A carpal tunnel syndrome (CTS) is caused by increased pressure on a nerve (median nerve) in your wrist canal, also known as carpal tunnel.

A carpal tunnel syndrome is a common condition in both men and women. It is seen more in people with diabetes, thyroid disease, rheumatism. It can also occur frequently in pregnant women. However, often no underlying problems or conditions are seen.

Symptoms

The complaints are usually numbness and tingling in the hand and sometimes accompanied by pain. The complaints are usually located on the thumb, index finger, middle finger and ring finger or part of them. Over time, fine motor skills and strength may also be affected. Most complaints are often present at night and can lead to a bad night's sleep. Also certain daytime activities such as cycling, reading,... can lead to these complaints.

Diagnosis

Most often the diagnosis can be made as early as the consultation based on the patient's symptoms and the clinical examination by the doctor. If necessary, a nerve examination (EMG) may be requested to confirm the diagnosis.

G‍eneral treatment

Pain medication (anti-inflammatories), modification of activities or posture, night splint can sometimes lead to improvement of the symptoms. Especially in the early stages of the condition, symptoms may be relieved with an injection of cortisone.

In the end, an operation (Carpal Tunnel surgery) will often be necessary to be relieved of the complaints.

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A wrist cyst is a swelling at the wrist. It can occur on either the upper (dorsal) or lower (volar) side. They consist of a thin wall that is filled with fluid coming from the wrist joint.

Symptoms

A wrist cyst occurs very frequently and usually without an underlying cause. Often they cause no pain symptoms and thus do not require treatment. However, if the cyst grows larger, pain symptoms may develop.

Diagnosis

The diagnosis is usually made at consultation based on the clinical examination and the typical appearance of the wrist cyst. If necessary, additional ultrasound may be requested for confirmation.

‍General treatment

A wrist cyst should be treated only if it has become too large and is causing pain or movement restrictions. Draining the cyst is usually only a temporary solution.

Most often surgical removal of a wrist cyst is done anyway.

Dupuytren's disease is a benign condition in which nodules/lumps form in the palm of the hand, just under the skin. The nodules can connect with each other, forming strands in the palm and warping the fingers. Often this is a hereditary condition in which several people in a family suffer from the condition. The condition is much more common in men and is of northern European origin. It particularly affects the little and ring fingers. The first symptoms usually start at the age of 40 years

Symptoms

The first symptoms of the disease are, usually painless, small lumps or hardening in the palm of the hand. As the disease progresses, strands progressively form in the palm and over the fingers. Those strands will cause the fingers to become progressively more curved and, as a result, can no longer be fully extended. This, of course, will cause poorer function of the hand in day-to-day activities.

‍Diagnosis

The diagnosis of the disease is made at the consultation based on the clinical examination.

G‍eneral treatment

The disease itself cannot be cured to date. That is, preventive treatment for the disease makes no sense. Only if the fingers are crooked and this causes trouble with activities is treatment appropriate. The disease cannot be improved by medication or physiotherapy. 

Surgical treatment of Dupuytren's disease involves (partially) removing affected tissue in the palm and/or fingers.

Symptoms

This is a common disorder of the hand that involves a staggered sensation when stretching the affected finger. Sometimes the finger is blocked in a bending position and must be manually straightened back up with the other hand. This is usually accompanied by a shooting pain. Often there is also pain and a lump felt at the base of the finger, in the palm. 

The condition is caused by inflammation of the flexor tendon of the finger. It is more commonly seen in people with diabetes and rheumatoid arthritis but can occur in anyone.

Diagnosis

The diagnosis is usually made at the consultation based on the patient's symptoms and the clinical examination. If necessary, additional ultrasound may be requested to confirm the diagnosis.

‍General treatment

In the early stages of the disease, anti-inflammatories and rest can sometimes help. If insufficient, additional injections of cortisone may be given. If this is insufficient or if the symptoms return quickly, we usually proceed to surgery. For this surgery it is usually possible to go home after the surgery, so you don't have to stay overnight (day admission). The intention is to be able to move and use the finger quickly after the operation. Usually we count on about 6 weeks of rest during which no strenuous efforts should be made.

Osteoarthritis of the base of the thumb is a condition in which the cartilage a the bones at the base of the thumb has thinned or even disappeared completely. Osteoarthritis causes inflammation and especially pain.

Osteoarthritis of the base of the thumb is more common in women as early as age 40. Sometimes prolonged repetitive movements of the thumb and certain working conditions can accelerate osteoarthritis. A hereditary background may also be present.

Symptoms

Mainly the symptoms are pain a the base of the thumb and pain with certain gripping movements (opening a bottle or jar, tying a shirt,...) as well as reduced mobility of the thumb. As a result, the function of the hand deteriorates and we usually see external swelling at the base of the thumb. If the osteoarthritis worsens further, a deformity of the thumb develops.

