Mr George-Malal treats a variety of orthopaedic hand and wrist conditions at his NHS and private practice. Typical conditions are triggering of fingers, contractures of the hand, compression of nerves producing pins and needles or numbness, Ganglion cysts, aches and pains of the hand and wrist, whether it be due to wear and tear, inflammation or arthritis.
We rely on our hands for so much, and hand or wrist pain can severely impact your quality of life. Mr George-Malal would initially try non-operative treatment modalities including injections and physiotherapy to restore hand and wrist strength and a full range of function and motion. Mr George-Malal is supported in treating your hand and wrist problems by an experienced team of occupational and hand therapists.
Surgery is often only required for a small minority of patients and will be advised if it is the most appropriate course of action.
Some of the standard wrist and hand conditions that Mr George-Malal treats include the following:
Carpal tunnel syndrome occurs when the median nerve is compressed in the carpal tunnel as it passes across the wrist. Typically, you’ll experience a ‘pins and needles’ sensation and weakness in the fingers, which is usually worse early in the morning or might wake you up from sleep. There is often no specific cause, but it can be worsened by repetitive strain and certain medical conditions. If conservative, non-surgical treatments fail to improve CTS, Mr George-Malal may advise Carpal tunnel decompression surgery. This is a day case procedure usually performed under a local anaesthetic and involves dividing a ligament to relieve pressure on the nerve.
Ganglion cysts are very common and present as a small swelling, usually on the top of the wrist where it joins the hand. These cysts are benign, but they can sometimes be painful, affect hand function, and be an aesthetic concern. Exactly why they develop isn’t known, but it can result from repetitive strain, causing synovial fluid to build up and form a sac. Once a ganglion cyst is diagnosed, Mr George-Malal can you advise you on the appropriate treatment option. This includes aspiration or surgical removal through minor surgery.
Also known as palmar fibromatosis, Dupuytren’s contracture is a benign hand condition where hard nodules form beneath the skin of the palm. It can cause the fingers to pull into a bent position. Dupuytren’s is usually a genetic condition, and it can affect other areas of the body. Symptoms typically start with a swelling in the palm and, in some cases, worsen over time to affect your ability to straighten your fingers. Mr George-Malal may advise surgery in these cases. Depending on the severity of the condition, this can either be a needle fasciotomy to divide the tissue cord that is tightening the finger, or open release and removal of the cord. Very severe cases might also need skin to be grafted into the area.
Trigger finger occurs when the tendons which move the thumb or fingers becomes inflamed and trapped in the sheath within which it moves. It is usually caused by age related changes but can also result from trauma, repetitive strain or certain medical conditions. It can be very painful and affect your quality of life. Trigger finger may improve with conservative treatments such as rest and analgesics, the use of a splint or steroid injections. Severe or recurrent cases might need surgery which entails cutting the tendon sheath to increase the space for the tendon to pass through.
