Pain at the base of the thumb (rhizarthritis/DeQuervain's tendonitis)
It used to be that only people older than 50 years of age were seen with pain at the base of the thumb due to wear and tear of a very special saddle joint between a wrist bone,the trapezium and the middle hand bone of the thumb. Indeed, the thumb is a very special finger - very mobile (cfr. key pinch) but also very strong (cfr. Lifting furniture) . This combination of agility and strength is unique and helped by a strong ligament keeping the thumb-rider in the saddle. With usage the ligament becomes frail and the rides moves out of the saddle loading abnormal pressures and osteo-artritis develops. Splinting, physio, taping, cortisone injections can buy time but ultimately surgery could be indicated to reconstruct the thumb and the ligament. This is a highly skilled procedure but allows after several months to use the thumb and hand again without pain and with good grip strength. It is interesting to note that younger patients are presenting possibly to the SMS texting hype. This condition however is different from a painful tendonitis over the wrist called DeQuervain's tendonitis (the inflammation is much closer to the forearm).
Baron Guillaume Dupuytren described more than two hundred years ago a chronic condition affecting the hand and fingers with thickened cords and bands forcing the fingers in a fist like configuration. This can take many years, affects more men and usually runs in the family. There is no particular conservative management but surgery is only indicated when and if the contractures exceed certain angulations. This is complex surgery given the proximity of critical vessels and nerves and require magnification and skills.
Chronic inflammation of the tendon sheath of one of the finger benders (flexor) results in narrowing of the tunnel (pulley) through which the tendon is supposed to slide and glide resulting in triggering and occasionally the 'locked finger'. Cortisone injections are usually successful in the first instance (unless for the thumb) but if this fails, surgical release of the pulley would do (Day Care - local or regional anaesthesia).
After a major injury (a bad fall) or with age the hand and wrist can become painful. Several factors could be responsible for this - ligament instability, an unrecognized fracture (cfr. Scaphoid), muscle, tendon or cartilage damage such as in osteo-arthritis. Apart from a thorough clinical exam, special radiographs and MRI scanning might be needed. Sometimes your condition requires a wrist arthroscopy as a day care procedure under general anaesthesia. Through keyholes and with a very small camera the joint is explored and where possible damage repaired or damaged fragments removed. Usually a speedy recovery follows.
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