Orthopedics and traumatology
Orthopaedics and Traumatology
Queste specialità si occupano di studiare l’apparato locomotore e di diagnosticare e trattare le patologie che interessano ossa, articolazioni, legamenti, tendini e muscoli.
Orthopedics specifically studies pathologies:
- Of the spine
- Of the shoulder
- Of the hand
- hip
- Of the knee
- Of the foot
The trauma is concerned with all injuries resulting from trauma to bones (fractures), tendons, muscles, ligaments, and joints.
- Spinal pathology
- Kyphosis and Scoliosis of Childhood and Adolescence
- Cifosi e Scoliosi dell’adultoKyphosis and Scoliosis of the Adult
- Osteoporosis and vertebral failures
- Disc hernias
- Spondylitis and Spondylodiscitis
- Primary and/or secondary tumors of the spine
Shoulder pathologies:
- Sub acromial conflict syndrome
- Rotator cuff injury
- Shoulder instability and dislocation
- Arthrosis with possible prosthetic treatment (total prosthesis, resurfacing prosthesis or reverse prosthesis).
- Pathology of the Hand
- Carpal tunnel syndrome
- Canalicular syndromes of peripheral nerves (ulnar at elbow and ulnar at wrist)
- De Quervain’s syndrome
- Finger Snap
- Trapeziometacarpal arthrosis or Rizoarthrosis
Hip pathologies
- Arthrosis with possible treatment with prosthesis using minimally invasive surgical technique
- The Acetabular Conflict
Pathologies of the Knee
- Arthrosis with possible prosthetic treatment (total prosthesis or monocompartmental prosthesis)
- Meniscal injuries
- Cartilage lesions and their treatment by conservative therapy with chondroprotective drug infiltrations, hyaluronic acid, and/or viscosupplementation
- Ligamentous injuries and in particular the anterior cruciate ligament
- Femororotulae syndrome
- Patellar tendinopathies
Foot Pathologies
- Hallux Valgus
- Metatarsalgia
- Hammer fingers
- Congenital malformations such as congenital clubfoot, hypometrae and superadducted 5th toe
- Flatfoot of the child and adolescent
- Canalicular syndromes (tarsal tunnel syndrome and/or Civinini Morton syndrome)
- Plantar fasciitis
Regarding Traumatology at the Casa di Cura San Rossore, all types of fractures, non-emergency, of both children (above 4 years of age) and adults can be treated with open techniques and possible prosthetic, minimally invasive and percutaneous replacements.
Inoltre possono essere diagnosticate e trattate (con le migliori tecniche mini-invasine) le lesioni tendinee quali la lesione del tendine di Achille, la lesione del tendine rotuleo e la lesione del tendine quadricipitale, l’epicondiliti (gomito del tennista) e le tendinosi associate a peritendiniti dell’achilleo e del rotuleo.Regarding Traumatology at the San Rossore Treatment Center, all types of fractures, non-emergency, of both children (above 4 years of age) and adults can be treated with open techniques and possible prosthetic, minimally invasive and percutaneous replacements.
Performance and therapy
The trend in surgery today is to use increasingly innovative and minimally invasive techniques in order to reduce complications, but more importantly to improve and shorten the postoperative recovery process. Percutaneous foot surgery is a revolutionary surgical technique that fits well into this process. In fact, due to its minimally invasive nature, it is rapidly gaining popularity in foot surgery, increasingly replacing traditional so called “open” techniques.
