Hand problems?

Let us help you!

doktorno@kezklinika.hu
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Introduction

dr. Judit Réka Hetthéssy

Hand Surgeon at the Department of Orthopaedics Semmelweis University

Hand problems are quite common and may make day-to-day life difficult. Consultation, examination to find the cause of the problem and treatment options are available.

I graduated from the Faculty of Medicine Semmelweis University in 2005. For almost a decade I worked at the Department for Traumatology, Pediatric Traumatology and Hand and Microsurgery at the National Center for Traumatology as a resident and later as a trained orthopedic and traumatology surgeon. After finishing my training in orthopedics and traumatology (specialization exam in 2012 with excellent result) I trained as a hand surgeon and passed the National Hand Surgical Specialization Examination in 2015 with an excellent result. In 2016 I passed the European Board of Hand Surgery Diploma Examination.

During these years I laid great emphasis on training abroad. I was awarded the Traveling Fellowship of the Federation of European Societies for Surgery of the Hand (FESSH), and spent the fellowship at the Klinik für Plastische und Handchirurgie UniversitätsSpital in Zürich, Switzerland (2012 October-November). I also had the opportunity to learn about modern concepts in hand and especially wrist surgery during a Leonardo Mobility Grant at the Hand und Plastische Chirurgie Orthopädische Klinik in Markgröningen, Germany (2013 November-2014 January). In 2016 I was awarded a scholarship by the European Wrist Arthroscopy Society, and had the opportunity to visit the Institute of Plastic Surgery and Hand in Santander, Spain (2016 April-May). In 2016 I was also awarded the Travelling Fellowship of the American Society for Surgery of the Hand, and had the opportunity to visit several hand sugery centers in the United States including the Hospital for Special Surgery in New York, and the Mayo Clinic in Rochester.

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dr. Hetthéssy Judit Réka fotó
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Symptoms

What can I help you with?

  1. Tunnel syndromes

    Pain, paraesthesia and nocturnal pain in the fingers may draw attention to a tunnel syndrome.

    What is a Tunnel Syndrome?

    The nerves innervating our and fingers may come under chronic pressure at certain defined points, this is what we call tunnel syndrome. Typically this occurs where the nerve passes through a U shaped bony tunnel. The ligament at the top of the tunnel may lose its elasticity and become rigid due to certain circumstances (i.e. over-exertion, smoking). This closes the U-shaped tunnel, the nerve comes under chronic pressure and the tunnel syndrome develops.

    What symptoms may occur in a Tunnel Syndrome?

    Symptoms are defined be the nerve that has come under chronic pressure.

    Carpal Tunnel Syndrome occurs when the median nerve comes under chronic pressure. The median nerve gives sensory innervation to the thumb the index, the middle and half of the ring finger and innervates most of the muscle pad around the thumb. Most commonly carpal tunnel syndrome is caused by thickening of the ligament (carpal ligament) passing transversely above the nerve at the base of the palm. Leading symptoms of Carpal Tunnel Syndrome are: tingling, pain or numbness in the thumb the index, the middle and half of the ring finger often accompanied by nocturnal pain and cramping, loss of dexterity and perhaps wasting of the muscle pad surrounding the thumb.

    Cubital Tunnel Syndrome occurs when the ulnar comes under chronic pressure at the elbow. The ulnar nerve gives sensory innervation to the half of the ring finger and the little finger and innervates most of the muscle pad around the little finger. It also innervates most of the “small muscles” of the hand responsible for dexterity. Most commonly Cubital Tunnel Syndrome is caused by thickening of the ligament passing transversely above the nerve at the elbow. Leading symptoms of Cubital Tunnel Syndrome are: tingling, pain or numbness in half of the ring finger and the little finger often accompanied by nocturnal pain and cramping, loss of dexterity and perhaps wasting of the muscle pad surrounding the little finger.

    Guyon Tunnel Syndrome occurs when the ulnar comes under chronic pressure at the wrist. The ulnar nerve gives sensory innervation to the half of the ring finger and the little finger and innervates most of the muscle pad around the little finger. It also innervates most of the “small muscles” of the hand responsible for dexterity. Most commonly Guyon Tunnel Syndrome is caused by thickening of the ligament passing transversely above the nerve at the wrist. Leading symptoms of Guyon Tunnel Syndrome are: tingling, pain or numbness in half of the ring finger and the little finger often accompanied by nocturnal pain and cramping, loss of dexterity and perhaps wasting of the muscle pad surrounding the little finger.

    Examination

    If the examining professional (hand surgeon) suspects a Tunnel syndrome based on the above symptoms, physical examination, “nerve conduction” studies (measuring nerve function) and perhaps an ultrasound of the nerve may be necessary.

