Hand and wrist surgery: conditions treated, tests and what to expect

Hand surgery includes bone and joint problems, tendon and nerve conditions, soft tissue disorders such as Dupuytren contracture, injuries including tendon and nerve repair, and reconstruction. In the UK, hand surgeons are usually orthopaedic or plastic surgeons who have completed their general surgical training and then a hand surgery fellowship, and the British Society for Surgery of the Hand (BSSH) is the professional body. Hand therapists, usually occupational therapists or physiotherapists, provide splints, exercises and wound care alongside the surgeon.

Because hands are used for almost everything, even a modest problem can affect work, sleep, driving or hobbies, which is why the specialty places weight on function rather than appearance.

The NHS describes carpal tunnel syndrome as pressure on the median nerve in the wrist, causing aching, numbness, tingling and pins and needles, weakness of the thumb or difficulty gripping, often worse at night. Risk factors include pregnancy, being overweight, repetitive wrist bending or gripping with vibrating tools, arthritis or diabetes, and a family history. A night splint is the first step and can take up to 6 weeks to help; a steroid injection may follow, though the NHS notes it is not always a cure. If it worsens or other measures fail, referral for surgery is considered, and the NHS says surgery usually cures carpal tunnel syndrome.

Nerve conduction tests are used when the diagnosis is uncertain, and the NHS says scans such as ultrasound or MRI may also be used. Cubital tunnel syndrome is compression of the ulnar nerve at the elbow, which typically causes tingling in the ring and little fingers; it is assessed similarly and sometimes treated with night positioning, activity changes or surgery to release or move the nerve.

Dupuytren contracture happens when tissue under the skin of the palm thickens and tightens, mostly affecting the ring and little fingers, often in both hands, and tending to worsen slowly over months or years. The NHS links it with family history, smoking, heavy alcohol use, diabetes and epilepsy. Three main treatments are listed: fasciectomy (the affected tissue removed, with a recovery of 4 to 12 weeks and the lowest chance of recurrence), needle fasciotomy (up to 2 weeks recovery, but more likely to come back) and dermofasciectomy with a skin graft.

Trigger finger is a thickened tendon that catches as a finger or thumb bends, causing clicking, stiffness and sometimes pain, worse in the morning. The NHS lists age over 40, diabetes and rheumatoid arthritis as risks, and treatments of painkillers, splinting, steroid injection and, only if these fail, surgery. De Quervain tenosynovitis affects the tendons at the thumb side of the wrist and is managed in a similar stepwise way.

A ganglion cyst is a smooth, fluid-filled lump, usually on the wrist or hand near a joint. The NHS says most do not need treatment, but they can be drained with a needle, injected with steroid or removed surgically, and a removed cyst usually does not return though it sometimes can.

The BSSH says the joint at the base of the thumb often becomes arthritic with age, with osteoarthritis usually appearing after 45. Treatment options typically include splints, injections and, where those fail, surgery on the joint. Wrist and finger joint arthritis follow a similar pattern, and inflammatory conditions such as rheumatoid arthritis need rheumatology input as well.

Fractures of the wrist, scaphoid and metacarpals, cut tendons and nerve injuries need early assessment because delays can limit recovery. A hand that is cold, pale, numb after injury, or has a deep wound or deformity should be seen urgently.

Clinicians usually diagnose from the history and examination of grip, sensation, movement and tendon function. The NHS says carpal tunnel syndrome can usually be diagnosed by asking about symptoms and checking the hand.

On the NHS, a GP can refer to a hand clinic, and the NHS says that in many areas you can refer yourself to community MSK services for physiotherapy without seeing a GP. The national standard for starting treatment is 18 weeks from referral, and in England you may be able to use the Right to Choose to pick a provider for consultant-led care. Many hand operations, including carpal tunnel release, trigger finger release and ganglion removal, are done as day cases under local anaesthetic.

Privately, you can self-refer to a consultant or be referred by your GP. Insurers typically ask for a referral letter and pre-authorise the procedure. Costs depend on the consultation, imaging, nerve tests, the surgical setting, anaesthesia, hand therapy sessions and any follow-up. Ask what is included and whether therapy is part of the quote.

• Note which hand you use most, your job and hobbies, and which activities set off symptoms.

• Bring a list of conditions such as diabetes, thyroid disease or arthritis, because they affect nerves and tendons.

• Ask what happens if you wait, since some conditions can be watched and others, such as persistent numbness with muscle wasting, should not be left.

• Ask about recovery, driving, time off work and what hand therapy would be needed.

• Seek urgent help via NHS 111, A&E or 999 for a hand that is hot, red and very painful, a deep cut with numbness, a finger that cannot bend after injury, or a hand that is pale, cold or blue.