For General Practice

This is probably the most common hand condition that we see in our clinics, yet still remains controversial. At present the Scottish Government is auditing the management of this condition in all hospitals in Scotland.

An area often forgotten about is the distal radio-ulna joint. Tradionally the distal ulna was excised (Darrach’s Procedure) if troublesome, either from arthritis at the DRUJ or from abutment into the lunate.

There is no fixed angle of contracture where we decide to operate. The main advice we can give is – when the patient finds the contracture interferes with activities of daily living or hobbies.

Ideal patients would be those who are low demand due to systemic conditions such as rheumatoid disease, or those over 65 who have retired.

Trapezectomy has now become more of a popularised procedure for basal thumb OA.

Steroid injection is the main stay of treatment.

This procedure has been performed for over 25 years, but originally with the silicone Swanson Replacements. Pain relief has always been good, but function and movement have been disappointing.

Wrist arthroscopy allows visualisation of the radio-carpal and midcarpal joint. It allows staging of cartilage injury in patients with SLAC or SNAC wrists: i.e. those who have developed OA after a scaphoid non-union or ligament injury.