FAQ Category: Hand

The extensor tendon is what works to allow you to extend your hand and fingers. Without them working properly, you would not be able to flatten you hand out or point your fingers. There are many ways the extensor tendons can become damaged, and if they are not treated properly, you could be left with a long-term inability to use your fingers to their fullest potential.

Trigger finger is a common tendon disorder of the hand. The flexor tendon pulls and causes your finger to fold or bend to the point that it locks. In most cases of trigger finger, it is idiopathic, which means that doctors don’t know why it happened, there is no known cause.

People with diabetes react differently to some types treatments than people without diabetes. At the same time, people with diabetes who take insulin may react differently than those who don’t take insulin. Although studies have been done on the effectiveness of corticosteroids to treat trigger finger, there aren’t a lot of data on the subject of treating people with diabetes who have trigger finger. The few studies that have been done show that people who take insulin do not have as high a success rate as those who do not take insulin, so this could be why your brother’s doctor is suggesting surgery.

As well, the decision to suggest surgery may have little to do with the diabetes, but the length of time your brother has had the symptoms and how severe they are. This also plays a role into how effective injections may be.

Trigger finger, a condition where a finger or fingers bend in a way that looks like you are about to shoot a gun, is a problem that can make it difficult to perform every day tasks. When the trigger finger causes pain or discomfort, and affects your life, you may look into getting treatment for it. The initial, first-line treatment for trigger finger is a corticosteroid that is injected directly into the affected area. Barring other issues and if the problem hasn’t been present for too long, this injection often works the first time.

If the injection doesn’t work, a second injection may be tried or surgery may be suggested.

Injections into the finger may be uncomfortable or painful, but surgery has its risks, so it is usually better to try the more conservative approach (injection) before trying surgery, if at all possible.

Studies show that early treatment of benign tumors such as osteochondroma of the fingers have the best results. Waiting too long results in soft tissue, joint, and bone changes that are more difficult to change.

But that doesn’t mean that surgery to restore a more normal alignment can’t be done. It’s likely that you will regain motion and function but maybe not perfection. In a recent case series of 10 patients with benign osteochondroma of one finger, there was one patient who had the condition for 20 years before having surgery.

Motion was improved 100 per cent. Although he was still unable to fully extend the finger, pain from arthritis was much improved and he could use that hand to pick things up once again.

The first step is to see a hand surgeon. The surgeon’s examination and X-rays will give enough information to make a treatment plan with projected outcomes (what is expected to happen) and pronosis (how likely it is). Just letting it go will likely result in progressive arthritis with pain, and loss of motion and function. Surgery now may head those problems off before it’s too late.

Numbness and tingling in the fingers and hands from an unknown cause is often a signal that the sensory nerve to that area is being pinched or compressed. The condition is referred to as a compressive neuropathy. Nerve injury or damage of this type can occur as a result of trauma – the nerve gets pinched (compressed), crushed, cut, or stretched. Chronic nerve compression can also develop as a result of degenerative conditions or health problems like diabetes and chronic alcohol abuse that lead to nerve damage.

Diagnosis and treatment of compressive neuropathies have presented quite a challenge to physicians. The best treatment is always one that provides a cure for the problem. But what we understand about how nerves function and what’s happening biologically at the cellular level in these injuries is very limited right now. In fact, we only really have theories and models of what scientists think is going on to use when planning treatment.

Part of the problem is that there are so many different parts to the nerve that could be affected. For example, there’s the lining around the nerve and the connective tissue between the lining and the nerve. There are individual nerve cells that could be damaged. The nerve can be injured anywhere from where it connects to the spinal cord all the way down to where the nerve integrates with the skin or muscle it communicates with.

Treatment and prognosis vary depending on which part of the nerve is damaged and how severe is the damage. But it’s not like a cut on the finger that can be seen and a bandaid applied. You can’t see the nerves. They can’t be X-rayed. So how does the physician diagnose the problem? Well, first the patient’s history and symptoms help identify which nerve is affected. Sensory or motor changes (or both) provide helpful information.

Then a series of tests are applied. Some of these are simple nerve tests performed by the physician. Others are more technical involving nerve and muscle testing. The test results help point to which nerves are affected and the specific area of the nerve. It’s really more of a process of elimination and deductive reasoning than a quick aha!

Your symptoms may be coming from compression of nerves in the forearm and hands that are part of the peripheral nervous system (PNS). The peripheral nervous system is made up of all the nerves coming from the spinal cord and going out to the rest of your body. The peripheral nerves can be sensory only, motor only, or mixed (both sensory and motor). Compression of a peripheral nerve can result in a problem called compression neuropathy.

