The Hand and Wrist Service forms part of a range of services provided by the Sussex MSK Partnership. It is a service provided by clinicians called Extended Scope Practitioners. These are specialist therapists with knowledge and skills in caring for patients with hand and wrist conditions. The aim of the service is to provide patients with a high quality service that is based in a community setting, such as a GP surgery.

Where are the Hand and Wrist Service clinics located?

Brighton and Hove:  Beaconsfield Medical Practice, Amex Diagnostic Treatment Centre
Crawley:
Crawley Hospital
Horsham:
Horsham Hospital
Mid Sussex:
The Vale

The following information is for all patients who have been offered an appointment in our service.

Who will I see and what will happen?

You have an appointment with a clinician who is best able to deal with your condition. Please allow about 30 minutes for your appointment (this may be longer or shorter depending on your clinical need). During the consultation:

  • You will be able to discuss your history and symptoms and the clinician will assess your condition.
  • You will get a chance to talk about different options for treatment, and receive information that will
    help you manage your condition.
  • The clinician will explain any medical treatments available, including risks and benefits.
  • Medical students or other trainee clinicians or colleagues may be observing in the consultation, as part of their training or supervision. The clinician will ask your permission for this to happen and it will only happen with your consent.

What should I bring? What else do I need to know?

  • Please bring a list of your current medicines, including prescribed and non-prescribed medicines (e.g. over the counter medicines and supplements). You do not need to bring your medicines with you.
  • If you have had a scan or X-Ray outside your local NHS provider, please send us your CD and contact us to arrange for these to be available at your appointment. Please bear in mind that it can take a long time to get hold of these, so the sooner you can let us know the better.
  • If appropriate, you may be offered a steroid injection during the appointment. Your clinician will always discuss this and ask for your consent first. If you do have an injection, you will be advised to rest for 30 minutes afterwards, and then consider whether you are safe to drive home.
  • Depending on your condition, you may need to expose your shoulder(s), so you can be examined properly.
  • You are welcome to bring a relative or a friend to your appointment. Alternatively, we can arrange a chaperone if you would like someone to be with you. This is an independent person specially trained to support patients. Please let our team know on 0300 303 8063 before the appointment if you would
    like a chaperone.
  • If you need an interpreter, please contact our team on 0300 303 8063 and we can arrange for one to be at the appointment with you. We can also arrange for interpreters for telephone appointments.

What will happen afterwards?

You will be able to discuss with the clinician what will happen next which may be one or a combination, of the following things:

  • You may be discharged from the service.
  • You may be sent for further tests, such as a blood test, x-ray or MRI scan.
  • You may be offered a follow-up appointment, either on the telephone or face-to-face.
  • You may be referred to a hospital of your choice if further advice or treatment is required.

Whatever happens, you will receive advice on how best to look after yourself and manage your condition. If you have any other questions, please let us know by contacting 0300 303 8063 where our team will be pleased to help you.

Advice and Exercises

Joint Protection

In inflammatory Arthropathy pain is a common symptom. Improper use of painful joints can lead to a decrease in hand function.  Joint stiffness, pain and swelling are often common experienced symptoms in this type of condition.    This is usually accompanied by a decrease in grip strength which at times can make life difficult. Below is general advice and guidance on how to  protect your joints.

