Any condition that damages a joint is called arthritis. In a
normal joint, cartilage covers the ends of the bones and
allows them to move smoothly and painlessly against one
another. With osteoarthritis (also called degenerative
arthritis), the cartilage layer wears out and the bones
rub against each other. As the cartilage layer continues
to wear out, symptoms of arthritis develop and the joint
is eventually destroyed.

In the hand, the second most common joint to develop
osteoarthritis is the joint at the base of the thumb, known
as the basilar joint, between the thumb metacarpal and
a bone of the wrist called the trapezium.

Who gets arthritis at the base of the thumb?
Arthritis in the basilar joint of the thumb is more common
in women than in men. It usually starts after age 40.
Past injuries to this joint such as fractures or sprains may
increase the chances of developing this type of arthritis.

What are signs and symptoms of arthritis at the
base of the thumb?
The first symptom of basilar joint arthritis is pain with
activities that involve gripping an object with the thumb
and fingers (pinching). These activities could include
opening jars, turning door knobs, opening car doors,
and turning keys. Heavy use of the thumb may also cause
pain in the basilar joint, as can changes in weather, such
as a change in humidity or temperature. As the disease
worsens, less activity is needed to produce pain. Pinching
strength decreases and swelling may develop when using
the thumb. As the arthritis continues to worsen, the basilar
joint begins to look bigger and “out-of-joint.” At this point,
movement of the thumb becomes limited.

Close inspection will sometimes show a lump at the base
of the thumb. Forcing the thumb firmly against the wrist
bone while moving the joint will usually produce pain and
may produce a gritty feeling indicative of the bones are
rubbing against each other.

Carpal tunnel syndrome is a condition caused by
compression of the median nerve in the wrist. The nerve
passes through a space in wrist called the carpal tunnel
and is accompanied in the tunnel by a number of tendons.
The nerve provides sensation in the thumb, index, middle
and half of the ring fingers of the hand, as well as
innervating some of the muscles of the thumb.

Carpal tunnel syndrome occurs when pressure builds
up within the tunnel and compresses the nerve which
then ceases to function normally, giving rise to numbness,
tingling, and pain felt in the hand and fingers and
occasionally in the forearm.

What are the causes of carpal tunnel syndrome?
Often the cause is unknown but the nerve can be
compressed in several ways such as swelling of the
lining of the flexor tendons, called tenosynovitis; joint
dislocations, fractures and arthritis can narrow the
tunnel. Fluid retention during pregnancy can cause
swelling in the tunnel and symptoms of carpal tunnel
syndrome, which often (but not always) resolve after
delivery. Thyroid conditions, rheumatoid arthritis, and
diabetes are also associated with carpal tunnel syndrome.

Signs and symptoms of carpal tunnel syndrome
The symptoms of carpal tunnel syndrome are usually
pain, numbness and tingling, or a combination of the
three. The numbness or tingling most often takes place
in the thumb, index, middle, and ring fingers. The
symptoms usually are felt during the night but also may
be noticed during daily activities such as driving or reading
a newspaper. Patients sometimes notice they have a
weaker grip, occasional clumsiness, and may drop things.
In severe cases, sensation may be permanently lost and
muscle may be lost at the base of the thumb (this is called
thenar atrophy).

How is carpal tunnel syndrome diagnosed?
A detailed history including medical conditions, work,
hobbies and sport, and whether there have been any
prior injuries is important. An X-ray may be taken to check
for other causes of the complaints such as arthritis or a
fracture. In some cases, laboratory tests may be carried
out if there is a suspected medical condition that is
associated with carpal tunnel syndromeElectrical studies
of function of the median nerve (nerve conduction studies)
may be undertaken to confirm the diagnosis and assess
the severity of the condition.

deQuervain’s tenovitis is a condition caused by
inflammation of tendons and their surrounding
sheath along the thumb side of the wrist.

Pain and tenderness are felt along the thumb side of
the wrist, usually noticed when forming a fist, grasping
or gripping things, or turning the wrist. Swelling may be
evident and there may be an occasional “catching” or
“snapping” when moving the thumb.

