Melbourne Hand Surgery 

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Latest news at 11 June 2021: Masks are mandatory when you attend our practice in person, and we request that you log your attendance via our Victorian Government QR code, by entering location code 3D7RE3 into the Services Victoria App or by writing your details on the physical register at our reception.

Elective surgery resumes on Tuesday 15 June. Dr Tomlinson is operating at The Avenue and Glenferrie Private; Epworth Cliveden is indefinitely closed at this time. We are continuing to perform rooms procedures. 

All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. We have enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.

Osteoarthritis

Definition

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Osteoarthritis is a degenerative condition where the smooth articular cartilage that covers the ends of the bones is gradually destroyed. The end result is that bare bone ends rub against each other, which causes pain and stiffness. Osteoarthrits can affect any joint in the hand. It most commonly affects the base of the thumb (termed "basal joint arthritis" or "1st CMCJ arthritis", as in the picture on the right and x-ray below) and the fingers (interphalangeal joints).

Osteoarthritis in the fingers

Hebeden's nodes are bony nodules (termed "osteophytes") that form at the end joints of the fingers (the "distal interphalangeal joints"). They are not treated with surgery, and nor are Bouchard's nodes, which is the term given to the bony nodules that form around the proximal interphalangeal joints.

forlife 200x145Digital mucous cysts are also found around the distal interphalangeal joints in people with osteoarthritis. They are ganglion cysts that arise from the distal interphalangeal joint and form a lump between the joint and the nail fold. They are more common in women than men and they commonly create a ridge in the nail. Mucous cysts can be conservatively treated through observation and aspiration (where the contents of the cyst are drained with a needle and syringe) but this method of treatment carries significant risks of recurrence and of infection - and these infections can result in a need for admission to hospital and multiple surgeries to treat the infection. Surgical excision of mucous cysts involves the excision of the cyst and any osteophyte related to the cyst; it is a very effective method of treatment. This procedure can be performed under local anaesthetic as day surgery (wide awake hand surgery).

Non surgical options

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Non surgical options include

  • use of heat and ice
  • analgesics (such as paracetamol)
  • anti-inflammatories
  • corticosteroid injections
  • splinting
  • changed activities

Indications for surgery

Surgery is indicated for osteoarthritis when pain severely limits daily activities despite adherence to non-surgical therapies.

Surgical options

Surgical options involve joint preservation or reconstruction wherever possible. The two main surgical treatments are:

 

FRACS

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