Hand

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the most common nerve compression syndrome. In it, the median nerve is compressed within the carpal tunnel — a narrow passage on the palm side of the wrist, bounded by the carpal bones and a firm ligament. Through this tunnel run, alongside the nerve, the flexor tendons of the fingers. If the space becomes narrowed — for example by swelling of the tendon sheaths — pressure is placed on the nerve.

Diagnosis

Typical features are tingling, numbness and pain in the thumb, index finger, middle finger and the adjacent half of the ring finger — often particularly at night. As the condition progresses, weakness of the ball of the thumb and a loss of strength when gripping can occur. In addition to the clinical examination, a measurement of nerve conduction velocity confirms the diagnosis and assesses its severity.

Treatment

In mild cases, conservative measures — such as a night splint that holds the wrist in a neutral position, or local infiltrations — can relieve the symptoms.

If the symptoms are pronounced or persistent, or if there are already signs of muscle weakness, a surgical procedure is advisable, in which the ligament over the carpal tunnel is divided and the nerve is thereby relieved. This is a routine, minor procedure. The exact approach is discussed individually.

Trigger Finger (Stenosing Tenosynovitis)

What is a trigger finger?

In a trigger finger, the gliding of a flexor tendon through its tendon sheath is impeded. A thickening of the tendon or a narrowing of the sheath means the tendon can no longer glide smoothly. As a result, the affected finger catches when bent and then springs forward suddenly — sometimes it can only be straightened again with the help of the other hand.

How is the diagnosis made?

The diagnosis is made clinically. The characteristic catching and snapping of the finger, often combined with pain and tenderness over the affected tendon sheath on the palm side, is typically clear. Imaging is usually not necessary.

What we recommend

In the early stages, conservative measures — such as relieving strain, a splint or a local infiltration — can improve the symptoms. If the catching is pronounced or persistent, a small surgical procedure provides reliable relief: the constricting part of the tendon sheath is divided, allowing the tendon to glide freely again. We will be glad to advise you individually at the practice.

De Quervain's Tenosynovitis

What is De Quervain's tenosynovitis?

De Quervain's tenosynovitis is a painful irritation of the tendon sheath of two tendons that run on the thumb side of the wrist and move the thumb. The cause is usually overuse through repetitive movements of the thumb and the wrist. As a result, the tendon sheath thickens, and the tendons can no longer glide smoothly.

How is the diagnosis made?

The diagnosis is made clinically. Typical features are pain on the thumb side of the wrist, which increases with movement of the thumb and on pressure. A specific test, in which the thumb is enclosed in the fist and the wrist is tilted, characteristically triggers the pain.

Treatment

In the foreground is conservative therapy — with relief of strain, a thumb splint, pain-relieving and anti-inflammatory measures and, where appropriate, a local infiltration. Only if the symptoms persist despite consistent conservative treatment is a small surgical procedure considered, in which the affected tendon sheath is opened. The exact approach is discussed individually.

Bouchard's Osteoarthritis

What is Bouchard's osteoarthritis?

Bouchard's osteoarthritis refers to wear of the proximal (middle) finger joints. It belongs to the group of finger osteoarthritides and leads to pain, swelling and increasing restriction of movement in the affected joints. Over the course of the condition, characteristic bony thickenings can develop at the middle finger joints.

Diagnosis

The diagnosis is made on the basis of the typical clinical picture and an X-ray, which shows the narrowing of the joint space, bony attachments and changes in the bone close to the joint.

Treatment

Treatment of Bouchard's osteoarthritis is in most cases conservative — with pain-relieving and anti-inflammatory measures, physiotherapy and occupational therapy to maintain mobility, and aids that relieve the affected joints. The aim is to relieve symptoms and preserve the function of the hand. The exact approach is discussed individually at the practice.

Heberden's Osteoarthritis

What is Heberden's osteoarthritis?

Heberden's osteoarthritis refers to wear of the distal (end) finger joints — the joints closest to the fingertips. It is the most common form of finger osteoarthritis and leads to pain, swelling and the characteristic bony thickenings (Heberden's nodes) at the end finger joints.

Diagnosis

The diagnosis is made on the basis of the typical clinical picture and an X-ray, which shows the narrowing of the joint space and the bony changes.

Treatment

Treatment of Heberden's osteoarthritis is in most cases conservative — with pain-relieving and anti-inflammatory measures, physiotherapy and occupational therapy, and aids that relieve the affected joints. The aim is to relieve symptoms and maintain the function of the hand. The exact approach is discussed individually at the practice.

Thumb-Base Osteoarthritis (Rhizarthrosis)

What is thumb-base osteoarthritis?

Thumb-base osteoarthritis (rhizarthrosis) refers to wear of the saddle joint at the base of the thumb — the joint that connects the thumb to the wrist. As this joint is heavily used in almost every gripping movement, wear here is particularly common. It leads to load-dependent pain at the base of the thumb, especially during gripping and twisting movements.

Diagnosis

The diagnosis is made on the basis of the typical clinical picture — load-dependent pain at the base of the thumb — and an X-ray, which shows the narrowing of the joint space and the bony changes at the saddle joint.

Treatment

In the foreground is conservative therapy — with a splint that relieves the saddle joint, pain-relieving and anti-inflammatory measures, occupational therapy and aids that make gripping movements easier. Local infiltrations can relieve symptoms.

If conservative measures are exhausted and the symptoms severely limit quality of life, a surgical procedure may be considered. The exact approach and the appropriate timing are discussed individually at the practice.

Dupuytren's Disease

What is Dupuytren's disease?

Dupuytren's disease is a benign change in the connective tissue of the palm. Strands and nodules form in the tissue beneath the skin, which over time can shorten. As a result, individual fingers — most commonly the ring and little fingers — are increasingly pulled towards the palm and can no longer be fully straightened.

Diagnosis

The diagnosis is made clinically. The palpable strands and nodules in the palm and the increasing flexion of the affected fingers are typically clear. The extent of the restriction is assessed in order to plan the further course of treatment.

Treatment

As long as there is no relevant restriction of movement, Dupuytren's disease can be observed. Treatment becomes appropriate when the fingers can no longer be fully straightened and everyday function is impaired.

In a surgical procedure, the altered connective-tissue strands are removed, allowing the affected fingers to be straightened again. The exact approach, as well as the aftercare with hand therapy, is discussed individually at the practice.

Ganglion Cyst

What is a ganglion cyst?

A ganglion cyst is a benign, fluid-filled swelling that arises in the vicinity of joints or tendon sheaths — most commonly on the wrist. It is connected to a joint capsule or a tendon sheath and filled with a viscous fluid. A ganglion is harmless, but depending on its size and location it can cause pain or be perceived as disturbing.

Diagnosis

The diagnosis is usually made clinically, on the basis of the typical, well-defined swelling. An ultrasound examination can confirm the fluid-filled nature of the swelling and distinguish it from other changes.

Treatment

A ganglion that causes no symptoms does not necessarily need to be treated. If it causes pain, restricts movement or is perceived as disturbing, treatment is appropriate. Depending on the situation, the options range from observation to a surgical procedure in which the ganglion is removed together with its connection to the joint or tendon sheath. The exact approach is discussed individually at the practice.