Wrist & Hand
Triangular Fibrocartilage Complex (TFCC) Injuries Wrist
TFCC injuries can occur with a sudden injury as in a wrist sprain or may come on more gradually as part of an overuse type injury. Patients usually present with pain ulna sided wrist pain (little finger side of the wrist rather than the thumb side). Sports like tennis, polo and gymnastics can cause TFCC injuries.
The TFCC helps to stabilise the wrist at the radio-ulna joint.
Management may involve splinting of the wrist in the short term. Steroid injections administered by experienced practitioners can be very therapeutic. A small number do not settle with this conservative approach and ultimately require keyhole surgery.
De Quervains tenosynovitis
This condition causes a painful inflammation of the tendons of the wrist near the base of the thumb (abductor pollicis longus and extensor pollicis brevis tendons). It can occur spontaneously or perhaps related to overuse of the wrist eg repeated lifting of a baby. Pain is generally worse when gripping or making a fist. Usually this is a clinical diagnosis and x-rays and scans are rarely needed. In resistant cases a diagnostic ultrasound scan would be the investigation of choice. Management includes avoiding the precipitating activity where possible. Physiotherapy can also be useful including the use o a wrist splint. Anti-inflammatory tablets can also be quite helpful. In resistant cases an injection of steroid into the 1st extensor compartment is usually indicated. Dr Davies is very experienced at performing such injections.
Trigger finger occurs when thickening or nodule formation prevents a flexor tendon from gliding within its sheath, catching at the site of the first annular pulley. Patients with this condition may present with palmer pain and difficulty with finger flexion and extension, with a locking, popping sensation as the tendon slides through the tight area. Trigger finger occurs more commonly in persons with repetitive use injuries, diabetes, rheumatoid arthritis, carpal tunnel syndrome, Dupuytrens disease, underactive thyroid gland and heart failure. Diagnosis is made through history and examination. Treatment options include relative rest, pain medications, splinting, steroid injection, and operative therapy.
Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb, index and middle fingers. The carpal tunnel is a narrow, rigid passageway which contains the median nerve and a variety of tendons. If the median nerve becomes squashed in this tunnel at the wrist a patient may complain of the typical burning / tingling sensation of the affected digits.
This is usually a clinical diagnosis made by performing special tests (eg Tinel’s and Phalen’s tests), however, nerve conduction studies can confirm the diagnosis in more difficult cases and prior to surgical intervention.
Steroid injections can sometimes alleviate these symptoms. However, definitive treatment is a surgical decompression of the carpal tunnel often performed under local anaesthetic.