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Hand Surgery

Both surgeons at the Cape Joint Surgery maintain a keen interest in hand surgery, a sub-speciality in orthopedics which overlaps with plastic surgery to some extent and requires meticulous technique and soft-tissue management. Dr Engela was involved with the Groote Schuur Hospital hand clinic for many years and was the driving force behind the establishment Read on … !

Hand Problems in Adults

Non-traumatic hand problems in adults are extremely numerous and both diagnosis and management are challenging. Some of the most common conditions are discussed below. Even these fairly straightforward problems are unfortunately prone to misdiagnosis and injudicious surgery.

Ganglion Trigger Finger Carpal Tunnel Syndrome Ulnar Nerve Entrapment Arthritis of the thumb and fingers Dupuytren’s contractures Nerve Read on … !

Hand Problems in Children

Children may be born with hand problems, defects or extra digits. These are best treated by super-specialized combined plastic surgical or orthopedic surgical congenital hand units such as the one at Red Cross Children’s Hospital.

Trigger fingers is one type of hand problem that can occur in children and are usually managed non-surgically until the Read on … !

Hand Clinic

The Constantia hand clinic was established more than 15 years ago. The hand clinic has been specifically set up in order to provide a comprehensive service to patients with acute and chronic hand conditions. This is done in conjunction with hand therapists.


The Cape joint surgery continues to provide a extensive elective hand service, Read on … !

Finger Dislocation

Finger dislocation is one of the most underrated injuries in the hand mostly by rugby players that “just pull it back into position”. The injury is more serious and is associated with ligament damage and often bone damage that may require more treatment.

If Finger dislocation is left untreated the fingers tend to become Read on … !

Thumb Arthritis

Thumb Arthritis or Arthritis of the base of the thumb (carpo-metacarpal arthritis or CMC OA) is the most common site in the hand to be affected and has a good outcome after surgery should conservative treatment with splinting and cortisone injections not be successful.

All other joints of the wrist and hand can be involved Read on … !

Subacute Osteitis

Subacute osteitis is a rare condition, which may occur around the hip in young children. This usually results after a bone infection has been partially treated with antibiotics, which were discontinued too early. The diagnosis may not have been made in this case is often when antibiotics were prescribed empirically for a child which was Read on … !

Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis consists of a spectrum of inflammatory arthropathys which affects children (girls in the early teenage years more often than boys). The patients present with synovitis of various joints (usually a polyarthropathy (more than one joint involved), although initial presentation may be in the form of a monoarthropathy). The wrist-, knee-, and ankle Read on … !

Hand Trauma in Children

Hand injuries are always serious problems and should be seen by a specialist hand surgeon. This is not because surgery is frequently necessary, in fact the opposite holds true, the reason is that all hand injuries require multi-disciplinary rehabilitation from day one in order to prevent disasterous complications such as stiffness.

Finger dislocations are injuries Read on … !

Trigger Finger

A trigger finger presents as a finger that clicks or is stuck in flexion, often associated with pain due to swelling and inflammation (synovitis) of the tendon.

The treatment of choice for trigger finger is a cortisone injection into the tendon sheath and if this is not successful, then surgical release of the tendon Read on … !

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition due to compression of the Median nerve in the wrist. The most common symptoms of Carpal Tunnel Syndrome include pins and needle feeling in the hand often associated with pain in the hand and forearm mostly at night or the early hours of the morning. The symptoms may vary Read on … !

Scaphoid Fractures

Scaphoid fractures are often difficult to diagnose and may end up with non-union if not treated correctly in the early phase of the injury. Repeat radiographs or MRI scans may help to detect scaphoid fractures. There are different treatment options available for the treatment of Scaphoid fractures including cast application, splinting and surgical fixation. Non-unions Read on … !

De Quervain's Tenovaginitis

De Quervain’s Tenovaginitis of the first extensor compartment of the wrist is a common problem in adults of various ages and mostly has an insidious onset without any predisposing factors. Patients usually complain of severe pain over the thumb-side of the wrist, which is exacerbated when the thumb is gripped in the palm and the Read on … !


Muscles are connected to bones via tendons and these structures are often placed under tremendous strain during physical activity, especially during sporting activities. Some of these structures, such as the tendons of the rotator cuff in the shoulder run over bony ridges or through bony canals, which may cause friction or impingement, leading to recurrent Read on … !

Wrist Arthroscopy

Both surgeons at the Cape Joint Surgery have experience in Wrist arthroscopy.

Wrist Arthroscopy is keyhole surgery of the wrist which is an important tool to treat and make a diagnosis in certain conditions. Wrist fractures into the joint can be seen and accurately reduced and fixed. Triangular fibrocartilage (TFC) tears can be treated. Ligament Read on … !

Dupuytren's contracture

Dupuytren’s contracture is a disabling condition which affects mostly men. The fibrous tissue layer in the palm of the hand shortens over time and prevents various fingers from fully extending. It is often surprising how severe these contractures become before patients seek orthopaedic attention.

Basically, with Dupuytren’s contracture, once the hand can no longer Read on … !


A ganglion is not simply a herniation of the small joints in the hand and wrist. These lumps may be sentinels for more serious problems such as inter-carpal (small bones of the palm) ligament degeneration. Pressure on adjacent structures such as nerves may occur. Ganglia are often painful and will require initial treatment with needle Read on … !

Forearm fractures

The forearm consists of an articulation between the radius and ulna which effectively extends from the elbow to the wrist. Any fractures along this length, forearm fractures, are managed as fractures involving a joint and therefore require accurate reduction and internal fixation, unless they remain undisplaced with plaster cast and/or splint treatment. Surgical internal fixation Read on … !


Osteoporosis is a condition which occurs in postmenopausal females as well as elderly males due to a change in the hormone milieu in the body. This condition decreases the density of the bone (i.e. not simply a decrease in the calcium content, which only forms part of the bone components) and predisposes patients to so-called Read on … !