The team of orthopaedic surgery specialists at Clinique Paris Lilas are microsurgeons with expertise in hand and wrist surgery, which they perform exclusively.
Carpal tunnel syndrome is a common condition, especially in women over fifty, heavy workers and people suffering from certain illnesses (thyroid disease, diabetes, etc.).
This syndrome corresponds to compression of the median nerve in its narrow canal in the wrist area. This median nerve allows us to feel sensitivity in the pulp of the thumb, index and middle fingers.
Surgery allows the nerve to be freed endoscopically, i.e. not with a scar in the palm, but by making a one-centimetre skin incision hidden in a fold of the wrist.
The surgical procedure involves enlarging the tunnel through which the flexor tendons of the fingers and the median nerve pass. Performed under local anaesthetic in the upper limb, the endoscopic technique allows the patient to return to work more quickly than with open surgery. The operation is performed on an outpatient basis (without hospitalisation).
Babies, children and adults can all be affected by spring finger.
The flexor tendons of the fingers pass under tunnels opposite each phalanx, creating a "reflection pulley" to prevent the tendon from pulling away from the skeleton.
When the tendon thickens in certain places to form a nodule, often as a result of chronic inflammation, it becomes more difficult to slide under the pulley.
The phalanx suddenly blocks and then unblocks like a spring.
If the blockage does not disappear after an infiltration of a cortisone product with an anti-inflammatory action, the microsurgeon must then widen the pulleys to allow the tendon to slide again.
The surgical operation indicated consists of tenolysis, i.e. freeing the adhesions around the flexor tendons.
Dupuytren's disease affects 4 to 10% of the French population to varying degrees. A painless phenomenon, the fibrous membrane under the skin of the palms and fingers (palmar aponeurosis) thickens and retracts, causing one or more fingers to bend (the 5th and 4th fingers in three-quarters of cases).
When full extension of the fingers is no longer possible, two types of surgery are possible:
This involves simply cutting a flange (a strip of fibrous connective tissue). The operation is usually performed with a needle, under local anaesthetic. It cannot be used for all forms of Dupuytren's and there is a risk of recurrence.
This is the most common solution, but also the most radical and delicate, and must be performed by an experienced surgeon.
The surgeon removes all the bands and nodules responsible for the retraction of the fingers, while preserving the noble elements such as the tendons, nerves and vascular network.
Sometimes, a skin graft is necessary. Re-education is essential, often combined with a hand orthosis to optimise grip recovery and reduce the risk of recurrence.
Cysts of the wrist and fingers are particularly common. There are several types.
Synovial cysts, the result of a synovial hernia, are swellings filled with fluid from the joints (dorsal cysts of the wrist or pulse groove, on the anterior surface of the wrist). Synovial cysts form spontaneously or following trauma. The cysts are removed when they are painful or unsightly, under local anaesthetic and on an outpatient basis.
Some cysts, known as digital mucoid pseudocysts, develop opposite the fingertip joint. In 75% of cases, they are linked to osteoarthritis of the joint. Surgery is the only proven effective treatment. The cyst and often the damaged skin around it must be removed, and sometimes the corresponding osteoarthritic joint must also be cleaned. The procedure is meticulous to limit the risk of recurrence.
Fractures are varied, often affecting the wrist bones, the carpal bones including the scaphoid, the metacarpals or the phalanges.
If the fracture is not displaced and the bone is of good quality, orthopaedic treatment (immobilisation) is usually sufficient.
However, if these conditions are not met, the surgeon will perform an operation to reconfigure the initial shape of the bone and hold the fragments together while the bone consolidates. Depending on the type of fracture, there are techniques such as pinning, screwing, fitting plates or even devices such as an external fixator.
The operation is performed under local anaesthetic, usually on an outpatient basis. Some fractures, such as scaphoid fractures, may have gone unnoticed, or may have left sequelae that warrant surgery.
If the X-ray does not reveal a fracture, the trauma may correspond to a sprain, i.e. ligament damage to a joint.
The wrist ligaments play a major role in mobility and grip strength. If left untreated, they can lead to premature and disabling osteoarthritis. This is why these injuries need to be treated early, using specialised techniques.
The coexistence of a radiology department with magnetic resonance imaging (MRI ) and an arthroscanner (CT scan of a joint combined with the injection of a contrast product) enables optimum assessment. Thumb sprains, in particular, are a frequent sports injury and should be treated early. A specialist consultation is essential. It often needs to be combined with imaging to decide on the best treatment strategy, i.e. wearing an orthosis or surgical repair to reintegrate the ligament.
Diseases caused by osteoarthritis lead to pain, reduced grip strength and reduced joint mobility.
Osteoarthritis is defined as age-related degeneration of the cartilage. It should not be confused with arthritis, which is cartilage degeneration secondary to an inflammatory process.
The most common complaint is osteoarthritis of the base of the thumb, known as rhizarthrosis. It causes difficulty in using the pincer formed by the thumb with another finger.
It affects 20% of women and is more or less well tolerated. If conservative medical treatment combining rest, analgesics or anti-inflammatories and wearing a custom-made splint at night is insufficient, surgery may be proposed.
This often involves removing the diseased bone. Other solutions include fitting a prosthesis or arthrodesis. Arthrodesis blocks the damaged joint by fusing the bone.
This is another very common rheumatic disease. It disturbs the joint axis, reduces mobility and leads to the formation of pseudocysts. When medical treatment fails, or the patient experiences pain or finger deformities that are deemed unacceptable, the surgeon has a range of techniques adapted to each situation.
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Tél : 01 43 62 22 22
41-49 Avenue du Maréchal Juin, 93260 Les Lilas