What to Do

  • Try to balance activity and rest.   If possible avoid repeating an activity for a prolonged period of time.   If you work in an office, alter your activity throughout the day.   If your job involves typing, alternate typing with other activities such as photocopying, faxing etc.   This will protect your joints by using different muscles.
  • Prioritize your activity. When doing this, consider the length of time and the level of difficulty an activity can take.   It can be helpful to plan specific activities for peak energy times.
  • Where possible use larger and stronger joints for activities, for example use both hands to lift objects.   This will help to    distribute the strain over several joints.  If an object is heavy use a trolley to transfer objects.
  • Try to avoid tight grips.   Tight grips can put strain on joints particularly the small joints of the fingers.   If possible enlarging handles of everyday tools such as cutlery which will put less strain on joints and ensure the grip is more comfortable.
  • Avoiding a prolonged grip can also reduce pressure on your joints.   Holding a joint in the same position may cause stiffness and pain in the joint and surrounding muscles. Some activities such as writing or knitting require a prolonged and tight grip. It is important to continue the activities you enjoy however perhaps plan scheduled rest times and change activities frequently.
  • Change an activity involving small finger joint. Chunky gel pens would help you with writing.   Consider using a soft touch key board if you spend a lot of time typing. Use an easel if you like reading but avoid holding a book for a long period of time.
  • Where possible avoid lifting or carry objects which can put excess strain on joints.   Try sliding an object rather than lifting the object.   Use light weight utensils and a kitchen trolley if necessary.   Remember to think about your position when performing a task.
  • A good sitting and standing posture can help reduce the strain on your joints.   Ensure your chairs and bed provides adequate support and good positioning.
  • Avoid positions of deformity by using a relaxed grip.
  • Regular physical activity is important to maintain muscle balance, strength and range of movement in all joints in the body.   Regular exercise can assist you to avoid gaining weight and put extra strain on the larger joints such as the knees and hips.   See the Sussex MSK Central website for further information including signposting to local services.
  • Conserve your energy.   It is important to think about the way you do jobs at home and at work. Consider re- arranging your home/ work environment if necessary to enable you to avoid stooping or bending. Rest when possible and sit down if you feel tired.   Try to work on surfaces below your elbow level.   Use labour saving devices where possible and keep tools sharp.   Share and delegate jobs. Plan your days and week to avoid periods of overload.   Remember, there are not many things you should not do- it is the way in which you do them that matters.

General Finger Exercises

gf1

The following are specific exercises which will improve your finger movement.   When carrying out these exercises always rest your elbow on a table or a surface such as the armrest of an armchair.   Try and keep your wrist straight.

Step 1: Stretch your fingers up straight

gf2

Step 2: Keep your main knuckles up straight, and then bend your other finger joints.

gf3

Step 3: Bend all your fingers joints into a fist

gf4

Step 4: Bend your main knuckles but keep all other finger

gf5

Step 5: Bend your main knuckles and the next joint up.   Keep the last joint straight

gf6

Repeat the above exercises 10 reputations once or twice daily.   This will improve hand movement.

Arthritis of the Base of the Thumb

  hw1

Arthritis at the base of the thumb is very common.   It is a progressive condition.  At any state in time, symptoms can vary and at times, your thumb can become rather painful.  Pain is often one of the prime presenting symptoms.  Because of the pain, there is a tendency that movement at the thumb decreases and your grip strength also decreases.

Pain

Pain is an unpleasant sensation.   Pain present at the base of the thumb can limit day to day function.     A sustained grip, against resistance, for a long period of time can trigger pain.   The intensity of the pain usually depends upon the grade of joint narrowing present at the base of the thumb.

How to manage your Pain

There are different approaches to manage your pain.

  • Application of hot packs for 15 minutes might help to relief pain
  • Immersing hand in very hot water (as hot as you can tolerate it) and squeezing a sponge in hot water may also assist with pain relief. Squeeze sponge in hot water for 5 minutes, followed by pinching the sponge with tip of thumb against the tip of each individual finger. Carry out this exercise for a further 5 minutes.
  • Analgesia should be used on a regular basis.   During an inflammatory episode always make sure you have your analgesia every four hours for the following week.   This will help to decrease the inflammation and decrease the present pain   Consult your GP for advice regarding the most appropriate analgesia.
  • In cases where pain is severe, and you are rating your pain above 7 on a 10 point scale, corticosteroid might be able to relief the present pain. However this can only be possible if there is still space at the joint.   With this type of injection, cortico-steroid is mixed with local anaesthetic. This type of management is purely for pain relief. Joint injections do not cure the cause of arthritis.

hw2Application of pressure over the following trigger points might assist with pain relief.

