Mr Sunil Auplish is a Consultant hand, elbow and shoulder surgeon at Clifton Park Hospital, and has many years of experience in treating hand problems. We have asked him to talk about the most common problems that people have with their hands, and what treatments are available to help them.
I have tingling in my thumb, index, middle or ring fingers
You may well have Carpal Tunnel Syndrome, which is a very common condition. It occurs when the main nerve in the hand is pressed by the roof of the tunnel that it runs through as it passes through the wrist. Most of the time this comes on by itself, but it can sometimes occur due to diabetes, thyroid problems or you have broken your wrist. It is often common in the later stages of pregnancy, but usually goes away after giving birth.
You may experience the tingling sensation more at nighttime due to the wrist being pulled into positions that squash the nerve further whilst you sleep. Wearing a splint may be recommended to help with this. If the problem persists, a steroid injection into the wrist often settles it down. In cases where an injection is not effective, or if your fingers start to go numb, I would normally recommend a small operation to take the pressure off the nerve (a ‘carpal tunnel decompression’).
The operation takes about ten minutes under local anaesthetic and is usually very successful. You will be able to use the hand from the day of surgery, albeit gently, to wash and dress yourself. I now use dissolving stitches that fall out after about ten days.
I have tingling in my little and ring fingers
This is usually from pressure on a different nerve: the Ulnar nerve on the inside of your elbow (your ‘funny-bone’). The problem usually begins on its own, without an injury, and often gets worse over time. This is one of the few conditions where a steroid injection is unlikely to help. Sometimes doing heavy activities can make the problem worse and changing how you do things can settle it down. If the tingling is very troubling, or if the fingers start to go numb or weak, then an operation to take the pressure off the nerve is usually very successful. Until recently, this procedure was conducted with the patient asleep under a general anaesthetic. However, advances in anaesthetic practices now enable us to give the option of a local anaesthetic if the patient finds this preferable. The operation is performed on the inside of the elbow, and requires no plaster cast so you are able to move the elbow gently from the day of surgery.
My fingers/wrist are stiff and painful
You may well have arthritis. If you have noticed extra bony lumps at the knuckles in your fingers, then this is very likely.
Painkillers bought over the counter from the pharmacy can often settle things down. If this does not provide relief, then your hand surgeon can inject the joints with a small dose of steroid, which may allay the pain enough to avoid surgery. You may also be able to adjust how you use your hand and wrist, in order to stop it hurting so much. We can provide advice on this during your consultation. When painkillers or steroid injections are not effective, then surgery may be an option: either a joint replacement or joining the bones together (a ‘joint fusion’). The hand and wrist area is a very complex structure containing many different joints and each one has a specific operation for that particular joint.
The bottom of my thumb is painful and my grip is weak
Arthritis in the joint where your thumb joins the wrist is a common complaint we see in many patients. This is pain felt at the fatty pad of the hand which gets worse when you try to use your thumb. For example: trying to open a jar usually makes the pain considerably worse.
I can administer a steroid injection that can alleviate the pain and often helps for several months at a time. A splint that supports the thumb can also assist in taking the strain and help with the pain when using your hands.
If steroid injections and splints do not help, then I would do a straightforward operation called a trapeziumectomy that solves the problem. This operation removes the arthritic bone so there are no worn, bony surfaces of the joint to rub together any more, which is what causes the pain.
If you have arthritis but do heavy or manual work, or are an artist or musician who needs more thumb strength, then the operation still works well for pain relief, but there are many other options to choose from that may be better for you and that we can discuss.
I have a lump/bump on my hand
The hand is a very common place to get a lump. Almost all of them are benign and completely harmless. Ganglions are some of the commonest lumps around the hand and wrist - especially on the back of the wrist but also on the front of the wrist and in the fingers. They are jelly-filled lumps that are aspirated (sucked out) with a needle and syringe. In the event they return, I can perform an operation to remove them, usually under local anaesthetic. You will be able to use your hand gently as you wish after the operation. Sometimes the diagnosis is not so clear, and an ultrasound scan will be used to check exactly what the lump is before it is removed.
I can make a fist, but my finger is stuck when I try to straighten it out - which usually happens with a click
This is a ‘trigger finger’ - a very common problem where your tendon develops a harmless swelling (‘nodule’) and then gets stuck as it tries to glide. A steroid injection settles this down in most people, but a ten minute operation under local anaesthetic will solve the problem if it comes back after trying the injection.
My fingers pull into my palm by a cord that has formed in the palm of my hand
This is Dupuytren’s disease. It tends to run in families although this is not always the case.
The disease itself is harmless, but becomes a nuisance if you cannot straighten your finger fully. This often means that the finger will be stuck when trying to put your hand in your pocket or putting gloves on, and your finger can often poke you in your face when trying to wash it! It most commonly affects the ring and little finger, but may be affect any finger, including the thumb.
If the disease is very mild then no intervention may be required, but in cases where you cannot place your hand fully flat on a tabletop then surgery is likely to help. The diseased cord is removed under local anaesthetic, which usually straightens the finger out. If the contracture is very bad then it can be difficult to get the finger fully straight. More complex procedures are available to return the finger to its normal position and function.
What we sometimes forget to tell you
• Steroid injections often do not start to work for a couple of weeks, and it is often 6 weeks before you really notice the difference.
• The hand is a very sensitive part of the body, so even after a successful operation the scar itself can be tight and sensitive for a few weeks or even months before it settles back to normal.
• Much of the success of hand surgery depends on doing lots of specialised physiotherapy after the operation to keep joints moving and the swelling down.
• Some operations can make it difficult to use the hand afterwards. It is worth talking to your surgeon about how you can wash, dress, drive and work after you have your procedure.
Tel. 01904 211663