic have techniques and methods for helping patients to improve their functional problems and live with the hands they have.

• Percutaneous surgery: Needle fasciotomy, also called aponeurotomy, is when the cords are broken with a needle to release the contracted fingers. Nik Jagodzinski performs this minimally invasive surgery under the WALANT technique.

• Open Surgery: For more advanced cases and recurrent cases, open surgery may be necessary to remove the diseased tissue and restore finger mobility.

• Visible lump: A small, rounded bump near the nail bed, often translucent and filled with clear fluid.

• Nail deformity: Dents or ridges on the nail plate may occur if the cyst exerts pressure on the nail matrix.

• Discomfort or pain: While often painless, cysts can become tender, especially if they rupture or become infected.

Mucous cysts may fluctuate in size and can sometimes resolve spontaneously, but they often recur if not treated properly.

At The Hand and Wrist Clinic, we offer several treatment options for mucous cysts:

• Monitoring: If the cyst is not causing any symptoms, it may simply be observed over time.

• Aspiration: Draining the fluid from the cyst can provide temporary relief, but recurrence is common and it can be complicated by infection.

• Surgical removal: For persistent or bothersome cysts, surgical removal of the cyst and the associated osteophyte (bone spur) may be recommended to prevent recurrence.

• Distal interphalangeal joint fusion: Recurrent or particularly bothersome cysts associated with painful arthritis at the distal interphalangeal joint can be successfully treated with fusion of this joint.

• Visible lump: A round or oval-shaped bump that may be soft or firm to the touch. Occasionally they may look like bubbles where multiple cyst cavities join together.

• Location: Commonly found on the back or front of the wrist, the base of the finger on the palm side, or the top of the finger’s end joint.

• Pain or discomfort: While many cysts are painless, some may cause pain, tingling, or muscle weakness, especially if they press on a nearby nerve.

• Change in size: The cyst may become more prominent with movement or when performing certain activities.

• Observation: If the cyst is not causing pain or limiting activity, monitoring the cyst for changes may be all that’s necessary. They may resolve spontaneously and require no treatment.

• Aspiration: The fluid/jelly can be drained from the cyst, providing relief from symptoms. However, ganglion cysts frequently recur after this procedure.

• Surgery: Surgical removal may be the best option for cysts that are painful, recurrent, press on nerves or interfere with hand function. This procedure aims to remove the cyst and part of the joint capsule or tendon sheath, which is the root of the cyst.

• Nodular masses: Visible and palpable lumps under the skin, often around the joints of the hands. They may appear to contain a chalky substance.

• Joint discomfort: Persistent aching or pain in the affected joints, which can be exacerbated by acute gout attacks.

• Reduced mobility: Difficulty in joint movement that can affect the ability to perform daily tasks.

Skin ulceration: In severe cases, the skin over the tophi may break down, leading to ulceration and infection.

The treatment at The Hand and Wrist Clinic is multifaceted and may include:

• Medication: To manage gout and reduce uric acid levels in the blood, thereby preventing the formation of new tophi.

• Lifestyle changes: Dietary modifications and weight management can help reduce the frequency of gout attacks.

• Surgical intervention: In cases where tophi are causing severe pain, limiting function or leading to recurrent infections, surgical removal of the tophi may be recommended.

• Inability to straighten the finger(s): The affected finger(s) may droop or hang down and cannot be straightened voluntarily.

• Pain and swelling: Around the affected area, especially if the condition is due to an injury.

• Weakness: A general feeling of weakness in the affected finger(s).

• Stiffness: Joint stiffness making finger movement difficult.

Treatment for dropped fingers at The Hand and Wrist Clinic may include:

• Splinting: To support the finger in the correct position and allow the tendon to heal.

• Hand therapy: Exercises to strengthen the muscles and improve finger mobility and strength.

• Surgery: In cases where the tendon is ruptured or the injury is severe, surgical repair may be necessary to restore function.

• Stiffness: Particularly in the morning, you may notice stiffness in the affected finger.

• Popping or clicking sensation: When you move the finger, there might be a noticeable click or snap.

• Tenderness or bump: The base of the affected finger may feel tender, with a nodule in the palm that you can feel moving.

• Locked finger: In severe cases, the finger may become stuck in a bent position and may need gentle pressure to straighten, which can be painful. Occasionally, the finger can become completely stuck in the palm and it cannot be straightened even with your other hand. If this happens, seeking treatment should become more urgent before finger joints become permanently stiff in that position.

At The Hand and Wrist Clinic, we provide various treatment options depending on the severity of the condition:

• Non-operative therapies: Initial treatments may include rest, bespoke made finger splints and anti-inflammatory medication to reduce pain and swelling.

• Steroid injections: Corticosteroid injections can be effective in relieving the symptoms for many patients.

• Surgery: If conservative treatments don’t relieve the symptoms, surgery may be necessary to release the tendon, allowing smoother movement.