Invented in the 1990s by Stephen Isham, founder of the Academy of Ambulatory Foot and Ankle surgery, and called M.I.S. (Mini Invasive Surgery), the technique was imported to Europe and developed by Spaniard Mariano De Prado. In recent years this technique has evolved naturally and is now performed in a very different way from what Dr. De Prado taught and described, whose basic principles, however, still remain valid. This method allows the correction of major forefoot disorders such as hallux valgus, hammer toes, metatarsalgia and 5th toe deformities. Some hindfoot pathologies such as calcaneal spur, Haglund’s heel can also be treated, and some surgeons have also begun to perform calcaneal osteotomies. Of course, percutaneous surgery also makes it possible to treat different but associated foot diseases simultaneously. Bone and soft tissue corrections are made with dedicated instrumentation through mini-incisions. This instrumentarium is very small and simple: microblades for skin incisions and any sections of tendons and joint capsules, spatulas with the function of creating a safe working chamber in which to introduce and operate the small surgical instruments, rasps to remove debris and bone material formed by the abrasive function of the burs, motorized burs with an abrasive function on bone prominences and a cutting function to reorient and correct bone deformities. Through the skin incision, it is thus possible to perform precise surgical gestures that can affect both soft and bony parts. Generally, these surgical gestures are performed under control of radioscopic images generated by a brilliance apparatus.
Surgeries are always performed under loco-regional anesthesia, that is, by small doses of local anesthetic to the ankle and foot; the average duration of a procedure is between ten and twenty minutes, and the access routes are so small that patients often mistakenly feel that they have been operated on with a laser. Surgery is usually performed on a day-surgery basis, and the patient is discharged walking as early as a few hours after surgery with a suitable flat, rigid-soled shoe. The foot is wrapped with a functional bandage, which is critical to achieving the result. In fact, the maintenance of the correction, obtained during surgery, will not rely on metal synthesis means, but precisely on the bandage that the patient will have to wear for about a month after surgery. Postoperative pain is usually reduced to a sensation of discomfort and is easily controlled with common analgesics. Another advantage of this technique, in addition to its minimally invasive nature, is the absence of pneumoischemia: in contrast to open surgery, no pneumoischemic tourniquet is used in the thigh or leg to prevent blood flow into the surgical field. By not using the tourniquet, all the complications associated with it can be avoided, and it is also possible to refer patients with peripheral vascular deficits to the procedure, reducing the risks of vascular complications. The combination of the aforementioned advantages makes the percutaneous technique particularly welcome by patients and connotes it, in some cases, as surpassing traditional open techniques, which nonetheless continue to have their application. In fact, percutaneous techniques cannot and should not be used indifferently in all pathologies and all patients, but only when these are harbingers of real benefit. This surgical technique in the right indications greatly reduces postoperative complications, accelerates postoperative recovery, and is an aesthetically unsurpassed surgery because it leaves imperceptible scars. Postoperative pain is very low and the period of immobility is minimized, and for all these reasons it is very agreeable to the patient.
Vascular surgery
Vascular surgery
Vascular Surgery is that branch of Surgery that deals with the prevention, diagnosis and treatment of vascular diseases in general (arteries, veins, lymphatics).
Diagnostics – Executable examinations:
- Specialist examination vascular surgery
- Specialist examination angiology
- Specialist phlebology examination
- Echocolordoppler examination cerebroafferent vessels (carotid, vertebral)
- Arterial and venous echocolordoppler examination of the lower limbs
- Arterial and venous echocolordoppler examination of the upper limbs
- Echocolordoppler examination of abdominal vessels (aorta and iliac vessels, cava and iliac veins)
- Echocolordoppler examination of renal and visceral arteries
- Saliva (DNA) tests for cardiovascular risk assessment and thrombophilia
- Assessments of vascular malformations
- Diagnosis and treatment of deep and superficial venous thrombosis
Outpatient treatments
- Sclerotherapy of capillaries, reticular veins, varices
- Lower extremity varices with minimally invasive techniques (lkaser, radiofrequency, sclerotherapy, CHIVA) under ambulatorial and under local anesthesia
- Mechanical lymphatic drainage (or pressotherapy) for edema or phlebolymphedema
- Elastocompressive bandages
- Treatment of ulcers and skin injuries in general (decubitus, phlebostatic, lymphatic, arteriopathic ulcers)
- Heterologous skin grafts
- Small amputations in patients with diabetic foot
- Incision and drainage of hematomas
Surgical interventions:
- Lower limb varices with the following techniques
- Stripping
- Laser or radiofrequency
- CHIVA
- Sclerotherapy and scleromousse
- Simple phlebectomies
- Interventions for hemorrhoidal goiters with HELP Laser technique;
- Incision and drainage of thrombosed hematomas and varicose goiters
- Placement of central venous catheters (PIC, PORT etc)
- Placement of caval fiilters (in the prevention/treatment of thromboembolism)
- Peripheral angioplasties in arteriopathic patients
- Major and minor lower limb amputations
- Treatment of vascular malformations
Referring specialists
Neurosurgery
Neurosurgery
Casa di Cura San Rossore represents a center of excellence for Neurosurgery in Pisa.
