What are common problems treated in an orthopedic hand surgery clinic?

From the Guidelines

Common problems seen in orthopedic hand surgery clinics include carpal tunnel syndrome, trigger finger, De Quervain's tenosynovitis, ganglion cysts, and various fractures or injuries, with treatment prioritizing conservative measures before considering surgery.

Common Hand Problems

• Carpal tunnel syndrome typically presents with numbness and tingling in the thumb, index, middle, and half of the ring finger, often worse at night, and is initially treated with wrist splinting at night, NSAIDs like ibuprofen 400-600mg three times daily, and ergonomic modifications, with surgical release considered if conservative measures fail after 6-12 weeks 1.
• Trigger finger causes painful catching or locking of fingers and is treated with rest, NSAIDs, and corticosteroid injections (typically methylprednisolone 40mg mixed with lidocaine), with surgery indicated after failed injections 1.
• De Quervain's tenosynovitis affects the thumb tendons with pain at the wrist's radial side, responding to thumb spica splinting for 4-6 weeks, NSAIDs, and possibly corticosteroid injections 1.
• Ganglion cysts are benign fluid-filled lumps commonly found on the wrist that may resolve spontaneously or require aspiration or surgical excision if painful or limiting function 1.
• Hand fractures require proper immobilization, often with custom splinting or casting for 4-6 weeks, followed by rehabilitation to restore strength and range of motion 1.

Treatment Approach

• Education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient 1.
• Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient 1.
• Orthoses should be considered for symptom relief in patients with thumb base OA, with long-term use advocated 1.
• Topical treatments are preferred over systemic treatments due to safety reasons, with topical NSAIDs being the first pharmacological topical treatment of choice 1.
• Oral analgesics, particularly NSAIDs, should be considered for a limited duration for relief of symptoms 1.
• Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning 1.
• Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA but may be considered in patients with painful interphalangeal joints 1.
• Surgery should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain, with trapeziectomy considered in patients with thumb base OA and arthrodesis or arthroplasty in patients with interphalangeal OA 1.

From the Research

Common Problems in Orthopedic Hand Surgery Clinics

• Fractures are the most common injury, followed by tendon injury, then skin lesions 2
• Metacarpal fractures are common, and many can be managed nonsurgically, but some may require referral to an orthopedic surgery subspecialist for possible surgical intervention 3
• Injuries to the hands and wrist are common in athletes, including acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains 4
• Metacarpal and phalangeal fractures are common injuries in athletes, and treatment requires consideration of specific sport, timing of injury, and level of play 5

Specific Challenges in Orthopedic Hand Surgery

• Complications that limit normal hand function can still occur despite advances in surgical techniques and therapy protocols 6
• Common conditions, such as trigger finger, de Quervain tenosynovitis, extensor tendon injury, and zone II flexor tendon injury, can be challenging to treat 6
• Incorrect or delayed diagnosis and iatrogenic injury related to treatment are common complications in the treatment of sports injuries of the hand and wrist 4

Treatment Considerations

• A detailed history and evaluation are vital to properly identifying and managing hand injuries 2
• Open reduction and internal fixation can afford the most stability while allowing for early rehabilitation in athletes with unstable or intra-articular fractures 5
• Surgical techniques and therapy protocols can help minimize the frequency of complications related to the treatment of hand disorders 6