Other Hand and Wrist Conditions

De Quervain’s disease

What is De Quervain’s disease?

De Quervain’s disease is inflammation of the tendons to the thumbs where they pass through the ‘first compartment’ of the wrist. These tendons travel through separate tunnels at the level of the wrist joint and the tunnels ensure that the tendons do not bowstring when the wrist is extended.

Usually the space inside the tunnel is lubricated by fluid, but if inflammation occurs within the tunnel, the tendons can become inflamed and swollen. This causes pain and irritation at the site. De Quervain’s disease is common in pregnant women due to the hormonal and fluid changes associated with pregnancy. It is also common in breastfeeding mothers for the same reason.

De Quervain’s disease is also called De Quervain’s tenosynovitis and first extensor compartment tenosynovitis.

What are the symptoms of De Quervain’s disease?

The main symptoms of De Quervain’s disease are localised pain, swelling and tenderness on the thumb side of the wrist and just above the wrist. The pain may be worse when you move your thumb and/or wrist.

What does your doctor look for?

Your doctor will feel your thumb and wrist, looking for pain and swelling. A Finkelstein’s test is often performed, where you make a fist with the thumb inside and you then move your wrist away from the affected part of the wrist. This often exacerbates the pain.

What investigations are needed?

Usually no investigations are required. Although an ultrasound scan or MRI scan may be useful for visualising inflammation.

How is De Quervain’s disease treated?

Treatment options for De Quervain’s disease include:

  • non-drug therapy (eg hand therapy and splinting)
  • medication (eg steroid injection into the joint)
  • surgery

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

De Quervain’s disease surgery

Surgery is usually performed under a local anaesthetic as a day procedure. It usually takes about 10 minutes to complete. A tourniquet is placed above the elbow to ensure a bloodless field. Then a 2–3cm incision is made over the thumb side of the wrist and the underlying fat is retracted. Nerves and blood vessels are identified and protected, and the extensor compartment sheath is then opened. The affected tendons are released and allowed to glide more freely. Occasionally multiple compartments need to be released. The skin is sutured closed and dressings are applied.

Post-op rehabilitation

You will be able to go home soon after the operation. The anaesthetic will wear off after approximately 6–8 hours, and any discomfort will usually be controlled with simple analgesia.

You should keep your hand elevated but there are no limitations on finger movements. These are actively encouraged.

The bandage dressings are usually removed after 48 hours. The sticky dressing over the wound is usually left on. It, and the sutures, are usually removed 10–14 days after surgery. You need to keep the wound dry until the sutures are removed.

Most people notice an improvement in their symptoms within the first few days but some have ongoing symptoms for up to 3 months following surgery.

You can return to driving once the sutures have been removed. You will need at least 2 weeks off work if your job involves heavy manual work or frequent hand-washing. Some people need a longer period off work and this should be discussed with your surgeon prior to the procedure.

Possible complications

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Some complications specifically related to hand surgery include: infection (less than 1% chance); neuroma (less than 1% chance) which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance) which is a reaction to surgery that can cause painful or stiff hands.

Specific complications related to De Quervain’s disease surgery include failure to completely resolve the symptoms. This is rare, occurring in less than 1% of patients. The nerves under the skin at this site are very close to where the incision is made and may be damaged during surgery. This can cause ongoing pain and possibly numbness just beyond the incision site.

Ganglion cyst of the wrist and hand

What is a ganglion cyst?

A ganglion cyst is asmooth fluid-filled lump that occurs under the skin near joints or tendons. These cysts most frequently develop on the back of the wrist, but they appear at multiple sites over the hand. A ganglion cyst is not a cancer and is usually harmless. The cysts can change in size (becoming larger or smaller) and may spontaneously disappear completely.

Ganglion cysts are the most common type of lump found on the hand or wrist.Many do not require treatment, however if the cyst is painful, interferes with function or limits the ability to use the hand then there are treatment options available.

The exact cause for formation of a ganglion isn’t known. Women than more affected than men, and ganglion cysts are most common in younger people between 15 and 40 years of age.