In fact, he performs neurosurgical procedures for the treatment of all diseases of the central and peripheral nervous system, but especially those complex and difficult-to-treat tumor, vascular, malformative, and disembiogenetic diseases affecting the deep parts of the brain and skull base:
- Meningiomas
- Neurinomas of all cranial nerves (acoustic, optic, oculomotor, trigeminal, glossopharyngeal, accessory, hypoglossal among the most relatively frequent)
- Jugular glomus tumors
- Hemangiopericytoma
- Chondromes and Chordomes
- Pituitary adenomas
- Epidermoids and Dermoids
- Craniopharyngiomas
- Neuroblastomas
- Pineal gland tumors
- Gliomas
- Arachnoid cysts
- Germinomes
- Arteriovenous malformations (Angiomas)
- Cavernous angiomas
- Cerebral aneurysms
- Neurovascular conflicts (Trigeminal, facial, glossopharyngeal, spinal accessory neuralgia), caused by abnormal contact between affected artery, vein, and nerve
Performance and therapy
The following spinal disorders are treated at the Casa di Cura San Rossore.
- Lumbago and lumbosciatica
- Lumbar disc hernia
- Cervical and Thoracic Disc Hernia
- Lumbar, Cervical and Thoracic Stenosis
- Lithic and degenerative spondylolisthesis
- Osteoporotic, traumatic and neoplastic vertebral fractures
- Primary or secondary vertebral neoplasms
- Spondylitic infections and spinal abscesses
- Spinal neurinomas and meningiomas and spinal cord neoplasms
- Adult degenerative kyphosis and scoliosis
- Idiopathic scoliosis of the adolescent
- Rheumatoid arthritis spinal pathology
The center specializes in:
- Treatment of spinal and nerve pain with echo and radioguided techniques
- Osteoporotic fracture treatment with vertebroplasty
- Microsurgical and minimally invasive treatment of lumbar and cervical degenerative pathology (disc herniations and stenosis)
- Open and/or minimally invasive treatment of lumbar spondylolisthesisLumbar spine arthrodesis surgery with open and/or minimally invasive technique with screw fixation and posterior( PLIF ,TLIF), lateral (XLIF) and anterior (ALIF)
- Anterior or posterior arthrodesis surgery of the cervical spine
- Vertebral excision and reconstruction for secondary vertebral neoplasms
- Microsurgical removal of spinal neurinomas or meningiomas
Gynecology and obstetrics
Gynecology and obstetrics
Type of examinations that can be performed:
- Routine hematochemical screening
- Hormone assays for endocrine metabolic evaluation
- Cervico-vaginal pathology screening
- Colposcopy, hysteroscopy
- Bone densitometry
- 3D gynecological ultrasound
- Video surgery service
- Minimally invasive gynecological surgery for treatment of benign pathologies and oncological pathologies
MININVASIVE SURGERY
Treatment Benign Pathologies:
- Uterine fibroids
- Abnormal uterine bleeding
- Ovarian cysts
- Endometriosis
- Adnexal pathologies
ONCOLOGIC PATHOLOGY TREATMENT
- Endometrial cancers
- Cervical cancers
- Ovarian tumors
LASER SMOOTH™ (FOTONA)
Minimally invasive treatment for functional restoration of vaginal structures. The technology consists of a totally safe laser treatment that requires no anesthesia because it is completely painless, with no incisions or stitches. Treatment is outpatient, rapid, and normal daily activities can be resumed immediately.