Dupuytren’s disease is an abnormal thickening of the fascia
(the tissue between the skin and the tendons in the palm)
that may limit movement of one or more fingers. In some
patients, a cord forms beneath the skin that stretches from
the palm into the fingers. The cord can cause the fingers to
bend into the palm so they cannot be fully straightened.
Sometimes, the disease will cause thickening over the
knuckles of the finger. It can also occur in the soles of
the feet.

What causes Dupuytren’s disease?
The cause of Dupuytren’s is unknown and there is no
permanent cure. The disease is usually painless. This is
a non-cancerous condition. Dupuytren’s disease mostly
affects white people with ancestors from Northern Europe.
It occurs more often in men than in women, and usually
starts after age 40. In many cases, the disease runs in
families. It is also associated with excess alcohol
consumption, diabetes and liver disease.

What are the features of Dupuytren’s disease?
Dupuytren’s disease occurs slowly. It is usually noticed as
a small lump or pit in the palm. This tends to occur near the
crease of the hand that is closest to the base of the ring
and little fingers. With time, a cord may develop between
the palm and the fingers.

The disease is usually noticed when the palm of the hand
cannot be placed flat on an even surface, such as a table
top. In severe cases, drawing of the fingers into the palm
interferes with everyday activities, such as hand washing,
wearing gloves and putting hands in pockets.

Ganglion cysts are very common lumps that sometimes
grow in the hand and wrist. The cysts are generally found
on the back or palmar side of the wrist when they are
commonly called a ganglion, the end joint of a finger where
they are called mucous cysts, and at the base of a finger.
Ganglion cysts usually come from nearby joints or tendon
sheaths. There is no specific cause.

What are the features of ganglion cysts?
These cysts appear as lumps that can be painful,
especially when they first arise or with constant or
strenuous use of the hand. Ganglions often change in
size and may disappear completely. These cysts are not
malignant (cancerous).

This is due to rupture of the extensor tendon at its
attachment to the finger close to the base of the nail.
It is normally caused by stubbing the tip of the finger.

What are the features of mallet finger?
It is not possible to actively extend (straighten) the far
joint of the finger. Occasionally an x-ray may reveal a small
fragment of bone has been pulled off with the tendon.

The scaphoid is the most common of the carpal bones to
be injured. A fracture of the scaphoid normally results from
a fall onto the outstretched hand.

What are the features of a scaphoid fracture?
There is pain, swelling and tenderness over the thumb
side of the wrist. Radiographs of the wrist confirm a
fracture. Occasionally initial radiographs taken soon
after the injury may not show the fracture. If a fracture
is suspected but not confirmed it should be treated as
one, the wrist immobilised in a splint or cast and then
re-examined and further radiographs taken 10-14 days
after the injury. An MRI scan of the wrist is also helpful
in establishing the diagnosis.

The hand and wrist are the most commonly injured part
of the body. The hand’s function is sensation and grip.
Internal complex structures of tendons, nerves and blood
supply can unfortunately be damaged.

Stenosing tenosynovitis, commonly known as trigger
finger or trigger thumb, is caused by the tendons that
bend the finger catching or sticking within an interal tunnel
at the base of the finger. The cause for this condition is
not always clear. The medical conditions of rheumatoid
arthritis, gout, and diabetes may be associated with
trigger finger/thumb symptoms. Triggering may affect
more than one digit.

What are the features of trigger finger?
Triggering may start with discomfort felt at the base of
the finger or thumb and a thickening may be found in this
area. Swelling of the tendon prevents it from gliding
smoothly through the surrounding sheath at the base of
the finger producing pain, “catching” or sticking of the digit
on movement. This is often worse on waking and it may
be very difficult or painful to straighten the digit from the
flexed position.

The London Orthoapedic Clinic boasts extremely
experienced traumatologists which will diagnose
and treat a wide variety of Fractures.

All fractures of the Upper and Lower limb are extremely
common and a regular occurrence. Our consultants will
be available, especially with our after hours/emergency
service and

hand surgery

available to fix all fractures.