Three common hand conditions explained

Dupuytren's Contracture

The condition

Dupuytren’s contracture (also referred to as Dupuytren’s disease) is a hand condition which causes the thickening of the tissue beneath the skin in the palm of your hand. This results in one or more fingers to bend towards your palm, usually affecting the ring and little fingers.

Dupuytren’s contracture affects approximately 20% of the UK population aged over 65 years. In the UK, more than two million people are thought to have Dupuytren’s disease (NICE 2022).

Symptoms

Early signs of this condition begin with uncomfortable nodules, dimples or ridges on your palm. This discomfort often improves over time. Further symptoms of Dupuytren’s Contracture include:

• Tenderness on the palm
• Fingers bent towards the palm as bands of contracted tissue (called cords) develop in your hand
• Inability to perform day to day tasks because you’re unable to fully straighten your fingers
• Dimples or pitted marks on the skin because of the constant tension

Causes

The cause of the condition is a genetic predisposition, as such it tends to run in families.  There is also an association with those who have diabetes, consume large amounts of alcohol or smoke excessively.

Treatment options

If you can straighten your fingers fully, you likely won’t qualify for treatment. However, if your symptoms are affecting your quality of life, you may be referred to our Consultant Orthopaedic Surgeons for further assessment and any appropriate treatment, including a Dupuytren’s fasciectomy or a needle fasciotomy.

Dupuytren’s fasciectomy/Fasciotomy

At Benenden Hospital, we offer patients with Dupuytren’s contracture surgery known as a Dupuytren’s fasciectomy or in less severe cases Needle fasciotomy. This surgery corrects the local thickening of the tissue in the palm of the hand or in a finger by removing the thickened tissue which connects the hand and fingers – the contracted cord of Dupuytren’s disease. It also corrects the fingers that have been pulled towards the palm of the hand.

This surgery can be carried out in three different ways depending on the severity of your Dupuytren’s contracture.

• Needle fasciotomy: one or more needle punctures are made in order to divide segments of the connective tissue (the cord) and allow the finger to straighten.
• Regional fasciectomy: a single, larger incision is made though which all the affected tissue is removed. This is the most commonly used procedure
• Dermofasciectomy: the affected connective tissue is removed together with the overlying skin and the wound is covered with a skin graft (from another part of your body). This procedure will be used if the skin is also affected by the disease

Trigger finger/thumb

The condition

Trigger finger can be a painful condition that causes a finger to catch or lock in position when it’s moved. It can also affect your thumb, known as trigger thumb.

This occurs when tendons (the bands of tissue that connect to the fingers and thumbs helping to move them) become inflamed or nodular. Also, ongoing irritation of a tendon sheath can scar and thicken the sheath, hindering the smooth movement of the tendon. With this condition, when you bend your finger it pulls the inflamed tendon through the narrowed tendon sheath, making it click or pop.

Symptoms

• Pain around the affected finger or thumb, this is more common in people aged over 40
• Soreness and tenderness at the base of the finger or thumb
• Clicking of your finger, often worse on waking in the morning
• The finger becoming locked in either a bent or straight position. As the condition worsens, the finger may need to be straightened using the other hand

Causes

The causes of Trigger finger/thumb are often unknown. If you have insulin-dependent diabetes it can make you prone but people without diabetes can still develop this hand condition. Rheumatoid arthritis sufferers with tendon nodules can be more at risk too.

Treatment options

Non-surgical

Taking breaks from activities that cause you pain in your fingers or thumb is a good place to start but isn’t always possible. Other non-surgical options are non-steroidal anti-inflammatory drugs and splinting. To help reduce swelling, a steroid injection may be recommended.

Surgical

There are two common types of surgery for the release of trigger finger:

• Open trigger finger release surgery – our Consultant Orthopaedic Surgeons make a small cut in your palm to get to the tendon and release it. This is usually very effective as a permanent treatment for trigger finger. It’s rare the problem will return to the treated finger or thumb
• Tenosynovectomy – if you have rheumatoid arthritis, this surgery may be recommended instead. It involves removing the tendon sheath to allow your finger tendon to move again

Carpal tunnel syndrome

The condition

Carpal Tunnel Syndrome is a common condition. Signs include tingling, numbness and pain in the hand and fingers caused by a trapped nerve in the wrist. Although you’re more likely to suffer as you get older, Carpal tunnel syndrome can occur at any age and in one or both hands.

Symptoms

Carpal tunnel syndrome is often worse at night or first thing in the morning. Symptoms include:

• Pain, numbness, burning or tingling in your thumb, index and middle fingers and part of the ring finger
• Weakness and clumsiness in the hand with reduced sensation and reduced grip strength
• When your wrist is bent forwards and your fingers are in a fist position, especially when holding an object such as your phone or steering wheel, you may notice discomfort
• It often causes severe pain at night

Causes

Your carpal tunnel is made up of the bones (carpals) in your wrist and a thick ligament. This tunnel contains the tendons that bend your fingers and thumb as well as the median nerve. Carpal tunnel syndrome occurs when the median nerve, which normally passes through a narrow tunnel in the wrist, gets compressed and squashed as it passes through.

Carpal Tunnel Syndrome is common. If you have diabetes, rheumatoid arthritis in your wrist joint, are pregnant, have thyroid problems or have inflammation of your wrist tendons, you’re more likely to develop carpal tunnel syndrome.

Treatment options

Lifestyle changes

Carpal Tunnel Syndrome sometimes clears up by itself in a few months, particularly if you have it because you're pregnant. But for all wrist problems it’s important to remain active and to vary the activities you’re doing throughout the day to ensure that you’re not repeatedly squeezing, gripping or typing. It’s also important to be aware of your wrist position and try to have it bent in either direction for any prolonged period of time.

If you exercise it’s important to alternate between heavier and lighter activities to reduce any strain. For cycling, gardening or golf, padded handles can help to support your wrist.

Wrist splint

If your symptoms are mild, you’ll likely be recommended to wear a wrist support or splint at night to help to keep your wrist straight and relieve pressure on your nerve. You may want to consider hand and wrist supports as part of computer work.

Injection

A steroid injection near the carpal tunnel can also reduce your numbness or pain.

Surgery

Carpal tunnel surgery is often required in those who’ve been struggling with symptoms for a long time and when lifestyle changes, exercises and splints haven’t worked. Surgery for carpal tunnel will help relieve your symptoms by reducing the pressure on your median nerve and decompress it. During surgery, a small incision is made at the front of the wrist, the ligament on top of the nerve is cut and the skin closed.

Access our hand and wrist treatments

If you’re struggling with any of the above symptoms, it’s important to either book a GP appointment or book in an initial consultation with one of our expert orthopaedic surgeons. Call our Private Patient team on 01580 363158 for more information or to book, or contact us using our online enquiry form or Livechat.

Published on 12 December 2024