Laser Smooth™ (Photon) treatment applies to the following cases:
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- Stress urinary incontinence
- Vaginal atrophy
- Vaginal dilatation
Otolaryngology
Otolaryngology
The Otolaryngology outpatient clinic at the Casa di Cura San Rossore in Pisa is concerned with the study and treatment of the full range of pathologies affecting the anatomical districts of the head and neck, as well as the ear, nose and paranasal sinuses, oral cavity, pharynx, larynx, salivary glands and facial nerve and tear ducts.
For this purpose, state-of-the-art diagnostic techniques such as rigid and flexible endoscopes are routinely used, allowing an ideal approach for earlier and better diagnosis that can provide more targeted therapy.
Generally, the ENT examination does not require sedation, and there are no age restrictions. Reporting is immediate.
Instrumental and diagnostic procedures such as:
- fibrolaryngoscopy
- Rhinoscopy with rigid optics
- Tone and impedance audiometric examination
- Clinical test of vestibular function
- Assessment and counseling for snoring and sleep apnea.
Otolaryngology outpatient activities also involve close collaboration, in a multidisciplinary mode, with other services within the clinic: Radiology, Dermatology, Allergology, Pneumology, Neurology, Neurosurgery and Ophthalmology.
In case of surgical indication, the patient is given the option of being followed in ordinary hospitalization or in day hospital, at the inpatient wards of the San Rossore Nursing Home, which, being equipped with two operating rooms that have state-of-the-art technical instrumentation as well as an intensive care unit, can allow all types of surgical treatment to be performed including those of high complexity.
Performance and therapy
Nasal cytology is a simple, noninvasive and painless method for the study of inflammatory nasal diseases, especially nonallergic rhinitis and nasosinus polyposis. It consists of sampling and microscopic study of mucosal cells of the lower turbinate, taken with a small soft plastic spoon (called Rhinoprobe or Nasal Scraping) and analyzed under an immersion microscope at 100x magnification. Nasal cytology provides the basic elements to diagnose the various forms of nonallergic rhinitis, allows the identification of mixed rhinitis, that is, in which allergic rhinitis overlaps with nonallergic rhinitis, and to set up the most correct therapy. In patients with polyposis, moreover, nasal cytology allows us to study their “level of aggressiveness,” stratifying cases from the simplest to the most complex. The examination is very easy to perform, and can be performed in all patients, including children.
Olfactometry is a noninvasive examination for measuring the sense of smell. It is a subjective, noninvasive test that is performed on an outpatient basis. It is performed by means of Sniffin Sticks, markers soaked in odorous substances, which, in various ways, are made the patient sniff them. The comprehensive olfactometric examination consists of several parts, including the screening test, discrimination test and identification test, all of which are designed to study olfactory ability as a whole. Indeed, there are many nasal and extra-nasal pathologies that can be associated with partial (hyposmia) or complete loss of the sense of smell (anosmia), with significant repercussions on quality of life, nutrition (e.g., difficulty in identifying spoiled foods), and even the sense of taste. Olfactometry helps quantify olfactory loss and check for improvement after appropriate therapies.
Colon-proctological surgery
Colon-proctological surgery
Hemorrhoids or hemorrhoid pathology is the most frequently encountered proctological disease. It is estimated that about 50 percent of the population over the age of 50 in most industrialized countries suffer or have suffered from disorders related to hemorrhoidal disease (hemorrhoids).
The most innovative surgical procedure with regard to the treatment of hemorrhoids is THD (Transanal Hemorrhoidal Arterial Dearterialization), a method that is performed by means of an apparatus to which an anoscope, specially constructed for this use, is connected.