    Treatment

    Mild Carpal Tunnel Syndrome may be treated with anti-inflammatories and night-time splinting with the wrist in a neutral position.

    If the results of the examinations point to more severe degree of Tunnel syndrome, or if conservative treatment was unsuccessful surgery may be necessary.

  2. Ganglion cysts on the hands

    Typically ganglion cysts appear on the back of the wrist, the base of the palm, at the base of the fingers in the palm of at the end of the fingers on the back side as a “lump”. This lump may be painful.

    What is a ganglion cyst?

    Ganglion cysts balloon out of the joints or tendon sheaths. They are usually filled with thick fluid. It is unclear exactly what causes ganglion cysts to form, but their appearance may be related to injuries, overexertion or degenerative changes in the joint.

    What symptoms may a ganglion cyst cause?

    Typically ganglion cysts appear on the back of the wrist, the base of the palm, at the base of the fingers in the palm of at the end of the fingers on the back side as a “lump”. This lump may be painful.

    Examination

    If the examining professional (hand surgeon) suspects a ganglion cyst based on the above symptoms, physical examination, X-rays and perhaps an ultrasound of the nerve may be necessary. X-rays may reveal underlying bony pathologies. Ultrasound may be used to confirm the clinical diagnosis of the ganglion cyst, and to better delineate its border and relationship to surrounding tissues.

    Treatment

    It is not absolutely necessary to excise ganglion cysts surgically. Treatment options should be discussed with the treating hand surgeon.

  3. Dupuytren’s disease

    Dupuytren’s disease is characterized by the inability to extend one or more fingers and is accompanied by a knot or a cord palpable under the skin.

    What is Dupuytren’s disease?

    Dupuytren’s disease affects a layer of tissue under the skin. As this layer changes knots and cords appear in the palm of the hand. Eventually these cords pull the fingers into a bent position, and the patient is unable to extend (stretch) the fingers. The exact cause is unknown, but genetic factors, diabetes and smoking may play a role in the appearance of Dupuytren’s disease.

    What symptoms does Dupuytren’s disease cause?

    Usually Dupuytren’ disease is a painless condition, however the knots in the palm may be tender. Leading symptoms are: Inability to extend the affected finger from its bent position, and palpable cords and knots in the palm.

    Examination

    If the examining professional (hand surgeon) suspects Dupuytren’s disease physical examination is usually enough to make a clinical diagnosis.

    Treatment

    In mild cases of Dupuytrens disease surgery is usually not recommended. If the cords pull the fingers further into a bent position surgery may be indicated.

  4. Trigger finger

    Difficulty or Inability to flex of extend a finger may be sign of a trigger finger. Extension of the finger is usually accompanied by a painful snapping/popping of the finger.

    What is a trigger finger?

    Harmonious bending-stretching of the fingers is ensured by a series of “ligaments” called “pulleys” aiding the movements of the tendons that bend the fingers. If one of these pulleys thickens and becomes rigid (i.e. due to over exertion) the tendon will catch on this pulley, making bending-stretching of the finger painful and often difficult. This is a trigger finger. When the finger is finally stretched it may be accompanied by a snapping/popping sensation.

    What symptoms does trigger finger cause?

    In early stages bending and stretching the finger is accompanied by discomfort and later by a snapping/popping sensation, which may be accompanied by pain. Trigger finger may lead to limited finger movement.

    Examination

    If the examining professional (hand surgeon) suspects trigger finger physical examination is usually enough to make a clinical diagnosis.

    Treatment

    Mild cases of trigger finger may be treated with anti-inflammatories. In more severe cases surgery may be indicated. During surgery the “pulley” on which the tendon catches is released, removing the cause of the trigger finger.

  5. Thumb arthritis (thumb basal joint arthritis, CMC I joint arthritis)

    Pain provoked by certain thumb movements may draw attention to Thumb arthritis (thumb basal joint arthritis, CMC I joint arthritis).

    What is thumb arthritis (thumb basal joint arthritis, CMC I joint arthritis)?

    Thumb arthritis develops when the cartilage of the basal joint of the thumb wears away. This may be accompanied by inflammation of the inner lining of the joint (synovitis) and pain.

    What symptoms does thumb arthritis (thumb basal joint arthritis, CMC I joint arthritis) cause?

    In thumb arthritis it is characteristic for the pain to be provoked by certain movements of the thumb (i.e. twisting movements, unscrewing a bottle etc.)

    Examination

    If the examining professional (hand surgeon) suspects a thumb arthritis based on the above symptoms, physical examination and X-rays may be necessary.

    Treatment

    Mild thumb arthritis may be treated with anti-inflammatories and night-time splinting. In certain cases the injection of steroids into the joint may be beneficial, and they may relieve symptoms.

