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Conditions of the hand



Dupuytren's Contracture

The Dupuytren's Contracture, named after Guillaume Dupuytren, is one of the most common conditions of the hand. Growth appears in the connective tissue of the skin. This first shows in the formation of a knot of skin and later in a bent position of the fingers. The bending of the fingers increases with the progression of the disease, so that the function of the hand is reduced. Particularly the ring finger and the little finger are affected by this disease. The cause remains unclear however there is a genetic predisposition. Men suffer from this disease more often than women. In rare cases the same symptoms apply to the sole of the foot. An operation should be performed if the function of the hand is limited. During this operation the cords of the connective tissue are removed. The skin cannot always be closed again primarily so that minor skin flaps or skin grafts might be necessary.

Important information: Dupuytren's Contracture

Stay at the clinic: out-patient or in-patient 1-5 days, depending on the severity of the condition

Duration of operation: 1-3 hours, depending on the severity

Type of anaesthesia: anaesthesia of the arm, or general anaesthetic

Follow up treatment: splint for 5 days, followed by therapeutic exercise

Risks: haematoma, injury to vessels and nerves, recurrence of the condition

Final result: Depending on the severity of the condition, the hand can normally be used for daily jobs after 10-14 days. The healing process might take longer with greater severity of the condition. Thumb basal joint arthritis - Rheumathoid arthritis

Wear and tear of the thumb basal joint can often be found in elderly female patients. In this case the limitation of movement that has taken place is not as important as the pain that severely limits the use of the hand. The reason for this degenerative arthrosis of the important joint has not been clarified exactly, nevertheless this joint wear and tear occurs more often in patients who have had an accident in this region or a loose joint apparatus. An operation should be performed, if a medication therapy with painkillers does not lead to improvement. Usually, the whole joint is removed in this operation and the thumb is kept in position with a part of the tendons.

Important information: Thumb basal joint arthritis - Rheumathoid arthritis

Stay at the clinic: 1-5 days, depending on the severity

Duration of operation: 1 hour

Type of anaesthesia: anaesthesia of the arm, or general anaesthetic

Follow up treatment: Immobilisation in a splint for 5 weeks, followed by therapeutic exercise

Risks: haematoma, swelling, scarring, loss of gripping strength

Final result: After approximately 3 months Ganglion

Ganglion is a benign cyst of a joint or tendon where joint or tendon fluids gather. This leads to a "bump" which is usually located above the wrist or on the bending side of the wrist. This should be operated on because up to now there is no other effective conventional form of therapy. Generally this can be done under local anaesthetic and only needs to be performed under general anaesthetic or anaesthetic of the arm when a larger or repeatedly occurring ganglion is operated on. Unfortunately, such a Ganglion can reoccur even after thorough operation.

Important information: Ganglion

Stay at the clinic: Usually the operation can be done at out-patients. When a repeatedly occurring ganglion is operated on, however, an in-patient stay of 1 - 2 days should follow

Duration of operation: 30 minutes - 1 hour, depending on the severity of the condition

Type of anaesthesia: generally local anaesthetic is sufficient. When a repeatedly occurring ganglion is operated on, however, anaesthesia of the arm or general anaesthetic may be necessary.

Follow up treatment: Immobilisation in a splint for 14 days to allow complete healing. It will be necessary to increase weight bearing carefully on a day-to-day basis.

Risks: haematoma, swelling, recurrence of the ganglion

Final result: After approximately 4 - 6 weeks Compression of the median nerve - Carpal Tunnel Syndrome

The median nerve, which supplies the thumb side of the hand, runs through a narrow channel (carpal tunnel) in the region of the wrist. This nerve can be constricted by pressure resulting from the swelling of the surrounding tissue. Typical symptoms for this constriction are temporary paralysis of the thumb, first and middle finger, and pain which occurs especially at night time and is strong enough to wake one up but can be reduced by shaking the hand. Elderly people mainly suffer from carpal tunnel syndrome. Women are affected more often through the hormonal changes during pregnancy or the menopause. Diabetes can also increase the risk of developing carpal tunnel syndrome. If the above mentioned symptoms have already occurred, a neurologist makes a special examination to determine the functioning of the nerve. An operation needs to take place if the pain is persistent. In this operation the narrow channel is opened and the nerve is given enough space again to function properly. This can be done under local anaesthetic and only in difficult cases has to be done under general anaesthetic or anaesthetic of the arm. After the operation a splint is put on for 10 days to achieve optimum wound healing.

Important information: Carpal Tunnel Syndrome

Stay at the clinic: out-patient, when accompanied by severe effects or repeated operations in the same region, 1 - 2 days in-patient

Duration of operation: 15 - 30 minutes

Type of anaesthesia: local anaesthetic, arm anaesthetic or general anaesthetic

Follow up treatment: Immobilisation in a splint for 10 days

Risks: haematoma, swelling, pain. When condition is long-standing the symptoms will not disappear immediately.

Final result: The hand can be used as normal again after about 4 weeks. Compression of the ulnar nerve - Sulcus Ulnaris Syndrome

The ulnar nerve runs on the inside of the elbow, at the so called "funny bone". In this place a narrowing of the nerve can take place as a result of a growth or other condition. A numb feeling, mainly of the little finger and the side of the hand, is a symptom; the back of the hand can also be affected. In advanced stages the muscles of the hand have shrunk and the hand is weak in general. An operation is performed to expose the nerve under a microscope and if necessary it is placed on the bending side so that it is not stretched with every movement of the elbow. Afterwards the arm is rested in a splint for 10 days to ensure good wound healing.

Important information: Sulcus Ulnaris Syndrome

Stay at the clinic: out-patient, when accompanied by severe effects or repeated operations in the same region, 1 - 2 days in-patient

Duration of operation: 30 minutes

Type of anaesthesia: local anaesthetic, arm anaesthetic or general anaesthetic

Follow up treatment: Immobilisation in a splint for 10 days

Risks: haematoma, swelling, pain. When condition is long-standing the symptoms will not disappear immediately.

Final result: The hand can be used as normal again after about 4 weeks