THD is a pioneering method in the treatment of hemorrhoids because it revolutionizes the surgical approach to hemorrhoid disease, ensuring maximum effectiveness of results and minimizing the levels of invasiveness, pain and stress for the patient.
The method that includes dearterization, that is, the selective identification and ligation of the terminal branches of the superior rectal artery, is mucopoxy, that is, the repositioning, thanks to submucosal stitches given from the point of ligation of the artery to the pectine line, of the pads in their natural anatomical location; all under local anesthesia with sedation, so that the patient can restore normal physiology and a rapid post-operative recovery, and without tissue removal. Therefore, in the postoperative period, discomfort for the patient is reduced compared to more invasive methods.
Referring specialists
Ankle surgery
Ankle surgery
Most patients who have an acute ankle injury benefit from physiotherapy, but if the condition persists, arthroscopic ligament repair is the most effective solution.
Ankle pain often results from impingement or cartilage injury. Hindfoot pain also results from impingement, cartilage injury, or Achilles tendon disorders. In turn, Achilles tendon pain results from tendinopathy or bursitis.
Although there are several treatment options for cartilage lesions and most of them are treated by arthroscopy, each patient is different and, therefore, each lesion requires a tailored solution.
Disorders treated:
- Achilles tendon
- Arthrosis
- Cartilage lesions and osteochondral defects
- Anterior and posterior ankle impingement
- Ankle instability
- Peroneal and posterior tibial tendon disorders
Referring specialists
Surgical phlebology
Surgical phlebology
VARICES OF THE LOWER LIMBS
Definition: varicose veins are a pathological dilatation of certain veins in the lower extremities and represent stage II Chronic Venous Disease. This disease is more frequent in the female sex (3:1 to 4:1), has a pronounced familial component, and other factors such as type of work activity, work environment, diet (importance of weight) and physical activity influence it.
Symptoms: They can cause complaints such as heaviness of the legs, edema (swelling) of the ankles, itching, tingling, pain, burning, and night cramps. In more severe cases and if present for a long time, thrombophlebitis of some of them, eczema (reddened and itchy lesions), skin dichromia associated with hardening of the skin (lipodermatosclerosis), and in even more severe cases ulcers may appear.
Types of intervention:
It is important, before undertaking any treatment, to undergo a specialty examination which must necessarily include in the course of it an examination Ecocolor-Doppler to define the origin, the cause, which led to the development of varicose veins and the best approach to eliminate them.
MICROSURGERY
Indications: all those patients at the early stage of the disease are candidates.
Type of Anesthesia: local
What the surgery consists of: using microincisions, varicosities are surgically removed. This type of technique, precisely because of its minimally invasive nature, does not involve cutting and therefore scarring; only sterile patches are applied after varicose veins are removed.
Post-operative course:after surgery, the patient walks immediately and after about 20 minutes can return to his or her activity.
TRADITIONAL SURGERY
Indications: All those patients in advanced stage of disease with excessive dilatation of the great saphenous vein or who have abnormalities in the course of the great saphenous vein and therefore cannot be subjected to endovascular treatments (LASER or Radiofrequency)
Type of anesthesia: local assisted
What the surgery consists of: a small cut (about 4-5 cm) is made in the groin, the diseased part of the great saphenous vein is removed, and the surgery is completed by removing the varicose veins present through microincisions (about 2-3 mm).
Type of hospitalization: Day Hospital
Post-operative course: about 15 minutes after surgery, ambulation is resumed, and after about 2 hours, the patient is discharged. The patient should wear an elastic stocking for about two weeks.
LASER OR RADIOFREQUENCED SURGERY
Indications:Candidates are those patients whose stage of disease is not advanced and whose great saphenous vein or small saphenous vein to be treated show specific ultrasound features.
Type of Anesthesia: local
What the procedure consists of: a micro-incision (about 2-3 mm) is made on the thigh or leg (the location varies from case to case), a LASER or Radiofrequency fiber is inserted inside the vein to be treated; an ultrasound-guided tumescent anesthesia of the venous axis is performed and the vein is obliterated. The procedure is completed with the removal of any varicose veins present using microincisions (approximately 2-3 mm).
