Carpal Tunnel/Dupuytrens/Base of Thumb Arthritis. Mr Steve Bostock Answers the FAQs...
Mr Steve Bostock, Consultant Orthopaedic Surgeon/Member of Sheffield Orthopaedics Ltd (SOL)
Claremont Clinics: Wednesday EVE
Carpal Tunnel Syndrome
What is it?
Carpal Tunnel syndrome is a condition caused by pressure on one of the main nerves as it enters the hand. This pressure causes tingling in the fingers, especially at night. Tingling may also occur during the day with activities such as driving, reading or taking a phone call.
What is the treatment for this condition?
You may be supplied with a splint to try from your GP or a steroid injection can also be helpful if the symptoms are mild. If the symptoms are more severe, or these measures fail, you will almost certainly be referred for surgical treatment.
What does surgery involve?
Surgery for Carpal Tunnel syndrome is straightforward and performed under local anaesthetic as a day case. A cut is made in the palm of the hand and the tissue pressing on the nerve is divided. A dressing is required for 2 weeks and most patients return to their normal activities within a period of 4-6 weeks.
Base of Thumb Arthritis
What is causing the pain at the base of my thumb?
In the hand, the base of the thumb is the commonest site of arthritis (wearing away of the cartilage). When arthritis affects this joint it gives rise to pain which is aggravated with gripping and pinching activities. The thumb may also become stiff.
Is there any treatment for my thumb pain?
Yes. The first thing to do is an x-ray to see if arthritis is present and if so, how severe it is. Then you may be offered a steriod injection. This is often performed using an x-ray machine to guide the needle accurately into the joint. If the injection is ineffective or if the condition is severe, you may be offered surgery.
What is the surgery for this condition?
Surgery involves removing a small bone from the base of the thumb called the ‘Trapezuim’ and the procedure is called a ‘Trapeziectomy’. This surgery requires a general anaesthetic but is usually performed as a day case. After surgery, the thumb is typically immobilised in a splint for the first 2 weeks, followed by physiotherapy and a return to light use of the hand within 4-6 weeks. It may take 3-4 months to return to heavier lifting and gripping activities.
What is Dupuytrens contracture?
Dupuytrens contracture is a thickening of the tissues that lie beneath the skin in the palm of your hand. This thickening is progressive and frequently forms into one or more ‘cords’, which pull on one or more fingers. The condition may run in the family and the ring finger is the most frequently affected by the tightness.
When should I seek advice?
It may be helpful to seek advice early to establish the diagnosis, but treatment is not normally offered until a tightness has developed, i.e. you cannot get the palm of your hand flat when placed on a table (‘the table top test’).
If I do need treatment, what will this be?
Once a deformity has become established, you are likely to be offered day surgery to remove the thickened tissue. For the first week or so the hand is immobilised in a plaster splint, followed by physiotherapy and a gradual return to normal daily activities between 3-6 weeks for most people. As an alternative to surgery there may be the option of an enzyme injection to break down the thickened tissue, this new treatment can be given in the outpatient department but is not suitable for all patients.
A private consultation with Mr Bostock at Claremont is £200 if you don't have health insurance.
To book an appointment, call our friendly Private Patient Team on 0114 263 2114 or email firstname.lastname@example.org. You will need a referral letter from your GP or you can see one of our Private GPs quickly for this if you prefer.
© Steve Bostock, 2016