Nonsurgical

The majority of patients referred to a hand surgeon will not require hand surgery. Specialised physiotherapy or and therapy can often be a great help and help to settle down many conditions. Splintage may be required. Steroids can often be helpful either as definitive or adjunctive treatment. Sometimes a combination of local anaesthetic and steroid is used as a diagnostic aid and may well treat the condition as an added bonus.

Trigger finger release

This is only indicated if steroid injection has failed to cure the condition. It is performed under local anaesthetic as a simple daycase procedure. Below a video of LSO surgeon Mr Mark Phillips performing the surgery.

Carpal tunnel release

This is a very effective surgical treatment with the vast majority of patients being pleased with the outcome. This operation is carried out for patients with numbness or pain in the hand with a diagnosis has usually been proven by clinical examination and nerve conduction studies. A steroid injection may be used to reinforce the confidence of the diagnosis as well as a temporary treatment. Steroid injection for this condition is not normally curative.

Dupuytren’s Contracture

When the condition is bad enough to warrant intervention, an injection of an enzyme to dissolve the cord followed by rupture of the cord at 24 to 48 hours later should be considered first. Another option would be to consider cutting the cord with a needle under local anaesthetic. For more difficult contractures open surgery is indicated and often provide a better long­ term result than the more conservative options listed above. Below Mr Mark Phillips is performing the operation on video.

Ganglion surgery

Ganglions can be excised as a relatively simple operation as a day case. This can be done under local or general anaesthetic. A fairly prompt recovery can be expected but recurrence rates are fairly high at 20 to 30%.  Here is a video of LSO surgeon Mr Phillips performing an operation to remove a ganglion.

Wrist arthroscopy

This is occasionally indicated as an investigation for patients with wrist pain. It is used as an investigation when clinical examination and x­rays and MRI scans have not established the diagnosis. It can be used as a treatment for TF CC tears and ganglions. It is sometimes required before proceeding to more major surgery to establish which operation would be more appropriate.

Trapezectomy

Excision of the bone at the base of the thumb is currently the best treatment for families arthritis. This has been the case for many decades. Joint replacement surgery does not appear to be superior at the moment. The results from this operation are generally very good with about 90% of patients feeling pleased they had it done. Some patients suffer with persistent pain after surgery. It takes about 3 months before the benefit is felt.

More details of what to expect after surgery performed by Mr Mark Phillips can be obtained from his own information sheets provided here.

DeQuervains Tendinitis

If injections fail to control symptoms for this condition, surgery is sometimes indicated. Only about 10% of patients require this. It is usually performed under local anaesthetic. Here is a video of Mr Philips performing this operation.

CONSENT

These Videos of my work to be used for teaching and for patient information only

Patient consent for these purposes has been obtained and all are anonymised.

Mark Phillips

Hand & Wrist Surgeon