ABOUT HAND AND WRIST PAIN TREATMENT
The base of the thumb joint is called the ‘Carpo-meta-carpal (CMC) joint’. This joint is prone to wear and tear, also known as ‘Osteoarthritis’.
The symptoms associated with this is a gradual worsening of the
- decreased strength
- loss of joint function
In moderate to severe cases of arthritis, a lump around the joint location can be seen. This is due to the enlarged or bony overgrowth due to bony repair.
Middle of the thumb joint called MCP (Metacarpophalangeal) joint, MCP joint is also prone to develop arthritis, but less common compared to the base of the thumb.
If you are experiencing painful joints, muscles, tendons or ligaments please get in touch for a diagnostic scan and or treatment
Who is prone to develop?
Occupations involving the repetitive use of the thumb joint, such as builders, butchers, carpenters, chefs, drummers, computers and keyboard users, engineers, housekeepers, plumbers, and painters. Other locations of hand /wrist prone to Arthritis:
- Radiocarpal joints
- Distal radio-ulnar joint
- Scapholunate joint
- Meta Carpo-phalangeal (MCP) joints.
- Interphalangeal joint (PIP/DIP)
- Scapho-trapezio-trapezoid joint (STT joint)
hand and wrist pain conditions treated
- De Quervain's Tenosynovitis
- Trigger finger /thumb
- Carpal Tunnel (Median nerve) syndrome
- Ganglion cyst aspirations and infiltrations
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is an inflammation of the tendon sheath around the tendons (Abductor pollicis longus, Extensor pollicis brevis) that supply to the thumb.
• You may notice swelling /lump in between the base of the thumb and wrist.
• Very painful to move the thumb. Ex: Pinching, grasping, lifting, wringing.
• Make a fist by placing the thumb inside the palm and bend the wrist towards your little finger – if it causes pain, this can be due to De Quervain’s tenosynovitis.
- Any repetitive activities, such as sports, hobbies, typing, carpentry, painting, decorating can lead to this condition.
- This condition is commonly seen after pregnancy.
- In some cases cause is unknown.
If your symptoms do not improve with pain, rest, physiotherapy, medication you will benefit from an Ultrasound diagnostic scan to confirm the diagnosis and guided steroid injection to reduce the inflammation.
Surgery may be needed if you are not responded to the steroid injections.
Trigger finger /thumb
This is an inflammatory condition, which affects the tendon that catches or locks when tried to bend or straighten the affected finger or thumb. Tendon catching is due to the swollen nodular part of the tendon that cannot move freely throughout the tendon sheath.
- The sudden or gradual development of snapping tendon.
- You may feel a lump at the base of the finger – due to nodular thickening the tendon.
- Snapping/catching is more common in the mornings.
- Rheumatoid arthritis
- Occupation involving repetitive usage of hands/wrists.
Ultrasound sound can diagnose the trigger finger and helps to guide the needle to accurately infiltrate Corticosteroid injection to the problematic area. Prior to this rest, ice and physiotherapy are suggested.
Carpal Tunnel (Median nerve) syndrome
In this case, the median nerve is entrapped in the wrist at the carpal tunnel level.
- Loss / weak grip strength.
- .sually worse at night and in the morning.
- Tingling/pins and needles in the thumb, ring and middle finger.
- Reduced sensation/ numbness along the thumb side of the wrist
- Wrist tendons tenosynovitis
- Mass/cyst in the carpal tunnel
- Wrist injury
- Family history
Steroid injections can reduce the inflammation around the nerve and bringing the symptoms. Sometimes you may need another injection in a few months’ time. Surgery is needed if steroid injection fails to control the symptoms.
Ultrasound-guided injection ensures the steroid injection is carried out around the nerve, without actually damaging the nerve itself.
Ganglion cyst aspirations and infiltrations
A ganglion cyst is a thick fluid-filled sac, usually appears in the middle of the back of the wrist or front of the wrist on the thumb side.
- Not harmful, but It can be painful at times.
- It looks and feels like a smooth lump under the skin.
A ganglion cyst sometimes resolves on its own, other times, it requires aspiration of cystic fluid. Diagnostic ultrasound ensures the diagnosis of cyst and accurately aspirate the fluid/gel.
FREQUENTLY ASKED QUESTIONS ABOUT ULTRASOUND GUIDED INJECTIONS
How long does an ultrasound guided injection take?
This will vary dependant on the area and other factors, but an assessment, scan & ultrasound-guided injection will generally take around 60 minutes. Ultrasound guided injection alone is done in a few seconds. Injection alone is carried out in few seconds.
