Conditions & Treatment

Arthritis is a common condition affecting many joints of the body. It can be caused by damage to the joints through wear and tear as we age, previous injuries and various autoimmune diseases.

The base of the thumb is a common joint for arthritis to affect. Treatment options depend on the joints involved and the severity and duration of symptoms. Non-operative treatment options include splinting and exercises. There are many different surgical options available for trapeziometacarpal joint (basal thumb) arthritis.  While many surgeons remove the entire trapezium, we have found that partial resection of the trapezium produces the best functional outcome with resolution of pain. This procedure is done through 2 small ‘keyhole’ (arthroscopic) portals.

Carpal tunnel syndrome is caused by compression of the median nerve by the transverse carpal ligament of the wrist. It causes numbness in the thumb, index finger, middle finger, radial side of the ring finger and palm. These symptoms often cause people to wake at night. Treatment comprises of splinting, steroid injection or surgery via an open incision or a supraretinacular endoscopic technique devised by Mr Ecker. Surgery can be performed as a day case under local anaesthetic.

Cubital tunnel syndrome is caused by compression of the ulnar nerve on the medial side of the elbow, or the ‘cubital fossa’. It can cause weakness and lack of dexterity in the hand with numbness or altered sensation in the small and ring fingers. In severe cases there can be wasting of the intrinsic muscles of the hand. Elbow flexion often precipitates the onset of symptoms. Surgical treatment options include endoscopic ‘keyhole’ release of the ulnar nerve or open transposition of the ulnar nerve via a larger incision.

Distal radioulnar joint instability is caused by a deficiency in the triangular fibrocartilage complex. It results in mechanical ulnar sided wrist pain. Depending on the anatomy of the tear, the triangular fibrocartilage can be repaired arthroscopically using a suture. Rarely the repair requires a tendon graft.

The radius is one of two bones that make up the forearm. A distal radius fracture is a fracture of the radius that has occurred near the wrist. 

Distal radius fractures are common and are often associated with a fall on an outstretched hand. They are diagnosed based on history, examination and imaging (x-ray and/or CT scan). 

Distal radius fractures vary in severity.  Some can be successfully managed with splinting while others require surgery to realign the fractured bone in the correct anatomical position to heal.  Surgery may be performed via open incision or arthroscopically depending on the fracture configuration.  Most distal radius fractures unite at 6-8 weeks.

Dupuytren’s fibrosis is a genetic condition with variable penetrance, meaning it can ‘skip’ generations. It causes an over-production or under-resorption of the normal retinacular system in the hand and fingers, which gradually ‘pulls’ the finger into the palm. There are multiple treatment options for Dupuytren’s fibrosis depending on the severity of the contracture; percutaneous needle aponeurotomy, collagenase injection, limited fasciectomy, fasciectomy with Z-plasty and dermatofasciectomy and full thickness graft.  Your surgeon will discuss the best treatment options for you based on the severity of the contracture and the joint/s affected. 

Finger dislocations are common, particularly in sports people. The most common joint to injure is the proximal interphalangeal joint (the middle joint of the finger).

Joints are surrounded by soft tissue that allows the joint to move with stability. When a joint is dislocated some of the soft tissue structures are damaged. Once enlocated, most dislocations can be managed with splinting and therapy.  However, some dislocations require surgery.

There are many different types of fractures that affect the hand, wrist and fingers. Some can be treated by splinting and therapy, while others require surgery to ensure correct alignment of the fractured bone.  Depending on the fracture, surgery could be performed via open incision or arthroscopically via ‘keyhole’ portals.

Gamekeeper’s thumb is the term used to describe an injury to the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb. It can be treated surgically by re-attaching the ligament to the bone with a small ‘anchor’.

Keinbock’s disease is not something which can be treated alone with hand therapy. If you suspect you have Keinbock’s disease you should see your GP and ask for a specialist hand surgeon referral. Your GP may also suggest an X-ray to assess the health of your lunate (a small moonshaped carpal bone).

