Expert diagnosis and management of common upper limb conditions
The small bones which form the universal joint of the wrist are arranged in an arc. A big strong ligament sits across the front of this arc forming the roof of the carpal tunnel. Through the carpal tunnel, pass the tendons that drive the fingers and thumb together with the main nerve that supplies the thumb side of the hand – this is the median nerve.
A mallet finger describes deformity where there is an inability to straighten (extend) the last joint of the finger or thumb. This means that the last segment of the finger including the fingernail, droops. The deformity results from the tendon that straightens the joint tearing (avulsing) away from the base of the bone.
De Quervain's Tenosynovitis
De Quervain's TSV is a painful condition affecting two tendons at the base of the thumb as they travel side by side along the inside of the wrist. They pass through a soft tissue channel or sheath, with the inner walls of the channel producing a slippery fluid to lubricate the tendons as they slide back and forth.
Osteoarthritis occurs when the smooth cartilage that covers the ends of the bones begins to wear out prematurely. This may be caused from normal wear and tear, and previous injury to the joint. In the hand the joints at the base of the thumb and the small joints of the fingers are particularly susceptible to developing osteoarthritis. The joint at the base of the thumb allows swiveling and pivoting movements and is subject to unusual amounts of stress during gripping.
Dupuytrens Disease is a condition which affects the tissue just under the skin (the fascia) of the palm of the hand and fingers. The fascia thickens, causing dimpling of the skin and usually presents as a thick nodule or shortened cord in the palm of the hand preventing the fingers from fully straightening.
Trigger finger is a common condition caused by the inability of the tendon in the palm of the hand to glide freely within its sheath (protective covering). This is thought to be caused by either thickening of the tendon or narrowing of the sheath due to inflammation.