Type of Hospitalization: outpatient
Post-operative course: The patient can ambulate about 10 minutes after surgery, and after about 30 minutes, he or she can be discharged. The patient should wear an elastic stocking for about two weeks.
SCLEROTHERAPY / SCLEROFOAM
Indications:any type of patient can undergo this procedure. It is generally reserved for those who cannot cope with the previously described interventions (the result of which has a longer duration of time)
Type of Anesthesia: none
What the procedure consists of: a chemical substance in liquid or foam form (Scleromousse or Sclerofoam) is injected inside the vein to be treated;
Type of Hospitalization: outpatient
Post-operative course: the patient ambulates immediately and can, after about 30 minutes, be discharged. The patient should wear an elastic stocking for at least two weeks.
EMODYNAMIC TREATMENT (CHIVA or ASVAL)
Indications:any type of patient can undergo this procedure.
Type of anesthesia:local/local assisted
What the surgery consists of: This technique involves multiple surgeries scheduled a few months apart with the aim of facilitating the passage of blood flow from diseased superficial veins to deep veins. Small incisions (2-3 mm to 4-5 cm) are made in one or more places on the thigh or leg by which certain types of veins are ligated. There is no removal of present varices, which disappear independently over time.
Type of hospitalization: outpatient
Post-operative course: depending on the level at which surgery is performed, the patient ambulates immediately or after about 20 minutes and can be discharged after about 30 minutes. The patient should wear an elastic stocking for at least two weeks.
It is important, before undertaking any treatment, to undergo a specialty examination which must necessarily include in the course of it an examination Ecocolor-Doppler to define the origin, the cause, which led to the development of varicose veins and the best approach to eliminate them.
For information you can call the following address: +39 050 586217
Referring specialists
Hand surgery
Hand surgery
Hand Surgery intervenes to treat the following diseases:
- Compressive peripheral neuropathies of the upper limb (carpal tunnel syndrome, ulnar/radial nerve compression)
- Tenosynovitis (Trigger finger, De Quervain’s disease)
- Dupuytren’s disease
(Aponeurotomy for Dupuytren’s Disease and Lipofilling: minimally invasive treatment of Dupuytren’s Disease or retraction of the palmar aponeurosis: new surgery that avoids long incisions and allows faster healing [dott .ssa Grazia Salimbeni]) - Rhizoarthrosis, arthrosis of the hand and/or wrist
- Rheumatoid arthritis with related wrist and/or finger deformities
- Flexor/extensor tendon injuries, hammer toe, Segond
- Ulnar collateral ligament injury 1°mf (Stener’s lesion)
- Congenital malformations hand
- Hand tumors (epithelioma, xanthoma, schwannoma, lipoma, angioma, etc.)
- Complex hand and/or wrist trauma with tendon, nerve, and bone
- Reimplantations with microsurgical technique
- Post-traumatic hand outcomes, hand burn outcomes
Some more information
Carpal tunnel syndrome (CTS)
Carpal Tunnel Syndrome (CTS) is the most common peripheral neuropathy and is due to compression of the median nerve at the wrist as it passes through the carpal tunnel. The carpal tunnel is a duct located at the wrist formed by several carpal bones over which the transverse carpal ligament (LTC), a fibrous ribbon that forms the roof of the tunnel, is stretched. Within this conduit runs the median nerve along with the 9 flexor tendons of the fingers. Surgical therapy of carpal tunnel syndrome is indicated in the presence of typical algic-paresthetic symptoms, after electromyographic (EMG) confirmation.
The traditional technique, which still remains, however, involves a 2-3 cm longitudinal incision to the hand, distal to the wrist crease, allowing the carpal duct to be opened by sectioning the LTC.
The endoscopic technique, used at the Casa di Cura San Rossore instead involves a small transverse incision at the level of the wrist crease that allows for the insertion of an endoscope connected to the camera system, which allows for perfect visualization of the inside of the carpal tunnel and related structures.
