22 New Year New You • Health, Fitness & Nutrition When should you see a hand surgeon?


Saturday 6th January 2018


Hand surgeons are very specialised doctors that can help manage problems such as trauma, day-to-day pain/loss of function or occasional birth abnormalities with the hand and the wrist


Sporting injuries to the hand Our hands are the interface between our bodies and our sporting equipment. Even if your sport doesn’t involve a racket or a ball, hands or wrists can be injured in pursuits such as skiing, snowboarding, netball, basketball, boxing and even yoga.


Fractures Serious wrist fractures and ligament injuries such as dislocations of the small bones in the wrist can occur due to a heavy fall at speed or even a slow fall at an awkward angle. It’s important not


to ignore wrist swelling and


pain, and to have an early x-ray to exclude a fracture and prevent deterioration of a treat- able condition. Remember always to


bring


x-rays taken abroad home with you so you can continue your care locally.


Thumb injuries Sprains of the ulnar collateral


ligament of the


thumb are very common — easily done by a fall with a ski pole in your hand or during a hand-off in rugby. It’s essential to use ski poles correctly and have these injuries treated. A partial sprain of the thumb will recover well after a period of immobilisation (sadly this is usually six weeks in a plaster or brace) but a complete or incorrectly healed sprain of the thumb can lead to lifelong weakness and instability with a risk of arthritis.


Finger injuries The majority of finger and hand injuries don’t need surgery. But the fingers tend to swell very quickly. If you injure your hand remove any rings and make sure that you ice and elevate the hand. If there’s a lot of swelling, pain and a loss of movement then you’ll need an x-ray.


Wrist sprains It’s very common to miss simple wrist sprains when doing sports, particularly if the wrist is cold and there’s only a small amount of swelling at the time of the injury. These injuries will usually not require a surgical procedure; however, small tears to the intricate structures around the wrist joint can result in weakness and difficulty doing repetitive tasks such as using a computer or basic jobs around the home and garden. It’s important that such injuries have appropriate imaging such as an MRI scan and x-ray followed by review and a therapy programme.


Injury prevention The key to prevent hand or wrist injury is to have the correct technique and use appropriate protective gear when possible: • Use the correct type of taping when boxing • Pre-strap the hands when playing rugby • Have excellent technique when practising pilates or yoga


• Use wrist guards or learn to fall in the right way when you snowboard


• Use ski poles correctly — or not at all if you’re a novice


• Wear gloves when ice skating for extra protec- tion and teach your children to close their hands and fingers when they fall to prevent the blade of an ice skate going through the fingertip


What to do if you have had a hand injury? It’s important to immobilise the injured area, e.g. wrist, finger or hand, with a splint or a brace and elevation is essential, especially if you are due to fly. Ice and anti-inflammatory medication are also important. Prolonged immobilisation can lead to permanent stiffness so if in doubt seek attention from an appropriate local service or where possible a specialist hand doctor.


Common hand conditions and how to manage them Arthritis: There is a 70% chance that you will develop arthritis — pain in the joint at the bottom of your thumb — by your 70th birthday. You feel it at the base of your thumb where the fleshy part (of the thumb) joins the wrist. Pain comes when opening a jar, doing up buttons or tying your shoelaces. And activities such as lifting a heavy saucepan or gardening will often exacerbate the pain. Treatment of arthritis of the thumb should


be carried out in conjunction with a specialist therapist who treats hands, as well as with a hand surgeon. It’ll start with modification of activities, splints and analgesia, moving onto joint injections if required. If there’s still pain, surgery is the next option and can be discussed with your specialist surgeon.


Inflammation of tendons at the bottom of the thumb (De Quervain’s disease): This is very common and especially afflicts new mothers. Pain is felt at the bottom of the thumb and along the side of the wrist by the thumb. It’s particu- larly bad when the thumb is placed into the palm or when the wrist moves towards the little finger. This can be very successfully treated in most cases with a splint. An injection of steroids will decrease the inflammation in 65% of people. If non-surgical treatment doesn’t succeed, then a small operation under local anaesthetic can release the tendon from its tight sheath, providing instant relief.


Trigger thumb and fingers: This condition involves the thumb or fingers locking down in a flexed position. This is because the tendon which straightens the thumb becomes stuck in a small tunnel. A steroid injection can often relieve symptoms (60% of the time) but is less successful in diabetics. If this isn’t successful a small procedure under local anaesthetic has an extremely high success rate. Young babies and children can have a ‘congen-


ital’ trigger thumb and parents may notice their child’s thumb does not extend fully. This fairly common and is caused by a tight pulley that prevents the thumb’s flexor tendon straight- ening fully. A watch and wait policy can some- times work but if not a straightforward and very successful


surgical procedure under general anaesthetic is carried out to release the thumb.


Dupuytrens disease: This is a condition where lumps are felt in the palm, and the fingers start bending and get tight. It can be precipitated by trauma. Early referral


of the condition is recommended so that fixed contracture


can be prevented. Surgery isn’t


recommended for very early disease (nodules and pits with no deformity) as this can exacer- bate the disease. Three main treatment options are available — surgery, needle fasciotomy and collagenase injection — and your surgeon can direct you to the most appropriate.


Painful tingling fingers The fingers can tingle and be sore because of compression of the nerves in the hand, elbow and the neck. Carpal Tunnel Syndrome — compres- sion of the median nerve at the wrist — is the most common of these conditions. It’s often very problematic in pregnant women and can disrupt sleep. If it’s treated early on, it will respond well to a splint and sometimes steroid injection. If you have tingling fingers, it’s important to make sure that it’s not just from the carpal tunnel as nerves can be trapped in the neck. A hand doctor can help differentiate these issues.


Hand and Orthopaedic Surgeon, Maxim D Horwitz


There is a 70% chance that you will develop arthritis — pain in the joint at the bottom of your thumb — by your 70th birthday


Mr Maxim D Horwitz MBChB FRCS (Orth) DipHandSurg Consultant Hand and Orthopaedic Surgeon NHS: Chelsea and Westminster hospital Private: Clinics in central London thehanddoctor.co.uk/contact T: 0208 150 8290 E: info@thehanddoctor.co.uk


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