    If the results of the examinations point to more severe degree of thumb arthritis, or if conservative treatment was unsuccessful surgery may be indicated.

  6. Rheumatoid hands

    Recurring inflammatory joint problems may draw attention to rheumatic diseases.

    What are rheumatoid hands?

    Investigating, diagnosing and medical treatment of rheumatic diseases is carried out by doctors specializing in rheumatology. However the recurring inflammations in the hand may lead to states that require the attention of a hand surgeon.

    What are characteristic symptoms of a rheumatoid hand?

    Recurring inflammation in the joints of the hand, wrist and fingers, accompanied by inflammation around the tendons are typical in rheumatism. We may also see early-onset thumb arthritis.

    Examination

    If the examining professional (hand surgeon) suspects a rheumatoid alterations on the hand and wrist based on the above symptoms, physical examination and X-rays may be necessary.

    Treatment

    In mild cases the inflammation may be treated with anti-inflammatories and night-time splinting. In certain cases the injection of steroids into the joint (usually the thumb basal joint in thumb arthritis) may be beneficial.

    If the results of the examinations point to more advanced stages of disease, or if conservative treatment was unsuccessful surgery may be indicated.

  7. Congenital hand deformities

    A wide variety of congenital anomalies may appear on the hand. The fingers may vary in number (i.e. supernumerary digits - polydactyly), length (short digits), structure and angulation (campodactyly, clinodactyly) or size (giant digits-macrodactyly). We may encounter “webbed digits” (syndactyly), or split hand (cleft hand). Congenital trigger thumb (pollex flexus congenitus) is relatively common. Bending and stretching of the thumb may be limited and painful. Bending and stretching of the thumb may be accompanied by a painful snapping/popping sensation.

    In more severe cases surgery may be indicated.

    In case of webbed digits (syndactyly) better function may be achieved by separating the digits surgically.

  8. Post-injury states

    Fractures, dislocations and ligament injuries are common on the hand and wrist. Post-injury states (pain, limited range of motion etc.) may require the attention of a hand surgeon.

  9. Tumors of the hand

    Slow or rapid growing “lumps” may appear on the hand and wrist. This lump may be painful. Examination, establishing a diagnosis may require a hand surgeon. Surgery may be indicated.

  10. Tenosynovitis, DeQuervain Syndrome

    Pain provoked by certain thumb movements may draw attention to DeQuervain Syndrome.

    What is DeQuervain Syndrome?

    Long-standing or recurring over-exertion of the thumb may lead to tenosynovitis, and inflammation around the tendons, and at a later stage DeQuervain Syndrome may develop. The tendons moving the thumb are surrounded by a tendon sheath, which may become thickened and rigid due to certain circumstances (i.e. over exertion). This causes the movement of the tendons within the tendon sheath to be painful or even limited.

    What symptoms occur with DeQuervain Syndrome?

    In the early stages of DeQuervain Syndrome certain movements of the thumb may cause discomfort. In later stages these movements may provoke sharp pain.

    Examination

    If the examining professional (hand surgeon) suspects Dupuytren’s disease physical examination is usually enough to make a clinical diagnosis.

    Treatment

    Mild cases of DeQuervain Syndrome may be treated with anti-inflammatories and night-time splinting. In more advanced cases, or if conservative treatment was unsuccessful surgery may be indicated to release the thickened tendon sheath.

*Should surgery be neccessary procedures are performed at the Orthopaedic Department of Semmelweis Univesity.
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Reservations

You can find me here

Tuesday
17:30-19:30

Menta Egészségközpont
1115 Budapest Bartók Béla út 92-94 II. Floor, building B, stairwell II
Entrance from "Benedikt Ottó" street

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Consultation available
National health insurance card “TAJ kártya” and referral from GP “háziorvos” is NOT necessary

Pre-arranged appointment is necessary

To make an appointment 06 1 209 3355
9:00-15:30: 06 1 466 9878
Wednesday
10:00-14:00

Semmelweis University Department of Orthopaedics
1082 Budapest, Üllői út 78/b

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Consultation and operative procedures available.
National health insurance card “TAJ kártya” and referral from GP “háziorvos” is necessary

Pre-arranged appointment is necessary

To make an appointment 06 1 209 3355
9:00-15:30: 06 1 466 9878
Weekdays

Semmelweis Egészségügyi Kft
1082 Budapest, Üllői út 78/b

assignment_turned_in

Consultation and operative procedures available.
National health insurance card “TAJ kártya” and referral from GP “háziorvos” is NOT necessary

Pre-arranged appointment is necessary

To make an appointment 06 1 209 3355
9:00-15:30: 06 1 466 9878
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