After correct positioning of the coaxial system, and under permanent visual control, a simple pressure on the button of the handpiece allows the ligament to be sectioned by retrograde action of the handpiece.
This innovative system with its minimally invasive surgery concept offers significant advantages to the patient in both resumption time, safety, and minimal scarring outcomes.
Snapping finger or Notta ‘s disease;
The snapping finger phenomenon is due to difficult sliding of the flexor tendons in the digital duct, an expression of an inflammatory process of the flexor tendons.
The snapping is often painful, and results in a fair amount of functional limitation of the hand, so puleggiotomy surgery is necessary, whereby the digital tunnel is opened and tendon sliding restored.
Immediate mobilization of the fingers is recommended, also favored by the rapid reduction of the pain picture.
De Quervain ‘s stenosating tenosynovitis;
It is an often very painful tendonitis of the wrist, brought on by inflammation of the abductor long and extensor short tendons of the thumb, which run in the first extensor duct.
It is called stenosing because it too is characterized by a conflict of the tendons with the duct walls, brought about either by an anatomical predisposition or by triggering factors, such as repetitive manual activities.
The main symptom is pain on the radial side of the wrist, exacerbated by particular hand movements (Finkelstein’s sign).
The most effective conservative treatment turns out to be local cortisone infiltration combined with the use of splints, but the ultimate solution is puleggioplasty surgery.
The operation consists of a small skin incision to widen the tunnel and remove the synovitis, quickly resolving the painful picture.
Dupuytren’s disease
It is a typical pathology of the hand characterized by the occurrence of fibrous nodules in the palm of the hand, which slowly evolve into retracting chords of the digital rays, particularly at the level of the 4th/5th ray.
The disease often runs in families and predominantly affects the male sex, although with fair individual variability in severity and progression.
Selective aponevrectomy surgery is still the main corrective surgical technique, and it must be performed by experienced surgeons, given the vasculo-nervous structures in the palm and the need for skin plastics.
Postoperative physiotherapy treatment is always recommended.
The Rhizoarthrosis
The picture of arthrosis of the base of the thumb, which develops at the trapeziometacarpal joint, is thus defined. This joint allows opposability of the thumb to the long fingers, proving essential for the overall prehensile function of the hand.
The disease is part of a normal degenerative process of cartilage but can manifest with a local painful picture that is accentuated in prehension movements, leading to often severe functional limitation.
Treatment initially is conservative (use of specific braces, physical and drug therapies)
In cases of very severe pain, intra-articular infiltrations of hyaluronic acid or corticosteroids can be used, but the ultimate solution is suspension arthroplasty surgery, which involves removal of the trapezium and a tendon plastic.
This surgery does not involve the implantation of foreign material such as prostheses or synthetic means. It is necessary to maintain a small plaster shower for 3 weeks, and then begin a course of physical therapy.
Rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory disease of autoimmune origin that affects the joints, occurs most frequently between the ages of 30 and 50 years, preferring the female sex.
The disease is characterized by the proliferation of synovial tissue with erosive activity starting in the joints and then progressively affecting the bones and tendons.
The affected joints are initially those of the extremities, the small joints of the hands and feet, which become inflamed symmetrically causing stiffness, pain and swelling, and progressively impairing joint function. The course of rheumatoid arthritis is variable, generally characterized by periods of exacerbation and quiescence of the disease.
The consequences of the chronic degenerative process in the hand can be extremely varied, always expressing joint, capsular, tendon, and bone involvement, coming to shape the typical deformities of the disease over time.
To this end, experience in surgical therapy of the rheumatoid hand suggests early synovectomy, that is, a kind of cleaning of the joints and tendons in order to prevent more serious developmental complications.
Extra-articular complications are usually tendon ruptures, which can be treated with tendon solidarizations or tendon transfers, while surgery for bone and joint injuries usually involves prosthetic implants or arthrodeses.
