Melbourne Hand Surgery 

Please note: We do our best to accommodate emergency and urgent referrals upon receipt of your doctor's referral. Dr Tomlinson is currently booked some months in advance so if your condition is urgent or you wish to be placed on our "Waiting for an Early Appointment" list to see Dr Tomlinson or Mr Babazadeh please provide us with your doctor's referral and your registration forms so that we can facilitate an urgent review. We strongly encourage individuals who are seeking non-surgical treatment of Dupuytren's contracture with Dr Tomlinson to seek placement on our waiting list and provide us with details of your availability, so that we can contact you in the event of an earlier appointment becoming available. If you have recently sustained a hand or wrist injury you may wish to explore the option of the Action Rehab Urgent Care Clinic, where your injury will be assessed and managed by an experienced hand therapist.

Osteoarthritis

Definition

thumb base arthritis bone skin

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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