Hand Conditions
Links
The following links are to web sites that provide further information about Hand Surgery conditions
- American Academy of Orthopaedic Surgeons information about hand and wrist conditions
- Patient leaflets for hand conditions BSSH
- The BSSH provides leaflets concerning the common conditions please download or look online here
- The British Society for Surgery of the Hand
- The Society is the professional representative body for hand surgeons in the United Kingdom, based at the Royal College of Surgeons.
- American Society for Surgery of the Hand
- Please click above for an information leaflet concerning the common hand conditions from the ASSH
- The Electronic Textbook of Hand Surgery
- An on-line textbook of hand conditions
- Interviews on different topics at The Sports Injury Clinic
Thumb Base Replacement
Mr Sorene was the first Surgeon in the UK to undertake a new cutting-edge joint replacement for thumb base arthritis.
This trapezio-metacarpal total joint replacement enables a quicker and less painful recovery with excellent results.
Painless movement of the thumb at only 2 weeks after surgery can be viewed in the video.
Read our frequently asked questions section below for more information.
Frequently Asked Questions
When do I know if I need a prosthesis?
This decision is dependent on symptoms (persistent pain after non operative treatment) and X-rays which help show if a prosthesis is appropriate.
Why does a surgeon decide to put a prosthesis rather than performing a trapeziectomy?
The prosthesis allows for a better recovery in both pinch and grip strength. It corrects the distortion of the thumb by restoring length and correcting malalignment; furthermore, pain relief is more quickly obtained.
When could I resume my manual activities?
It depends on the type of activity. In the majority of cases, 3 weeks is enough to resume the basic manual activities, such as the use of a computer keyboard.
Will the prosthesis need to be changed in time?
In case of complication, a change of prosthesis or a trapeziectomy remains possible.
Will I have pain after the intervention?
This surgery is not considered as painful, as local anaesthetic is often used to minimise postoperative pain and you may take analgesics and/or anti-inflammatories as tolerated.
Are follow-up visits necessary?
Yes, for the long-term follow-up of the prosthesis.
May I travel after the intervention?
Yes, although it may be reasonable to take your x-rays showing the prosthesis with you (for example photos on your mobile).
Kienböck’s Disease
Acute hand and upper limb trauma, post-traumatic hand and wrist reconstruction, flexor tendon reconstructive surgery, scaphoid surgery, vascularised bone grafting, chronic wrist pain, carpal instability surgery, Kienbock’s disease and lunate replacement surgery, rheumatoid arthritis and osteoarthritis surgery, partial and total wrist replacement, arthroscopic wrist and elbow surgery, finger joint replacements, peripheral nerve surgery, Dupuytren Surgery, sports injuries, the musician’s hand, paediatric trauma and elective hand surgery.
Stage 1
X-rays may be normal or suggest a possible fracture. Magnetic resonance imaging (MRI) may also be helpful in making the diagnosis in this early stage.
Stage 2
The lunate bone begins to harden. Brighter or whiter areas on X-rays indicate that the bone is dying. MRI or computed tomography (CT) may be used to assess the bone. Wrist pain, swelling, and tenderness are common.
Stage 3
The dead bone begins to collapse and break into pieces. As the bone begins to break apart, the surrounding bones may begin to shift position. Increasing pain, weakness in gripping, and limited motion may be experienced.
Advanced Grade 3B Kienbock’s disease with lunate collapse
Stage 4
The surfaces of adjoining bones are affected. One result may be generalised arthritis of the wrist.
Although there is no absolute cure, there are several nonsurgical and surgical options for treating this disease. The treatment depends on at which stage the lunate has reached. The goals of treatment are to relieve the pressure on the lunate and to try to restore blood flow within the bone.
Early on the wrist may be splinted or casted for two to three weeks. Anti-inflammatory medications, such as aspirin or ibuprofen, will help relieve any pain and reduce swelling.
There are several surgical options for treating the more-advanced stages of Kienböck’s disease. The choice of procedure will depend on several factors, including disease progression, activity level, personal goals, and the surgeon’s experience with the procedures.
In some cases, it may be possible to return the blood supply to the bone (revascularization). This procedure takes portion of bone (graft) from the inner bone of the lower arm.
If the bones of the lower arm are uneven in length, a joint leveling procedure may be recommended. The radius bone may be shortened by removing a section of the bone. This leveling procedure reduces the forces that bear down on (compress) the lunate and seems to halt progression of the disease.
If the lunate is severely collapsed or fragmented into pieces, it can be removed with the two bones on either side of the lunate. This procedure, called a proximal row carpectomy (PRC), will relieve pain while maintaining partial wrist motion.
Another procedure that eases pressure on the bone is fusion. In this procedure, several of the small bones of the hand are fused together. If the disease has progressed to severe arthritis of the wrist, fusing the bones will reduce pain and help maintain function. The range of wrist motion, however, will be limited.
There is also the option in certain cases of undertaking a lunate replacement.
Mr Sorene has an interest in Kienbock’s disease and undertakes all of the most modern treatments for Kienbock’s disease including arthroscopic treatment, wrist denervation, limited wrist fusions, proximal row carpectomy and lunate replacement surgery.
Wrist arthroscopy – ‘Keyhole surgery’
Proximal Row Carpectomy (PRC)
Lunate Replacement
Possible Complications
Can things go wrong?
Each possible treatment has potential risks and possible complications that need to be considered along with the potential benefits of treatment.
Complications are fortunately quite rare in hand and wrist surgery. However they still can occur.
Complications of hand surgery include pain, stiffness, complex regional pain syndrome, infection, nerve injury, neuroma formation in scars, scar pain, tendon injury, vascular injury, worsening of symptoms, residual symptoms and joint instability, haematoma or worsening of original symptoms.
In operations where there is metalwork involved additional possible complications of surgery may include non-union, malunion and hardware problems.
The close post operative attention that you will receive from the nurses, hand therapist and Mr Sorene would hopefully identify and problems early so that they can be rectified. You are free to call Mr Sorene at any time through the main hospital telephone for genuine emergency problems. Calls of a non urgent nature should be made during office hours with one of the secretaries.
