What are Congenital Hand Conditions?

Congenital hand differences affect approximately 1 in 2000 live births. It is the second most common congenital anomaly after heart conditions. Some congenital hand differences can affect the form and function of childrens’children’s hands, with lasting impact into their adulthood. Our specialists are world experts in congenital hand surgeries and have published several high impact papers that affect patient care (see list here). Since the 1980s, we have treated children from Singapore, the wider Asia Pacific region, and other countries.

Our practice is based mainly at KK Women’s and Children’s Hospital, the flagship paediatric hospital of Singapore. The multidisciplinary team consisting of surgeons, therapists and psychologists treat the entire range of congenital hand conditions, including the following:

• Extra digits e.g. thumb polydactyly, mirror hand
• Fused digits or syndactyly
• Wrist conditions like Radial club hand and Madelung’s deformity
• Short fingers or symbrachydactyly
• Large fingers or macrodactyly
• Missing fingers or thumb

Our Specialists

Meet the specialists who treat this condition:

• Assoc Prof Lam Wee Leon
• Dr Darryl Chew Ee Ming

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.

What are Nerve Injuries and Disorders?

Carpal Tunnel Syndrome

The nerves to our upper limb play an important role in providing movement, power and sensation. Nerve injuries can be devastating injuries and range from lacerations of the small nerves in our fingers to major ones like the brachial plexus in our necks. The symptoms can range from numbness to paralysis. Nerves can also be damaged by compression. Several compressive disorders like carpal tunnel syndrome remain the commonest conditions treated in our department.

Other than the general hand clinic, the department also runs a complex nerve clinic that caters to the entire range of nerve conditions including brachial plexus injuries, thoracic outlet syndrome and nerve tumours. By offering a one stop shop for surgical solutions to a variety of nerve disorders, we are able to help restore patients’ function and lives.

Nerve Compression

Nerve compressive disorders in the upper limb commonly affect the median nerve, ulnar nerve and radial nerve. They can present with numbness of the fingers as well as difficulty in gripping and are often a result of compression on the nerve from surrounding tissue.

Some of the common conditions include:

• Carpal Tunnel Syndrome
• Lacertus Syndrome
• Cubital Tunnel Syndrome
• Radial Tunnel Syndrome

These conditions can be improved with surgical release of the compression. Where applicable, we also offer endoscopic surgery, which has the same results as the traditional open approach but leaves a smaller scar.

Brachial Plexus Injuries

The brachial plexus is a complex network of the nerves to the upper limb following their exit from the spine and before they enter the limb proper. It controls movement and sensation to the entire upper limb as well as the shoulder and part of the back. Injury to the brachial plexus can result in significant weakness and numbness over affected areas. They can occur as a result of car accidents, shoulder dislocations, stab wounds, or even at birth.

Following investigations, we offer highly specialised surgery to explore and repair the brachial plexus through microsurgical nerve repair and nerve grafting. Where direct repair is not possible, we offer procedures such as nerve transfers, tendon transfers and tendon release as well as free functioning muscle transfers to improve functional outcomes.

Our unique Complex Nerve Clinic offers comprehensive care to patients with advanced nerve damage, where cases can be discussed in further detail with patient centred discussion. We work closely with our team of hand therapists to support rehabilitation and integration back to work and daily life.

Our Specialists

Meet the specialists who treat this condition:

• Dr Robert Yap Tze Jin
• Assoc Prof Lam Wee Leon
• Dr Joyce Tie Lin

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.

What Causes Spasticity and How Common is it?

Stroke is a prevalent condition in our society. There are close to 10000 new cases of strokes per year in Singapore alone and millions worldwide. Although a significant proportion of patients recover, there remain many with permanent disabilities. At least 75% of these have ongoing issues with the upper limb, interfering with activities of daily living including hygiene, feeding and dressing.

Spasticity is a condition where the arm and hand are unable to relax and over time, can result in contractures. Spasticity is usually the result of strokes or traumatic brianbrain injuries. In children, cerebral palsy can also result in spasticity.

Another important manifestation of stroke and related disorders is paralysis or loss of coordination (dystonia). Over time, contractures can result in the arm and wrist/fingers stuck in certain positions, resulting in loss of function as well as difficulty in caring for hygiene. Patients often complain of problems with posture, pain and disuse.