Apply pressure over the first web space by pinching the painful thumb with the opposite thumb.   Then strengthen your fingers and thumb to feel the stretch where you are clipping.   Hold for 30 seconds and repeat for 10 times

Thumb Exercises

Movement of the thumb is very important in day to day function.   Hence the following exercises can assist to maintain and improve the movement in your thumb.  These exercises should ideally be carried out after warming up your hand by using either a hot pack (hot water bottle wrapped around your thumb, or a warm wheat bag wrapped around your thumb) or     immerse  your hands in warm water.  Heat relaxes the muscles and makes all structures in your hand softer and more pliable to movement.   It is quite common that your hands/ thumb can feel uncomfortable or slightly painful when carrying out these exercises.  This is because we are stretching all the joints in the thumb till the end of their range.   If pain is still present half an hour after exercising, you should reduce the number of repetitions.

Exercise 1: Thumb Abduction/Adduction

e1Place hand sideways on a surface.   Apply pressure over the base of the nail of the thumb, push thumb away from the palm.   Repeat for 10 times.  As pain starts to decrease, and you feel more comfortable with these exercises, some resistance can be applied.  This can be achieved by placing the index finger of the non-affected hand over the tip of the exercised thumb.  Apply some resistance against the tip of thumb and do the same described movement.   The amount of resistance should be enough to avoid/ produce any pain over the base of thumb.

Exercise 2: Palmar Abduction

e2Place hand over the boarder of the little finger.   Move the thumb towards little finger to touch the tip of the little finger then lift thumb back to the original position of the exercise.   Make sure you are not overstretching your thumb at the middle knuckle as this can cause more damage than help.  Always make sure that the tip of thumb, the middle knuckle of the thumb and the base of the thumb are always aligned in a straight line.  This will protect your joints and your soft tissues (i.e. ligaments at the base of the thumb).  Repeat for 10 times.

If no pain is present, resistance can be applied.   This can be achieved by placing the index finger of the non-affective hand over the tip of the exercised thumb.  Apply some resistance against the tip of thumb and do the same described movement.   The amount of resistance should be enough to avoid/produce any pain over the base of thumb.

Exercise 3: Thumb extension exercises

e3Place hand sideways.   Gentle apply resistance to the base of the nail of the thumb.  Move the thumb upwards towards the ceiling/ away from your fingers.   Your thumb should be kept in a straight line and moved towards the ceiling.  Repeat for 10 times.  If no pain is present, resistance can be applied.   This can be achieved by placing the index finger of the non-affective hand over the tip of the exercised thumb.  Apply some resistance against the tip of thumb and do the same described movement.   The amount of resistance should be enough to avoid/produce any pain over the base of thumb.

Exercise 4: Thumb Opposition

e4Touch tip of thumb to tip of index finger to form an ‘O’.   Hold this position for 3 seconds, then let go.   Repeat for 10 times.

If no pain is present, resistance can be applied.   This can be achieved by pulling the tips of the thumb and index finger as shown in the first picture.  Maintain the contraction for 3 seconds.    The amount of resistance should be enough to avoid/produce any pain over the base of thumb.

Exercise 5: Web space exercises

e5Place hand flat on a surface.   With other hand apply some pressure over the middle joint of the index finger.   In addition try and move thumb towards and away from the index finger.  Maintain the contraction of the index finger for 3 seconds and move the thumb three times.   Repeat this exercise 10 times.

This exercise will help to improve the muscles between the thumb and the index finger. This is one of the main muscles which tends to become rather weak during the process of arthritis at the base of the thumb.

Activity Modification

If any activity or tasks are aggravating your symptoms, you ought to modify your activity.     When you are diagnosed with arthritis at the base of the thumb, any lateral pinching which tends to aggravates yours symptoms should be restricted.    Such activity is believed to elicit pain over the base of the thumb.   Therefore avoid

  • Any tight lateral pinch.   Use the palm of both hands to open jars or bottles
  • Always scoop objects using fingers, if pain is present at the base of the thumb
  • Use assistive devices if need be for better mechanical advantage

Thumb Dexterity Exercises

Hand dexterity always tends to decrease as arthritis in the base of the thumb tends to progress. In late stages fine motor movement tends to become rather difficult. The following are some exercises which can help maintain your dexterity.