Lacerations can affect intricate structures of the hand such as tendons, pulleys, nerves and vessels. It is important that these injuries are properly evaluated and treated to prevent longterm disability and reduce the risk of infection. Mr Ecker is skilled in complex microsurgery and offers an emergency service for trauma patients.

Mallet injuries are common and often caused by a ball or blunt force hitting the end of the finger.  This results in damage to the tendon that straightens the ‘tip’ (or the distal interphalangeal joint) of the finger.  The injury is characterised by an inability to actively straighten the tip of the finger, which rests in a flexed position. 

Mallet injuries can be caused by injury to the tendon or bone.  Those affecting the tendon and treated early often respond successfully to splinting.  Those affecting the bone can require surgery. It is important that these injuries are diagnosed and treated early. 

Nail bed injuries can be the result of a laceration or crush-type injury (like a car door). If not treated adequately, damage to the germinal matrix can cause longterm problems with the nail. Our surgeons are skilled in plastic and microsurgery.  Our team offers an emergency trauma service for these injuries.

Scaphoid fractures are often associated with high impact sports or a fall on outstretched hands. Pain can be transient and the injury may be dismissed as a ‘wrist sprain’.

Fractures of the scaphoid can be easily missed on x-ray and have a relatively high rate of non-union which can result in long-term wrist problems.  For this reason, wrist pain should be adequately investigated to identify a cause. An accurate diagnosis should be made based on history, examination and CT or MRI scan. 

It is important that scaphoid fractures are identified and treated early to prevent non-union.  Surgery can often be performed percutaneously through a few small ‘keyhole’ portals.  Our surgeons work closely with trained hand therapists in the post-operative period to ensure an optimal splinting and therapy program is implemented.

If a scaphoid fracture is undiagnosed or untreated, it can result in a ‘non-union’.  A non-union occurs when the bone fails to heal. Because of the anatomy of the vessels supplying the scaphoid, a non-union can cause disruption in blood supply to a portion of the scaphoid, causing the bone to die and disintegrate.

Scaphoid non-union can be treated arthroscopically by excising the non-union, correcting the deformity, fixing the scaphoid using wires and packing the defect with bone graft harvested from the iliac crest. This treatment option has a high rate of success and is performed via small ‘keyhole’ portals. 

The term ‘swan neck’ deformity is characterised by hyper-extension of the proximal interphalangeal (PIPJ) joint and flexion of the distal interphalangeal (DIP) joint. It can be associated with a ‘snapping’ motion of the finger on flexion. It is important that mallet injuries are treated early to avoid this deformity developing. Once established, splinting may improve the functionality and motion of the affected digit.

Distal radioulnar joint instability can be caused by a deficiency in the triangular fibrocartilage complex. It causes painful mechanical clicking and symptoms in the ulnar side of the wrist. Depending on the severity of the injury, the triangular fibrocartilage can be anatomically repaired using arthroscopic suture techniques. If the deficit is large the repair may require a tendon graft, which can be performed via a small incision.

Ulnar carpal impaction is a common cause of wrist pain. It is caused by the ulna (one of the bones of the forearm) being long in relation to the radius and impinging on the carpus (in particular the lunate). This may be a normal anatomical variation or occur as a result of injury (i.e. a mal-union after a fracture). It is easily diagnosed using x-rays which measure the ulnar variance and, depending on the degree of symptoms, most often treated with a ulnar shortening osteectomy.

The ulnar nerve supplies sensation to the small finger and the ulnar side of the ring finger. Compression of the ulnar nerve in Guyon’s canal in the wrist may cause sensory symptoms in the ulnar nerve distribution of the hand. It can be treated with an ulnar nerve decompression or ‘release’ from Guyon’s canal in the wrist.

An injury to the ligaments in the wrist is often dismissed as a ‘sprain’. A disruption to these ligaments can result in instability or dissociation of the carpal bones. It is important that wrist pain following an injury is investigated to exclude carpal instability (most commonly ‘scapholunate instability’, or instability between the scaphoid bone and the lunate bone). Depending on the type and degree of instability present, treatment options may include a proprioceptive exercise program, an arthroscopic dorsal capsulodesis, tendon weave procedure or partial fusion.