Our department specialises in management of these disorders. Our dedicated Spasticity and Rehabilitation (SPaR) Clinic for such patients provides holistic care pre- and post- surgery in a multidisciplinary setting. We work closely with our rehabilitation department to provide patients with the best care.

Some surgical interventions can include delicate operations such as muscle and tendon releases, as well as tendon transfers. Hyperselective neurectomy is a recently introduced procedure that is groundbreaking in its efficacy and low recurrence rate. The procedure aims to reduce tone through a one stage operation and can also potentially improve dystonic symptoms.

Our surgeons and rehabilitative physicians lecture regularly both nationally and internationally to share our expertise in many conferences and workshops.

Our Specialists

Meet the specialists who treat this condition:

• Assoc Prof Lam Wee Leon
• Dr Chung Sze Ryn

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.

What are Degenerative Disorders in the Hand and Wrist?

  
Mucoid Cysts

Degenerative hand conditions are extremely common.

Over time, our joints degenerate as part of aging. The cartilage lining the ends of the bones wear away, causing bones to rub directly on each other end-on-end. This can result in painful, swollen and stiff joints. Our therapists provide comprehensive care with activity modification advice and specific therapy services eg heat therapy, bracing and splinting.

Dorsal wrist ganglion

Traditionally, joint fusion can be considered for those with debilitating pain that cannot be managed conservatively. However, recent advances have allowed the design of new implants.

Base of Thumb Arthritis

X-ray image of thumb carpometacarpal osteoarthritis (1st CMC OA)

For osteoarthritis of the 1st carpometacarpal joint, the joint at the base of the thumb, we are the first centre in Asia to offer patients the TOUCH® Dual Mobility Implant. This implant has shown promising 5 year results with reduction in pain while preserving excellent range of motion thereby improving functional outcomes and restoring quality of life.

We are also the first centre in Asia to publish a substantive series with the use of this implant.

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.

What are Tendinopathies?

Trigger finger

Inflammation to the tendons are common from overuse and occasionally trauma in our fast-paced society with high work demands. They can cause finger pain and wrist pain on moving.

Common conditions include:

• Trigger finger or thumb
• De Quervain’s tenosynovitis
• ECU tendinitis
• Repetitive strain injuries

These conditions can typically be managed with a trial of immobilisation and rest through splinting, or injection (steroids, platelet-rich plasma); following which, surgical release of the enclosing tissue (i.e A1 pulley for trigger finger, 1st extensor compartment for De Quervain’s tenosynovitis) can be done through a short operation under local anesthesia.

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.

How Common are Hand Infections?

Infection Flexor Tenosynovitis (left) and Iinfection Paronychia (right)

Our hands are the gateways to our lives. They are therefore at an increased risk to infections. As the hand and wrist are composed of multiple joints and soft tissue compartments, it is important to treat infections correctly as these can spread rapidly from one compartment to another.

These infections commonly occur after introductory trauma (e.g., animal bites), and patients with poorly controlled diabetes are at higher risk. Early debridement of infected and unhealthy tissue is important to reduce further spread of the infection.

Some infections of the hand include:

• Paronychia
• Felon
• Flexor tenosynovitis
• Septic arthritis
• Osteomyelitis

For soft tissue infections where appropriate, our hospital is the only one in Singapore to provide minimally invasive surgery in the form of catheter irrigation. This aims to reduce scarring, length of hospital stay, and extent of devitalised tissue. View more about primary care for hand infections here.

Every consultant in our department manages patients with infections, which can often require urgent attention; if you suspect an infection, please consult your GP promptly or visit the Emergency department.All of our consultants treat patients with infections. As infections often present as an emergency it is important to see your GP as soon as possible or to attend the Emergency department.

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.

Why do our Hands Get Injured?

Finger laceration

The bones and ligaments of the hand are delicate and trauma to the hand through accidents and falls can result in fractures, dislocations, and injury to the ligaments or tendons of the hands and fingers. Following radiological imaging (e.g. X-rays, MRIs), such conditions can be treated via casting and splinting or surgically where appropriate. Some symptoms of hand trauma include significant or persistent pain, deformity, drooping of the finger, and difficulty in moving.

Distal Radius Fracture

  
Radiographs showing a fractured finger that has been fixed with a plate to correct the displacement and angulation 

Make an Appointment

Singapore citizens may visit the SGH Appointment Page to make a referral.
For overseas referrals, please submit your request via FormSG.