  • Use a small marble or a very small ball and with the tip of the exercised thumb move the ball with the thumb in a rotating mode. Start clockwise for 10 repetitions then anticlockwise
  • Hold the marble or ball with tip of the exercised thumb, and move the thumb forward and backward in a straight line
  • Use two marbles or two Chinese balls and try and start moving them in your hands by alternating/ rotating their position within your hand.   Repeat this for about 5 minutes. If thumb starts to become painful, build up your exercises

Useful Resources

Carpal tunnel Syndrome

This is a very common condition treated in our service.   For further information about the condition please click on the following link:

Condition

Surgery

Cubital Tunnel Syndrome

This is a condition which causes pins and needles over the tips of the little and ring finger.   For further information about the condition please click on the following link:

Condition

Surgery

DeQuervain’s disease

This is a condition where pain over the wrist could affect hand function. For further information about the condition please click on the following link:

Condition

Surgery

Dupuytren’s Disease

This is a condition where any of your fingers could be affected.   For further information about the condition please click on the following link:

Condition

Surgery

Finger Joint Arthritis

Arthritis of the fingers is a common condition. For further information about the condition please click on the following link:

Condition

Further information

Finger Fusions

PIPJ Replacement

MCPJ Replacement

Inflammatory Arthropathy

Inflammatory Arthropathy is a group of conditions where inflammation is present within the joint.   For further information about the condition please click on the following link:

Gout and Pseudogout

Rheumatoid arthritis

Ganglia

Finger Ganglia

Mucoid Cyst

This is a small cyst which can develop over the end joint of a finger, just below the nail bed.   For further information about the condition please click on the following link:

Condition

Surgery

Seed Ganglia

This is a small cyst which appears over the base of a finger.   For further information about the condition please click on the following link:

Condition

Surgery

Wrist Ganglia

These ganglia are very common around the wrist.   For further information about the condition please click on the following link:

Condition

Surgery

Thumb Base Osteoarthritis

This is a very common form of osteoarthritis.   Symptoms are often intrusive.  For further information about the condition please click on the following link:

Condition

Surgery

Trigger Finger/ Thumb

This is a very common condition which can affect any finger or thumb.   Symptoms are quite uncomfortable.   For further information about the condition please click on the following link:

Condition

Surgery

Thumb Ulnar Collateral Ligament injury

This injury is also known as Skiers thumb or Gamekeepers thumb.   It usually results from a forceful injury where the thumb gives way.   For further information about the condition please click on the following link:

Condition

Surgery

Arthritis of the Wrist

This is a common condition which can develop in the wrist.   Symptoms can vary depending on the area involved. For further information about the condition please click on the following link:

Scaphoid Trapezium Trapezoid Osteoarthritis

Surgery

Osteoarthritis of the Distal Radio- ulnar joint

Condition

Surgery

Multiple joint osteoarthritis of the wrist

Condition

Surgery

Further Information

Scaphoid Lunate Ligamentous Injury

The Scaphoid lunate ligament is one of the ligaments present in the wrist. This ligament can be damaged following a fall onto the outstretched hand.   For further information about the condition please click on the following link:

Condition

Surgery

Triangular Fibro- Cartilaginous Complex (TFCC) Injury

This is an injury to one of the ligaments present in the wrist which lies just below the base  of the little finger.  This can cause pain.  For further information about the condition please click on the following link:

Condition

Surgery

Tendonitis

This is an inflammation around or within a tendon.   There are various factors which can cause this.  For further information about the condition please click on the following link:

Condition

 

Workshops

Here are some information from our Hand and Wrist classes, these have been developed and approved by our clinical staff to be the best information for patients.

If you have a diagnosis which does not have a leaflet above, then please contact our clinical support team on 0300 303 8063 and they will work with our clinical team to find you some more information.