Are ultrasound guided injections painful?
Discomfort from the needle insertion can be minimised by using the local anaesthesia using a very fine small needle. Ram is an experienced and carried out more than 30,000 Ultrasound guided injections sofar. He routinely treats complex patients and patients with needle phobia, through the technique he developed through his experience.
What is an ultrasound guided cortisone / Steroid / Corticosteroid injection?
Cortisone injection is also known as Corticosteroid injection or steroid injection. This is a strong anti-inflammatory medication is used for many of the inflammatory and arthritis conditions to control pain, swelling, stiffness and improve function. Corticosteroid injections are NOT the same used by body builders use. Corticosteroid injections do not cause weight gain. To find out more please visit our ultrasound-guided steroid injections page from the 'Types of Guided injection' menu on the top.
Always, consider having the Steroid injections under ultrasound guidance for accuracy.
What is an ultrasound guided hyaluronic acid (HA) injection?
HA injection is also known as Gel injection or Lubricant injection. This viscosupplementation injection is a natural component of synovial fluid. This tends to increase joint fluid viscosity and restores the joint lubrication. Hence, acts as a shock absorber to control the joint /tendon symptoms. Limits the further damage to the joint and delays or avoids the need for the surgery. Aslo, helps to enjoy your daily activities or your preferred hobbies. To find out more please visit our GUIDED ULTRASOUND HYALURONIC ACID INJECTIONS page from the 'Types of Guided injection' menu on the top.
These injections are very popular, especially for knee joint pain. Any number of injections can be taken in a given period, due to minimal or no side effects from these injections. Usually a course of 3 Injections are preferred, though some may do well just with an injection per year 9 we have patients managing just with 1/year.
What is an ultrasound guided PRP injection?
Platelet Rich Plasma (PRP) injections are rich in growth factors ( helps in repairing the cell and its growth) and prepared from the patient's own blood. Separated growth factors from the patients blood is injected back into the affected area of the same patient. Due to PRP's ability to heal and even regenerate injured or aging tendons, ligaments and joints, providing some patients with an alternative to surgery. PRP therapy may reduce the required healing time for the injuries ( especially for sports injuries and early Arthritis ); otherwise athletes/ sports professionals may require longer periods of rest from their sports related activities. To read more please visit our Ultrasound Guided PRP page.
Always, consider having the PRP injections under ultrasound guidance for accuracy.
can i drive after an injection
You will not be able to drive immediately after the procedure. Bring someone with you Or use other form of transport to return home. This is mainly due to your driving licence policy, rather injection efficacy. Majority of the motor insurance policies will not allow you to drive for 3-5 hours after the injection with Local Anesthesia.
What should i expect after an injection?
After the injection you may feel pain free for couple of hours due to Local anaesthesia. However, pain returns after 2 hours, you may even feel more painful for couple of days due to bruising pain. Usually, you should starts feeling better from third day onwards. Pain relief from the steroid injection may take 1 to 2 weeks.
How to manage bruising pain?
Discomfort from the needle insertion can be minimised by using an ice pack ( wrapped in a towel, to minimise the risk of frostbite from a direct skin contact) to the area of treatment. 3-4 times a day and 10-15 minutes at each time
Will i always feel 100% pain free?
We can accurately inject the treatment area. However, pain relief depends on several factors, such as severity of the problem, body response to the steroid injection, rest period following an injection, rehabilitation and exposing to the risk factors.
how many injections can i receive?
corticosteroid Injections: 3 or 4 per treatment area / year.
Hyaluronic Acid : no limit as long as you are benefiting.
Platelet Rich Plasma (PRP) a course of 3, you can repeat as you like.
What conditions can be treated?
Arthritis, Tendinopathies, Ligament, Muscle and Nerve related problems. We also offer trigger point injections for persistent pain ( usually a course of 2-5 are effective).
How long the injection effect lasts?
It is hard to determine without an assessment. It may be possible to estimate after assessing the patient. Usually, lasts up to 3 months. There are many patients who benefited for more than a year to 2 years.
AREAS COVERED BY JOINT CARE CLINICS
We cover a wide area throughout Warwickshire and surrounds, either by home visit or clinics in the following areas: Rugby, Coventry, Warwick, Aylesbury, Milton Keynes, Leamington Spa, Stratford, Kenilworth, Whitnash, Atherstone, Bedworth, Leicester and Nuneaton. We also have clinics throughout the West Midlands including Birmingham and Solihull. We have a clinic in Newcastle covering the North East.
If you do not see your area listed please still get in touch as we may be able to refer you to another practitioner in your area.