Diagnosis

The diagnosis is made through a clinical examination and via imaging (RX or CT).

The treatment in the initial phase consists of rest, pain medication and a thumb brace. If this is insufficient, an injection of cortisone or gel may be given at the consultation to help with the pain.

If the complaints are insufficiently controlled or come back quickly, surgery is usually necessary.

There are 2 types of surgery possible, depending on the severity of the osteoarthritis. Either the bone, which is affected with osteoarthritis, is removed and replaced with its own tendon from the forearm (Burton Pellegrini surgery) or the joint at the base of the thumb is replaced with a prosthesis.

For both procedures, a one-night stay is recommended, especially to properly manage pain symptoms the first night. After the procedure, a cast is placed. After the cast, the thumb may be returned to progressively normal use, though initially with a protective brace. It is best to avoid heavier physical exertion during the first 2 months.

‍General treatment

In the early stages of the condition, anti-inflammatories and rest can sometimes help. If insufficient, additional injections of cortisone may be given. If this is insufficient or if the symptoms return quickly, we usually proceed to surgery. This surgery is possible through a day admission so you normally do not have to stay overnight. The intention is to be able to move and use the finger quickly after the operation. Usually we count about 6 weeks of rest during which no strenuous efforts should be made.

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A joint mouse is a loose piece of bone or cartilage. This can occur as a cartilage defect as described earlier, but is also often caused by a bone fracture or major accident to the ankle, which causes a loose piece of bone to enter the ankle.

Symptoms

This loose piece can then cause pain symptoms and "lock" the ankle.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

‍Treatment 

During keyhole surgery, this loose fragment is removed. 

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

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Painful entrapment symptoms (impingement) on the front or back of the ankle.

These entrapment symptoms can be caused by soft tissue thickening due to scar tissue, caused by, for example, twisting of the ankle. Ankle entrapment can also occur due to extra bone growth around the joint (osteophytes). These can also be caused by frequent sprains or a long-term high (sports) load. The entrapment caused by extra bone growth or by thickening of soft tissues mainly causes pain symptoms around the ankle and sometimes other sterile inflammatory reaction (heat, swelling).

During exploratory (keyhole) surgery, this tissue (soft tissue or bone) can be removed, so that the entrapment is resolved.

Symptoms

Pain, which occurs particularly during terminal movements of the ankle. They can also restrict movement by causing tissue entrapment.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

‍General treatment

During exploratory (keyhole) surgery, this tissue (soft tissue or bone) can be removed, relieving the entrapment.

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

When the ankle is twisted or sprained, the ankle ligaments may stretch or tear.

With an ankle sprain, the ankle often becomes immediately swollen and blue and is very painful. Usually an ankle can recover well after this with some rest (possibly a temporary cast and/or an ankle brace) and physiotherapy. If an ankle sprain occurs more frequently, symptoms may persist because the ankle ligaments have not healed properly. This can also damage cartilage of the joint.

Symptoms

• swelling
• pain
• frequent spraining of the unstable ankle

Diagnosis

The ankle specialist at the Orthopedics association n Sint-Trudo diagnoses ankle instability based on the patient's symptoms and physical examination. Imaging is also done to rule out that there is no fracture in the ankle, to see if the cartilage is damaged and which ligaments are damaged. This is usually done through a standard X-ray and/or an MRI scan.

Treatments

• Conservative treatment of ankle instability
• Operative treatment of ankle instability
• Arthroscopy of the ankle

Cartilage defects (osteochondral lesions) of one or more bone parts of the ankle (fibula, tibia, ankle bone). These can occur as a result of wear and/or (sports) injuries, but a cartilage defect can also occur spontaneously with no apparent cause.

Symptoms

With cartilage pathology, the ankle feels painful, unstable, is thick, "locks up" or creaks painfully and audibly. Basically, cartilage cannot fully repair itself because there are no blood vessels or nerves in it. Because of this, cartilage damage is not felt until the tissue around it becomes irritated. A small piece of cartilage may be broken locally, or the cartilage may be more or less damaged over the entire surface.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

‍General treatment

During keyhole surgery, a cartilage defect can be treated by "drilling up" the defect. First, this technique involves removing loose cartilage pieces and damaged cartilage. Then a thin drill is used to make holes in the bone layer below the cartilage. Bone marrow cells that can produce scar cartilage will now fill the holes in the cartilage. This stimulates repair of the cartilage.

In case the cartilage defect is a large loose fragment, the defect may also be cleaned and then the fragment fixed with a small screw.

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

Forced wear of the ankle joint

‍Treatment 

Through keyhole surgery, the remaining cartilage is removed and the bone is roughened to allow the tibia bone to attach to the talus bone. Two screws are usually inserted to attach the bones together. This procedure takes longer than the previously mentioned procedures.

It is, however, considered individually whether the arthrosis of your ankle can be fixed via keyhole surgery or open procedure.

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.