Medical Resources - Common Conditions

Carpal tunnel syndrome is a very common condition that often leads people to seek advice from a hand specialist. 

It happens when the median nerve which provides feeling and strength to part of the hand, becomes compressed as it passes through a narrow space in the wrist called carpal tunnel.

If carpal tunnel syndrome is left untreated symptoms can gradually worsen. In more severe or long standing cases there may be permanent loss of sensation in the fingers or weakness or wasting of the muscles at the base of the thumb. 

Dupuytren’s disease is a condition where the finger starts to curl into the palm. It develops because the tissue beneath the skin of than hand becomes thickened and forms tight cords over time. It tends to run in families, and can affect the soles of the feet and other body parts as well.  

When the contracture begins to interfere with function, treatment may be recommended. The most suitable treatment depends on how advanced or aggressive the disease is, but also on the patients priorities. Less invasive procedures often allow a faster recovery but carry a higher chance of recurrence, whereas more extensive surgery may reduce recurrence risk at the cost of a longer recovery and greater potential risks.  

A Trigger digit (trigger finger or trigger thumb) is a condition where a finger or thumb catches or locks when bending or straightening. Sometimes it becomes stuck in a curled position and may need to

 be straightened using the other hand. 

Trigger digits often respond very well to a steroid injection which can be given in clinic. Many patients experience significant improvement after one injection and a second injection may be considered if symptoms persist. 

If injections are unsuccessful or if symptoms are severe, a trigger release procedure may be recommended. This is performed under local anaesthetic through a small incision in the palm. The tight pulley is released, allowing the tendon to glide freely again and normal movement usually returns without loss of strength. 

Arthritis at the base of the thumb is a very common condition, particularly in women after the menopause. It occurs when the joint at the base of the thumb becomes worn and inflamed, leading to pain and stiffness. This can worsen over time and the thumb can gradually drift in towards the palm and the next joint may become overextended to compensate. In more advanced cases, persistent pain and weakness can affect everyday hand function.

If thumb arthritis becomes painful, supportive splinting can be very helpful in improving comfort and maintaining thumb position. Many patients find these splints effective and are able to manage symptoms for several years without further treatment. Steroid injections can also be offered during flare-ups to reduce inflammation and pain, although the joint may feel temporarily more sore for a few days afterwards, and simple pain relief is often recommended. If injections no longer provide lasting benefit, surgery may be considered. There are several well-established operations for thumb base arthritis including trapeziectomy or thumb joint replacement. These procedures are usually performed as a day case under general or regional anaesthetic.

The thumb knuckle joint (metacarpophalangeal joint) is stabilised by two key ligaments on either side, known as the radial and ulnar collateral ligaments. These ligaments are commonly injured during sporting activities such as rugby, netball, skiing, or snowboarding. The ulnar collateral ligament is particularly important for pinch strength, as it allows the thumb to act as a firm post. If this ligament is completely torn, it can sometimes become trapped beneath nearby tissue and may not heal properly on its own. Over time, this can lead to weakness, instability, and difficulty with grip, causing patients to drop objects or lose thumb function.

Assessment of thumb ligament injuries often involves clinical examination and imaging such as ultrasound or MRI. Mild sprains may be treated successfully with splinting, whereas a complete rupture may require surgical repair. Surgery is usually performed as a day case under local, regional, or general anaesthetic. The torn ligament is reattached to the bone using a small anchor, and in longer-standing injuries a reconstruction may be needed using a tendon graft or a strong synthetic reinforcement. 

Mucoid cysts (also called mucous cysts) are small, benign fluid-filled lumps that usually develop near the end joint of a finger, close to the nail. They are often associated with underlying arthritis of the distal interphalangeal (DIP) joint and arise as a result of joint fluid tracking outwards beneath the skin.

These cysts can cause discomfort, tightness, or sensitivity, and in some cases may lead to ridging or deformity of the nail. Occasionally, the skin over the cyst can become very thin and may leak fluid.

If a mucoid cyst is painless and not causing problems, no treatment may be necessary. However, if it becomes painful, repeatedly leaks, or interferes with function, surgical excision may be recommended. Surgery typically involves removing the cyst along with its connection to the joint and addressing any underlying bony prominences. This is usually performed as a day-case procedure under local or regional anaesthetic.

Mucoid cyst surgery is generally very successful, but as with all cysts, there remains a small risk that it may recur over time.

The ulnar nerve passes along the inner side of the arm and travels behind the bony prominence on the inside of the elbow, known as the medial epicondyle. At this point the nerve bends sharply around the elbow, which is why this area is commonly referred to as the “funny bone.” Knocking the elbow here can cause a brief electric shock or tingling sensation down into the hand.

Mild cases of cubital tunnel syndrome often respond well to non-surgical treatment, such as avoiding prolonged pressure on the elbow, wearing an elbow pad during the day, or using a splint at night to keep the elbow straighter. However, if symptoms persist, worsen, or if there is any weakness in the hand, it is important to seek specialist assessment sooner rather than later, as prolonged nerve compression can become more difficult to reverse.

If conservative measures do not improve symptoms, surgery may be recommended to relieve pressure on the nerve. Recovery varies between individuals, and although sensation may improve quickly, full recovery can take several months. In more severe or long-standing cases, surgery may not completely restore normal nerve function, which is why early consultation is advised.

Some types of arthritis, such as rheumatoid arthritis and other inflammatory arthropathies, occur when the body’s immune system attacks its own joints. Over time this can lead to inflammation, pain, joint damage, and fingers drifting into a deviated position. These conditions are usually managed in conjunction with a rheumatologist, and immunosuppressive medications are often very effective. Many patients maintain remarkably good hand function despite visible changes, and surgery may not be needed. 

If pain persists despite medical treatment, procedures such as synovectomy may be considered to remove inflamed tissue and reduce flare-ups. When tendons rupture, tendon transfer surgery can help restore lost movement by redirecting functioning tendons to replace those that have failed. In more advanced cases, where joints are severely damaged, joint replacement or joint fusion may be offered. Joint replacement can relieve pain while preserving some movement, whereas fusion removes the painful joint surfaces and allows the bones to heal together, which can be very effective when a joint has already become stiff and painful. Early specialist assessment can help determine the most appropriate option and prevent further loss of function.

After a significant wrist sprain, X-rays can sometimes appear normal even when an important ligament injury is present. The most commonly injured wrist ligament is the scapholunate ligament, although other ligaments may also be affected. A complete rupture can lead to ongoing pain, weakness, or clicking within the wrist. If left untreated, this type of injury may result in a gradual and predictable pattern of arthritis developing over time, which can cause increasing stiffness and discomfort later in life and may eventually require more complex surgery.

Another important structure in the wrist is the TFCC (triangular fibrocartilage complex), which acts as a shock absorber on the ulnar side of the wrist. 

Wrist ligament and TFCC injuries can often be assessed and treated using keyhole (arthroscopic) surgery, which allows detailed inspection inside the joint. Some problems can be managed arthroscopically, while others require a small open repair. Surgery is usually performed as a day case under general or regional anaesthetic.