The relation of gout and rheumatism to Dupuytren's contraction of palmar fascia, with results of treatment by Adams' operation : being a thesis for the M.B. degree at Cambridge University / by Charles Edward Hedges.

  • Hedges, Charles Edward, 1866-
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: The relation of gout and rheumatism to Dupuytren's contraction of palmar fascia, with results of treatment by Adams' operation : being a thesis for the M.B. degree at Cambridge University / by Charles Edward Hedges. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Left hand—corresponding fingers of left hand affected to a less degree. Operation on right hand hy Mr. Walsham on September 15, 1891.—Several punctures were made with a tenotome, in some cases passed between the skin and fascia, and edge directed downwards; in others, the knife was passed beneath the fascia and cut upwards. Fourth and fifth fingers were then brought into good position and extended on a back-splint. Discharged wearing splint. On May 10, 1895, I saw the patient, and the condition of his hands was as follows:—Left hand—the three inner fingers are flexed on the metacarpo-phalangeal and first phalangeal joints in such a way tliat their tips are within half an inch of palm of hand; tense bands of fascia can be seen running up to them and binding them down. In the right hand, which was the one oj>erated on, and was by far the worse of the two at that time, the ring and little fingers are almost straight, but there is great loss of power in these two fingers, and considerable difficulty in flexing them; says the operation did him some good, as he thinks his hand would soon have closed altogether, lie now wants Mr. Wal- sham to operate on the left hand, as it is practically useless to him. He wore the splint eight weeks after operation. 7. H. S., male, 33, costumier, admitted into Hospital on October 21, 1891, suffering from “bent” fingers. Condition of hand before operation. — Fifth finger of left hand bent so as nearly to touch the palm. Fourth finger of same hand bent to a less degree. Thumb also slightly affected. Operation by Mr. Walsham, October 22, 1891.—With a sharp tenotome, several subcutaneous incisions were made over the ulnar side of the hand, dividing several bands of fascia binding down the fourth and fifth fingers; puncture also made over the ball of thumb, dividing the fascia holding that down. The fingers were firmly bandaged to a back-splint. Patient w’ore this for one month. I saw the patient on May 13, 1895, three and a half years after the operation. The patient says all the fingers were put quite straight after the operation, now the little finger has gradually gone back to its original contracted condition, whilst the ring-finger is quite straight; movement and power of grasp good. There is a tense band of fascia spreading from base of the index finger of this left hand to the base of the thumb, and drawing them together. In the right hand there are three puckerings of the skin in the