Wrist Conditions

• Pain: Persistent or intermittent pain in the wrist, often aggravated by movement or after periods of rest.

• Swelling: The wrist may appear swollen or deformed due to inflammation within the joint.

• Stiffness: Limited range of motion and stiffness, particularly in the morning or after inactivity.

• Weakness: A decrease in wrist strength can make everyday tasks challenging.

• Clicking or clunking: Damaged joints may click or clunk when moved about or put under load. This can be painful and can sometimes damage the joint further.

At The Hand and Wrist Clinic we offer a range of treatments tailored to the specific type of arthritis and the individual needs of our patients:

• Conservative treatments: These may include rest, splinting, anti-inflammatory medications and corticosteroid injections to manage symptoms.

• Specialist hand therapy: Exercises and therapies to maintain joint mobility and strengthen the muscles around the wrist.

• Surgical options: In advanced cases, surgical interventions such as denervation, joint fusion, removal of affected joints, wrist arthroscopy or joint replacement may be recommended.

• Pain: Initially, pain may only occur with activity, but as the condition progresses, it can become constant.

• Swelling: The wrist may become swollen and tender to the touch.

• Limited range of motion: As the affected bone deteriorates, it may become difficult to move the wrist normally.

• Weakness: The wrist may feel weaker, making tasks that require a strong grip or fine motor skills challenging.

Treatment for AVN aims to preserve the health of the affected bone and prevent further damage:

• Non-surgical management: Early stages may be managed with medication, reduced activity, and physical therapy to maintain joint mobility and muscle strength.

• Surgical intervention: Depending on the severity, surgery may be necessary. Options include bone grafts, core decompression to relieve pressure and create a new blood supply, or in advanced cases, denervation, removal of bones or joint fusion or replacement.

• Pain and tenderness: Most noticeable over the thumb side of the wrist which may travel up the forearm.

• Swelling: The base of the thumb may appear swollen, and there may be a fluid-filled cyst in this region.

• A “sticking” or “stop-and-go” sensation: When moving the thumb.

• Difficulty moving the thumb and wrist: Especially when performing actions that involve pinching or grasping.

At The Hand and Wrist Clinic, we provide a range of treatments for De Quervain’s tenosynovitis:

• Conservative treatments: These may include splinting the thumb and wrist, anti-inflammatory medications and corticosteroid injections to reduce swelling and pain.

• Specialist hand therapy: Specialized exercises and therapies can help improve range of motion and strengthen the wrist and thumb.

• Surgery: If symptoms are severe or do not improve with conservative treatments, surgery may be necessary to open the compartment to make more room for the inflamed tendons, often using the WALANT technique.

• Pain and tenderness: Along the top of the hand or forearm, particularly with movement.

• Swelling: Visible swelling may occur along the path of the extensor tendons.

• Stiffness: Morning stiffness or stiffness after periods of inactivity is common.

• Difficulty extending fingers: Resistance or pain when trying to straighten the fingers or thumb.

• Conservative treatments: Such as rest, ice, compression, elevation (RICE), and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

• Bracing or splinting: To immobilize the affected tendons and allow them to rest and heal.

• Physical therapy: Exercises to improve flexibility and strength once inflammation has subsided.

• Corticosteroid injections: Can be used to reduce severe inflammation.

• Surgery: In chronic cases or when conservative treatments fail, surgical intervention may be necessary to release the constricted sheaths of the tendons.

• Visible lump: A round, smooth, and firm cyst that appears on the wrist.

• Location: Most commonly on the back of the wrist, but they can also occur on the palm side.

• Pain or discomfort: While many ganglions are painless, some may cause pain, especially when the wrist is moved, when pressure is applied, or when they push on nerves.

• Size fluctuation: The cyst may change in size and can increase with wrist activity and shrink in the days afterwards.

• Weakness or numbness: If the cyst compresses nearby nerves, it may cause weakness or numbness in the hand.

The Hand and Wrist Clinic provides several treatment approaches:

• Observation: If the ganglion causes no pain and does not interfere with activity, monitoring for changes is often recommended.

• Reassurance: Cancerous lumps in the hand and wrist are rare, but do occur. You may simply want reassurance that your lump is nothing sinister.

• Aspiration: The fluid from the cyst can be drained to reduce its size and relieve symptoms. However, ganglions frequently recur after this procedure.

• Surgery: Surgical removal (usually with the WALANT technique) is considered when the ganglion causes significant pain, interferes with function or is recurrent. This procedure aims to remove the cyst and part of the joint capsule or tendon sheath to reduce the chance of recurrence

• Pain and tenderness: Usually located on the top of the forearm, slightly above the wrist.

• Swelling and inflammation: Visible swelling may be present in the area where the muscles and tendons intersect.

• Crepitus: A grinding or creaking sensation when moving the wrist or thumb.

• Weakness: Difficulty performing tasks that require gripping or lifting.

At The Hand and Wrist Clinic, treatment typically includes:

• Rest and activity modification: Avoiding activities that aggravate the condition is essential for recovery.

• Ice and compression: To reduce inflammation and swelling.

• Anti-inflammatory medication: NSAIDs can help manage pain and inflammation.

• Specialist hand therapy: Strengthening and stretching exercises can aid in recovery and prevent recurrence.

• Bracing or splinting: To immobilize the wrist and allow the tendons to heal.

• Corticosteroid injections: May be considered if conservative measures are ineffective.

• Surgical release: When conservative treatments have failed, intersection syndrome can be treated by surgical decompression of the tendons and muscles in the forearm, often using the WALANT technique.

• Audible snapping: A snapping or clicking sound when the wrist is rotated or the hand is moved in certain positions.

• Pain: Pain on the ulnar side (little finger side) of the wrist, especially with rotation or gripping motions.

• Instability: A feeling that the tendon is moving out of place or the wrist is giving way during certain activities.

• Swelling: Some may notice swelling or tenderness over the ECU tendon.

At The Hand and Wrist Clinic treatment approaches may include:

• Rest and immobilization: A period of rest and the use of a splint or cast to allow the subsheath to heal and the tendon to stabilize.

• Anti-inflammatory medication: To reduce pain and swelling.

• Specialist hand therapy: Strengthening and stabilizing exercises for the wrist once the tendon has healed.

• Surgery: If conservative treatments fail to stabilize the tendon, surgical repair may be necessary to reconstruct the subsheath and secure the ECU tendon in its proper position.

• Inability to straighten the fingers: Particularly the ring and little fingers, due to tendon rupture.

• Swelling and pain: Around the ulnar aspect of the wrist and hand.

• Weakness in the hand: Difficulty with grip and manipulation of objects.

• Visible deformity: The affected fingers may droop or assume an unusual position.

• Splinting: To support the affected fingers and prevent further deformity.

• Surgical intervention: The primary treatment is surgical repair or reconstruction of the ruptured tendons to restore finger extension. Tendon transfers along with joint stabilization procedures may also be considered to prevent recurrence.