Conditions & Treatments
Mark has a wealth of experience in correctly diagnosing and treating various conditions of the hand and wrist. A selection of patients common hand and wrist complaints are listed below.
If you suspect that you are suffering from a medical condition, why not try our symptom related search to see a few suggestions of possible diagnosis.
Common Hand and Wrist Complaints
CARPAL TUNNEL SYNDROME (CTS)
Patients present to me every week with altered sensation in their hands, pain or both. This condition is by far the commonest cause. This condition has common associations with trigger finger and diabetes because it is caused by swelling of the tendons to the fingers that share the carpal tunnel with the Median Nerve. Tingling and pain often come on at night and shaking the hands relieves the symptoms. People with busy hands are often susceptible. Steroid injections, splints, hand therapy and postural adjustments are all worth trying. Surgery is a very effective treatment. The operation is usually performed under local anaesthetic and takes about 15 minutes in the operating theatre. General post operative advice is then followed.
The majority of patients have symptom relief within 2 weeks. Grip strength can be weakened for a couple of months. Return to work varies from 26 weeks depending on whether the work is heavy or not.
To view a typical Carpal Tunnel Decompression, please Cick Here
TRIGGER FINGER
This is a very common condition, especially in patients with diabetes (which is also common). It begins with mild discomfort in the palm, and results in locking of the finger in flexion. It then often ‘flips’ out straight. Some patients can’t bend the finger, partly due to fear of it getting stuck. The good news is that I see this condition in a new patient almost every week and the vast majority are cured by a single steroid injection which I can do in the clinic and takes only a few moments.
About one in ten eventually decide they would like an operation if the condition recurs after one or two injections. Most patients never need to come back for more treatment. The surgery is performed as a day case under local anaesthetic and takes about 15 minutes in the operating theatre. A small (1cm) transverse incision in the palm, and the tendon pulley is released. A small dressing and palm bandage is applied. General post operative advice is then followed.
To view a Trigger Finger Release Procedure, please Cick Here
DUPUYTREN'S CONTRACTURE
This condition is characterised by a thick ‘cord’ slowly forming in the palm and pulling the fingers down very slowly over several years. It is partly genetic, being more common in northern Europeans. Repeated minor trauma or surgery may also precipitate it. There is no urgency to treat and it is rarely painful. Nuisance symptoms such as difficulty getting gloves on, washing, shaking hands or playing musical instruments are the usual reasons for presentation.
Xiapex is no longer available, so in simple cases we are using Needle fasciotomy (NF). This is done under local anaesthetic in the operating theatre. It is a short procedure and involves inserting a needle under the cord to snap it. It doesn’t remove the cord or the nodules associated with it, but usually improves range easily. Recurrence rates are higher than open surgery, and nerve and tendon injury is a risk (as it is with open surgery).
But recovery is simpler and quicker. Mr Phillips usually refers patients to a Hand Therapist after the procedure for a splint. This will need to be worn until the finger is happily staying as straight as possible. The tendency for it to pull back is variable. While the splint is on you cannot drive. The splint is moulded to fit but can be easily removed and should be removed frequently for skin care and exercise. If there is a skin tear, dressings may be required for a week or so.
Surgery is now reserved for more severe cases. Surgery is however more effective than injections in the long term. I like all my patients to see a Hand Therapist after any intervention, with a view to optimising the outcome. Splints are often required, particularly at night, to prevent early recurrence. Wound care can only begin at 2 weeks when the first postoperative
dressing comes off.
To view a Typical Dupuytrens Contracture Treatment Procedure, please Cick Here
FRACTURES
I see many patients with Hand & Wrist fractures, which suits me, as this is my area of subspecialist interest. Over decades in busy NHS fracture clinics, I have developed a mature sense of which fractures are better managed with surgery and which will be better off without. I was also the primary advisor to the National Institute for Clinical Excellence on the use of Ultrasound to stimulate fracture healing.
Many private surgeons would rather do elective work only as the demands of trauma are difficult to meet in the private sector. In London Sports Orthopaedics however, we are keen traumatologists and have enormous cumulative experience, with many of us working in busy major trauma centres. I am the trauma lead for the group and we have tremendous support from our administrative staff and from London Bridge and our other hospitals to make urgent surgery possible in the private sector.
TRAPEZECTOMY
Removal of the trapezium bone is a well tried and tested procedure for thumb base arthritis. Joint replacements have been tried, but I (and many other members of the British Society for Surgery of the Hand) remain unconvinced that they are any better than this operation which Hand Surgeons have been doing since the 1950s with good results. It is usually done under General Anaesthetic as a day case. The hand is in a bandage until about two weeks.
Steroid injections are a good way of lessening symptoms for a few months. This allows surgery to be postponed until a more convenient time.
Splints can be helpful, and some are available commercially, or a Hand Therapist can make a bespoke one for you.
After surgery patients need the help of a Hand Therapist for a couple of months as range and power is regained. The hand should look normal and work normally afterwards, with good pinch strength and minimal or no pain.
DEQUERVAINS TENDINITIS
I see a large number of patients with various forms of tendonitis in the hand and wrist. In the city, patients come from having busy jobs at a keyboard, or from going to the gym, or commonly both! An MRI scan may help to localise the inflammation. New 3T high resolution scanners have revolutionised diagnosis of tendonitis in the last couple of years.
I tend to inject patients in the clinic as most tendons in the hand and wrist can be injected easily as they can be palpated under the skin. Excellent results are usual and surgery is rarely required. Hand therapy may be needed.
To read more on the steroid injections typically used in this procedure, please see the relevant section above.
