Hand surgery is specialised care

The navicular bone is one of the eight carpal bones which performs the greatest range of motion when moving the wrist. Due to this high degree of mobility, however, the bone is less well supplied with blood, which means that it needs longer to heal in the event of a fracture.

A typical situation which leads to a fracture is the reflexive reaction of stretching out your arms to prevent yourself from falling. The symptoms only last for a short time, so most people don’t go to the doctor about them. These breaks are often difficult to see in a conventional X-ray, which is why computer tomography may be necessary.

Depending on the location of the scaphoid fracture, a conservative measure may be discussed, such as immobilisation with a plaster cast, or else a surgical procedure, such as stabilisation by means of a screw. 

As with many other joints, it is also possible to perform an arthroscopy of the wrist area. A small camera (1.9mm) is inserted into the wrist using a tube as fine as a pin. Special instruments such as tactile hooks, small scissors and other instruments for treatment in the wrist can be inserted through an additional working access.

This method allows the actually prevailing conditions to be seen, which enables optimal and minimally invasive treatment, in other words with as little disruption to the body as possible. Some wrist changes and/or injuries can be treated well with this technique. For the same reason, a close-up examination can also be carried out prior to a further operation and can support optimal planning of the operative procedure. 

The distal radius fracture is the most common break in the human body. It is located in the wrist area. Wrist structures are also often involved.

Depending on the path of the fracture, it may be possible to treat it conservatively, i.e. without surgery.

If an operation proves necessary, the fracture can usually be treated with a state-of-the-art plate system (titanium plates and screws) to provide stability for exercise. The broken bone is thus strengthened by the plate to such an extent that the injured area can be exercised in physiotherapy after just a few days. Immobilisation and the wearing of a protective wrist cuff is necessary for a few weeks. If the bone heals well (X-ray controls), the load can often be increased, reaching full load after 4-8 weeks. 

Due to its high degree of mobility, the scaphoid bone unfortunately has a poor blood supply. If a scaphoid fracture is not detected, the bone frequently does not heal in one piece but forms into two separate bone fragments. These bone fragments are often linked by connective tissue of variable consistency. The medical term for this is a pseudarthrosis.

Having a pseudarthrosis can lead to premature wear and tear in the wrist. Pseudarthrosis of the scaphoid bone is often discovered by chance, sometimes only when subsequent wear and tear in the wrist cause discomfort.

A pseudarthrosis can be remedied by a number of measures. Decisions are made on a case-by-case basis and must be discussed carefully with the patient.

Since the scaphoid bone has a poor blood supply, such treatments often take a long time. 

If the little finger and the ring finger tingle, keep falling asleep or are permanently numb, if the function of the hand is becoming gradually weaker, this may indicate a restriction of the nerve at the side of the elbow (ulnar nerve).

As well as a typical examination finding (irritation of the nerve at elbow level, possibly at the ulnar wrist), neurological examinations point the way, as in the case of carpal tunnel syndrome.

If the problem is at elbow level, it can often be helped with appropriate relief and padding. If the problem is more serious, elbow surgery can also be offered.

I perform a very modern, endoscopically assisted procedure for this. This allows a very large overview and relief of the nerve over a very long pathway, with only a very small scar.

It is seldom necessary to carry out a more major operation to move the nerve to the flexor side of the elbow. 

One speaks of an overleg or medical ganglion when the joint capsule experiences a balloon-like protuberance through the synovial fluid. Over-legs can appear in different parts of the body. This is most common in hand surgery on the extensor and spoke side of the wrist. Also on the flexion side and spoke side of the wrist.

Typical symptoms of a ganglion are exercise-related pain. For example, very often pain when leaning on the stretched wrist. Also typical for the over leg are pain that occurs a little delayed to the load and persists after the load. Pain that does not respond to pain medication but gets better with rest and rest.

Such discomfort can occur before any swelling becomes apparent. Sometimes the legs are completely free of discomfort.

An ultrasound is often helpful in diagnosing a ganglion that has not yet been identified. I do this myself in practice.

Basically, an over-leg is harmless, but it can cause quite significant pain. An operation only needs to be discussed if the symptoms are disturbing. Basically, it's the patient's choice.

The first three fingers of your hand tingle, you wake up in the morning with numb hands and possibly even in pain, when you hold your hand in different positions (telephoning, reading the newspaper, driving a car) your fingers go numb? This suggests carpal tunnel syndrome.

Carpal tunnel syndrome is the most common nerve congestion syndrome and the most common surgery worldwide. Carpal tunnel syndrome is also very common at my consultancy.

The patient is usually referred to the neurologist first. He can measure whether the nerve is at all constricted, and if so, how severely. Once this measurement has been taken, it is usually decided whether an operation is necessary or not.

The carpal tunnel is a bony groove. The roof of the carpal tunnel is a band of connective tissue. This ligament is cut during the operation, thus creating more space in the carpal tunnel. When I perform this operation it is minimally invasive. Compared to the endoscopic procedure, this allows the nerve to be viewed during the operation and for peculiarities to be taken into account. 

This is an inflammation of two extensor tendons of the thumb in the first extensor tendon compartment, which is a tunnel-like structure above the distal radius.

Conservative treatment consists of wearing a wrist cuff with a thumb lock to rest the tendons. In addition, anti-inflammatory therapy (ergotherapy) should be carried out. If the anti-inflammatory, conservative therapy does not lead to healing, the problem can be fundamentally eliminated by splitting the first extensor tendon compartment during an outpatient operation.  

Snapping or trigger finger, also known as “mother’s thumb” (Tendovaginitis stenosans), is a mismatch between the flexor tendons and a tunnel (a ring ligament) under which the tendons run. The problem usually arises on the first of five ring ligaments. Any finger on either hand can be affected. The problem often manifests as a sticking sensation or trigger phenomenon in the affected finger. In many cases, the joint becomes gradually more painful and movement becomes increasingly restricted. Depending on the severity of the inflammatory or mechanical problem, it is treated with a dose of local anaesthetic or cortisone infiltrated by syringe. If the problem is predominantly mechanical, the problem can generally be resolved by widening the tunnel (“ring band splitting”). This relatively minor operation is performed as an outpatient procedure.