Prologue

The hand is unique, an organ both of sensation and motor function. We only become aware of the necessity of adequate hand function when faced with loss of function through trauma or disease and yet, almost everyone experiences this during their lifetime.

Hand surgery has only developed as a speciality over the last 50 years and now commands several leading journals, learned societies and specialist training devoted to disorders of the hand alone. The field continues to progress, demanding specialist techniques such as microsurgery, fixation of complex fractures of small bones and endoscopic techniques. The close liaison between hand surgeons and dedicated hand therapists ensures the smooth progress through recovery following surgery.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is caused by the median nerve being squashed at the level of the wrist. Pressure on the median nerve changes the way it works and is perceived as numbness, tingling and pain, which can affect the hand or the forearm. The thumb, index, middle or ring fingers can be affected and often the problem is most noticeable at night or during activities such as driving. Some patients experience problems with...Learn more....

De Quervain's tensynovitis is inflammation of the lining of the tendons which straighten the thumb at the level of the wrist. As the tendons pass through a tight canal, a vicious cycle of further inflammation and swelling is set up. This manifests as pain along the side of the wrist radiating toward the thumb and is worse when gripping or turning objects...Learn more....

Dupuytren's disease is an abnormal thickening of the tissue just beneath the skin on the palmar surface of the hand. It can start off as nodules or little pits but go on to involve the fingers, causing them to curl in and the patient is unable to straighten them completely. The problem can be progressive. Both hands may be affected and sometimes there is thickening of the skin over the knuckles on the back of the hand. The cause of Dupuytren's disease is not known, but...Learn more....

Ganglia are fluid filled sacs. They are commonly found on the back of the wrist but can occur on the palmar side. They can also be found at the end joint or at the base of the finger. They are associated with joints or tendon sheaths and the majority appear to arise spontaneously. They often fluctuate in size and sometimes grow rapidly, but are not cancerous. Ganglia can sometimes present with pain or tenderness...Learn more....

The three nerves of importance in the wrist are the median, ulnar and radial. These give rise to numerous branches in the hand and the ulnar and median nerves supply sensation to the skin on the palmar side of the hand as well as the small muscles, which permit fine movements. Each digit is supplied by two branches, the thumb, index, middle and part of the ring finger are usually innervated by branches of the median nerve...Learn more....

The most common joint affected in patients with rheumatoid arthritis is the wrist. The inflammatory process involves the tendons, joints and ligaments. The tendons usually glide within smooth sheaths lined by synovium and this material also provides the lubrication in joints.The problem in rheumatoid arthritis is that the synovium proliferates and becomes invasive, eroding the smooth joint surfaces, destroying the ligaments and may lead to...Learn more....

Any inflammatory or destructive condition of a joint is called arthritis. In a normal joint, the bone ends are covered with cartilage to provide smooth gliding surfaces. With wear and tear or degenerative (osteo) arthritis, the cartilage is worn away and the exposed bones rub together, leading to pain. Women tend to be affected more commonly than men, particularly in middle life. Previous injuries may predispose to...Learn more.....

Triggering occurs when the tendon develops a nodule or swelling of its lining. In the fingers and thumb the flexor tendons pass through a narrow lubricated canal. As the swollen segment of tendon squeezes through the narrow opening of the canal, there is sudden clicking of the digit. The repeated minor trauma associated with this leads to further inflammation and swelling. Sometimes the finger becomes stuck and...Learn more....