We recommend that adults and children over 12 wear face masks when attending our clinic, but no longer provide masks to patients and carers. Videoconsultations are conducted via telehealth at our dedicated virtual clinic. We are experiencing high demand for appointments hence 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. If our surgeons assess that your condition (especially recent injuries) is best managed with hand therapy rather than surgery we may recommend that you see a qualified hand therapist (physiotherapist or occupational therapist) rather than schedule an appointment with our surgeons. Dr Tomlinson will cease to offer consultations and surgical services where a Medicare Rebatable Item Code does not apply from 1 July 2023. This includes injections for palmar hyperhidrosis. If you are eligible to get vaccinated and/or boosted, please do. so.

Osteoarthritis

Created 03 January 2012, last modified 24 December 2013

Definition

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 200x145 Digital 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

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:

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