Below is information regarding some common conditions treated.

Carpal Tunnel Syndrome (CTS)

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a condition that is caused by increased pressure on the median nerve at the wrist. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal Tunnel Syndrome occurs when pressure builds up from swelling in this tunnel that in turn puts pressure on the nerve. When this pressure is great enough to disturb the function of the nerve, symptoms of numbness, tingling and pain may be felt in the hand and fingers.

What causes Carpal Tunnel Syndrome?

Usually the cause is unknown. Pressure on the nerve can occur for a number of reasons: swelling of the lining of the flexor tendons (tenosynovitis), joint dislocations, fractures or arthritis can narrow the tunnel, as well as keeping the wrist bent forwards or backwards for long periods of time. Fluid retention during pregnancy can cause swelling in the tunnel and consequently CTS, however these symptoms usually go away after delivery. Other conditions such as thyroid dysfunction, rheumatoid arthritis and diabetes can also be associated with carpal tunnel syndrome. More often than not, there is a combination of causes.

What are the signs and symptoms of Carpal Tunnel Syndrome?

Symptoms are usually pain, numbness or tingling – or a combination of the three. These symptoms typically occur in the thumb, index, middle or ring fingers (or combination) and are noticed mostly at night, but may also be noticed during daily activities such as driving or reading a newspaper. Patients can sometimes notice a weaker grip, occasional clumsiness and a tendency to drop things. In severe cases there may be permanent numbness as well as a weakening and shrinking of the muscles of the thumb that affects thumb pinch.

de Quervain’s tenosynovitis

What is de Quervain's tenosynovitis?

First dorsal compartment tendonitis, more commonly known as de Quervain’s tenosynovitis is a condition brought on by irritation or inflammation of the wrist tendons at the base of the thumb. The inflammation causes the compartment (a tunnel or a sheath) around the tendon to swell and enlarge, making thumb and wrist movements painful. Making a fist, grasping or holding objects are common painful movements with de Quervain’s tenosynovitis.

What causes deQuervain's tenosynovitis?

Irritation of the tendons at the base of the thumb. This may be the result of a sudden activity or due to performing a repetitive activity over time. For example, excessive use of scissors / secateurs.

What are the signs and symptoms of deQuervain's tenosynovitis?

Pain over the thumb-side of the wrist is the main symptom. Pain may radiate down the thumb or up the forearm.

Dupuytren's Contracture

What is Dupuytren’s contracture?

Dupuytren’s contracture is a condition in which the connective tissue under the skin within your palm contracts. It often starts with a firm knot or nodule in the palm of the hand. This may stay the same for months or years, or it may progress to the next stage of one or more fibrous bands extending into the fingers. These bands result in pulling the fingers into a flexed (bent) position. These abnormal fibrous bands do not involve the tendons that bend the fingers, so therefore once the abnormal tissue is removed, the fingers may have the ability to move normally again. The degree of straightening does however depend on how long the finger has been held into flexion.

What causes Dupuytren’s contracture?

The cause of Dupuytren’s is not fully understood. It runs in families to some extent, and there has been found to be an association with diabetes, epilepsy (possibly due to the medication used), and liver disease (possibly associated with high alcohol intake). Some people hear of this association and worry that Dupuytren’s will be taken to be an indicator of high alcohol intake, but there is no truth to this. Dupytren’s is seven times more common in men than in women, and occurs primarily in people of northern European origin.

What are the signs and symptoms of Dupuytren’s contracture?

The first sign is a thickening or nodule in the palm of the hand that most frequently develops near the base of the ring or little finger. Gradually, other nodules may develop and may extend a contracture across the first joint into the finger. The overlying skin begins to pucker, and cords of tissue can extend into the finger. As the process continues, these cords tighten and pull the finger in towards the palm. The ring finger is usually affected first, followed by the little, ring and index fingers.

Osteoarthritis of the Base of Thumb

What is Osteoarthritis?

Osteoarthritis of the basal joint of the thumb (also known as the carpometacarpal or CMC joint) is one of the commonest forms of arthritis in the hand. It occurs when cartilage at the joint wears out, creating direct contact between the bones which is then experienced as pain.

What causes Osteoarthritis?

