Melbourne Hand Surgery 

Coronavirus update: All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth (phone or video consultation) to maximise patient and staff safety. We have implemented enhanced hygiene meaures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. 

We are continuing to perform rooms procedures, including needle fasciotomies for Dupuytren's contracture. There are  currently restrictions on performing elective surgery in Victorian hospitals, as private hospitals are accommodating aged care residents as well as providing nursing staff for aged care residences. We are currently taking bookings for and scheduling emergency and category 1 surgeries at The Avenue and Epworth Freemasons. We are taking bookings for category 2 and 3 surgeries from 21 September, or as soon as the pandemic situation permits. Please note that all patients who are scheduled for elective surgery admission are required to undertake a COVID test and obtain a negative ("not infected") result prior to admission. 

Victorians are in this together and together we will get through this. Thank you for your understanding as our community works through these unprecedented times together (last updated: 3 August 2020).

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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