What are the symptoms of a ganglion cyst?

Most ganglions form a lump under the skin that you can easily feel and see. Ganglions often change in size but cause no discomfort. Large ones may be unsightly.

Occasionally, a ganglion will put pressure on the nerves that pass through the joint, which can cause pain and discomfort.

What does your doctor look for?

Your doctor will examine your hands and wrists for lumps, checking for any pain or swelling.

What investigations are needed?

Your doctor will usually be able to make a diagnosis of ganglion cyst on examination. But sometimes X-rays are ordered to look for an underlying bony problem.

An ultrasound scan or MRI scan may be required to visualise the ganglion more clearly.These tests may be ordered if operative treatment is planned.

How are ganglion cysts treated?

Treatment options for ganglion cysts include:

  • observation only – as many ganglions resolve on their own
  • non-drug therapy (eg immobilisation with a splint or cast, ultrasound-guided drainage of the fluid in the cyst)
  • surgery

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Ganglion cyst surgery

Surgical treatment is usually reserved for large or painful ganglions and frequently after treatment with drainage. Surgery involves removing the cyst and its stalk that goes down to the joint capsule (or tendon sheath).

Possible complications

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Complications specific to ganglion removal surgery include recurrence of the ganglion. Recurrence is more common with ganglions on the palm side of the wrist than on the back side of the wrist.

Trigger finger

What is trigger finger?

Trigger finger is a painful condition that causes the finger or thumb to catch or lock when flexed. When it affects the thumb, it is called trigger thumb. The condition occurs when tendons in the finger or thumb become inflamed.

Tendons are tough bands of tissue that connect muscles to bones. Within the hand, the tendons glide through a number of pulleys to keep the tendons aligned. Usually the tendons are well lubricated and slide freely through the pulleys.

Sometimes a finger or thumb tendon may become inflamed and swollen, and the swelling may lock behind the pulley within the palm of the hand (in line with the finger). This can cause a clicking, snapping or popping sensation as the finger is flexed and may actually require manual straightening with the other hand.

This is caused by repeated movement or forceful use of the finger or thumb. Rheumatoid arthritis, gout and diabetes can also cause trigger finger or thumb. It can occur at any age, but is most common in people aged 40–60 years. Women are affected more than men.

What are the symptoms of trigger finger?

The most common symptom is painful locking of the affected finger. In severe cases this may lock in a bent position and must be gently straightened with the opposite hand.

What does your doctor look for?

Your doctor will look for symptoms of locking of the finger or thumbs and for any swellings of lumps over the tendon in the palm of the hand.

What investigations are needed?

No investigations are required to diagnose trigger finger.

How is trigger finger treated?

Treatment options for trigger finger include:

  • non-drug therapy (eg splinting)
  • medications (eg anti-inflammatories, steroid injection into the tendon sheath)
  • surgery

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Trigger finger surgery

Surgery is usually performed under local anaesthetic as a day procedure. The procedure usually takes about 10 minutes to complete.

A tourniquet is placed above the elbow to ensure a bloodless field.  A transverse or oblique incision is made over the palm in line with the affected digit. The pulley is divided, allowing the tendon to move freely within the palm. The skin is sutured closed and dressings are applied.

Post-op rehabilitation

You will be able to go home soon after the operation. The anaesthetic will wear off after approximately 6–8 hours, and any discomfort will usually be controlled with simple analgesia.

You should keep your hand should elevated. but there are no limitations on finger movements. These are actively encouraged.

The bandage dressings are usually removed after 48 hours. The sticky dressing over the wound is usually left on. It, and the sutures, are usually removed 10–14 daysafter surgery. You need to keep the wound dry until the sutures are removed.

Most people notice an improvement in their symptoms within the first few days but some have ongoing symptoms for up to 3 months following surgery.

You can return to driving once the sutures have been removed. You will need at least 2 weeks off work if your job involves heavy manual work or gripping. Some peopleneed longer period off work and this should be discussed with your surgeon prior to the procedure.

Possible complications

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1–2% chance), which is a reaction to surgery that can cause painful or stiff hands