The basal thumb joint is a special joint consisting of a small wrist bone (trapezium) and the longer thumb bone (metacarpal). This joint provides excellent flexibility but this increased mobility is also considered to potentially play a role in the development of arthritis. This is due to the ligaments around the joint becoming more lax in later years and causing the joint to be less congruent. It is more common in women and usually starts after the age of 40.

What are the signs and symptoms of Osteoarthritis of the Base of Thumb?

The most common symptom is a deep, aching pain at the base of the thumb. The pain is aggravated with activities involving thumb pinch, opening jars, turning door knobs, keys and writing. Pain can also become constant and the loss of pinch and grip strength can occur. In more severe cases, the joint can move out of position and cause a “bump” at the base of the thumb, which may limit your ability to extend the thumb and causing the next joint up to hyperextend to compensate. X-rays help to confirm the diagnosis but very often, symptom severity is noted to not always correlate directly with the joint’s appearance on x-ray.

Mallet Deformity

What is Mallet Deformity?

A mallet finger is a common injury that can occur due to a cut from a sharp edge such as a knife, or as a result of a straight-on impact which causes a stretch or a tear of the tendon at the back of the finger. It can also occur as a result of a fracture at the base of the terminal bone.

What causes Mallet Deformity?

Mallet finger usually occurs while playing a sport that involves a ball - for example, reaching out to catch a hard pass in basketball. Instead of landing on the palm of the hand, the ball accidentally hits the tip of an extended (or partially extended) finger. It can also occur from performing normal everyday activities, such as putting linen away in the cupboard or knocking the extended finger on shelving.

What are the signs and symptoms of a mallet deformity?

The most obvious sign of a mallet deformity is the drooping of the tip of the finger, with an inability to straighten the finger by itself. Symptoms of mallet finger can include pain and swelling around the top part of the finger, near the outermost joint. These symptoms can occur right after the injury. Redness and swelling develop soon afterward.

Tennis Elbow

What is Tennis Elbow?

Tennis elbow or lateral epicondylitis, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons attach the muscles to the bone. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Tennis Elbow occurs gradually as small repeated injuries cause micro-trauma to where the muscle attaches to the bone. An acute injury, strain or direct trauma can accelerate the process.

What causes tennis elbow?

Tennis elbow is a repetitive overuse condition of the proximal forearm muscles. Repetitive overuse injuries occur from prolonged loads on muscles and tendons. Although known as tennis elbow, the injury can occur in a variety of sports and occupations. Excessive use of a hammer is just one example of an activity which can lead to tennis elbow. Tennis elbow can also emerge from tasks such as working on a computer keyboard for extended periods with incorrect posture.

What are the signs and symptoms of Tennis Elbow?

The symptoms of tennis elbow develop gradually. Typical complaints of tennis elbow include pain on straightening the elbow and with gripping activities and lifting heavy objects. Pain often occurs with simple tasks such as lifting a litre of milk out of the refrigerator or bringing a cup of coffee to ones mouth. Symptoms tend to worsen while using the arm and then lessen with rest. There is usually tenderness around the outside of the elbow when touched.

Keloid/Hypertrophic scars

What is a keloid scar or hypertrophic scar?

Keloids are the result of an overgrowth of scar tissue that usually develops after healing of a skin injury. The tissue extends beyond the borders of the original wound, does not usually resolve spontaneously, and tends to recur after its surgical removal.

In contrast, hypertrophic scars are characterized by raised lesions that typically do not expand beyond the boundaries of the initial injury and may partially settle. Hypertrophic scars are common after thermal injuries and other injuries that involve the deep dermis.

What causes a keloid or hypertrophic scar?

The exact cause of keloid and hypertrophic scars continue to be unknown as no specific gene has been identified. Trauma to the skin, both physical (eg, earlobe piercing, surgery) and pathological (eg, acne, chickenpox), is the primary cause identified for the development of keloids. The presence of foreign material, infection, hematoma, or increased skin tension can also lead to keloid or hypertrophic scar formation in susceptible individuals.

What are the signs and symptoms of a keloid or hypertrophic scar?

The cosmetic appearance of the scar is the main reason why people seek medical attention, rather than the symptoms which may include scar tenderness or itchiness. The appearance of a keloid scar is often a red, raised, thick scar which has grown beyond the original boundary of wound.

A hypertrophic scar is a widened scar that does not extend beyond the original boundaries of the wound.