When sensory nerves are affected the result can be symptoms of pain, burning, altered sensation, numbness and tingling, or even complete loss of sensation (paresthesia). Muscle weakness and atrophy are more likely to develop with motor nerve impairment. And a combination of these two sets of symptoms occur with compression of mixed nerves.

Physicians rely on three tools to diagnose nerve injuries: the patient history (your symptoms, what happened, how it happened, when it happened), clinical examination, and electrodiagnostic testing. There are nerve conduction velocity (NCV) tests that measure the speed that messages are sent along the nerve. Another test called compound muscle action potential (CMAP) measures the messages sent along nerves to the muscles. Sensory nerve action potential (SNAP) tests are used to assess nerves that only pick up sensory (not motor) input. There’s also the compound nerve action potential (CNAP) used to test nerves that are both sensory and motor nerves. The results of these tests can help determine where the nerve is damaged and how serious the injury might be.

The NC-Stat actually refers to a portable electrodiagnostic device that uses biosensors to detect changes in skin temperature when nerves are stimulated. The NC-Stat helps the physician get a quick idea whether there might be nerve compression before ordering more extensive and expensive nerve tests. The NC-Stat can be performed in the physician’s office using surface electrodes instead of needles.

The electrodes look like thin patches. They are placed over the skin along the length of the nerve. The nerve is stimulated to fire through one electrode while the second electrode records the nerve’s response. It doesn’t measure all nerve function but it can be quite helpful in detecting compression neuropathies.

Trigger finger is caused by the thickening of rings that surround the tendons that move the fingers from straight to bent and back. The rings are like a tunnel through which the tendons slide back and forth. If the rings thicken, they begin to put pressure on the tendon and sometimes block it from moving. If the person with the trigger finger manages to move it, the tendon may “catch” on a ring, causing that pulling or snapping feeling.

As for risk factors, it’s been found that more women develop trigger finger than do men and people with chronic health issues, like rheumatoid arthritis, diabetes, hypothyroidism (underactive thyroid) seem to be at a higher risk of developing the condition. As well, if you constantly have a grip on an instrument, be it a musical instrument or a tool, the constant bending of the finger could contribute to developing trigger finger.

Trigger finger, a condition where the tendons that control the finger are pressed on at the base of the finger, can be mild or severe. Surgical procedures of most types of problems are usually avoided if there is a way to treat them nonsurgically. The same happens with trigger finger.

Milder and moderate cases could be treated with:
– Rest
– Splinting
– Finger exercises
– Rest from activities that may encourage the bent position

If these don’t work, your doctor may recommend:

– Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain
– Steroid injections into the area
– Percutaneous trigger finger release, which involves numbing the area and using a needle to release the finger
– Surgery

Splints are often used to treat mild-to-moderate osteoarthritis in finger joints if they have become painful or difficult to use. As you say, the goal is to relieve the pain and we want to prevent your mother from hitting the joint against objects, such as tables. Treatment of osteoarthritis itself depends on how severe the disease has progressed. It can include medications to reduce inflammation and pain, corticosteroid injections into the joint, physiotherapy, or surgery.

There is no difference between Dupuytren’s disease and Dupuytren’s contracture – they are the same condition but just two different names.

The condition is caused by thickening of the tissue in the palm of the hand, just below the surface. In some people with Dupytren’s, this results in pulling on the tissue to the point that the fingers start to curl up and contracting. Others, however, have the thickening but no pulling. It is for this reason, some call it Dupuytren’s disease instead of contracture.

Doctors don’t yet know what causes Dupuytren’s contracture, a condition where the tissue beneath the palm of your hand thickens and tightens. This results on pulling, which in turn frequently results in the fingers being pulled inwards, towards the palm of the hand. What doctors do know is that it happens more often in men than in women, and usually later in life, in their 50s or 60s. There does tend to be a family history of the condition and people with chronic illnesses, such as diabetes and epilepsy do seem to be at a higher risk of developing it. Hurting your hand can contribute to the development, as can excessive alcohol intake.

The trigger finger and the mallet finger are both problems that involve not being able to straighten out the affected finger. The names reflect what the finger looks like.

With a trigger finger, rings of body tissue that form a tunnel for the tendon to your finger become inflamed or thick. Because they are larger than they should be, the tendon can’t slide through the rings easily and it catches, making a snapping or catching sensation. The finger could become locked in the bent “trigger” position.

With a mallet finger, the tip of the finger is hit by something hard, most often a ball. This results in the joint closest to the tip of the finger being injured and, perhaps, the tendon pulling away from the bone. The finger then bends at that joint and needs to be straightened out.

While it’s true that the doctor won’t be able to see how often your didn’t wear his splint, it will be obvious by the slow healing or misalignment, that your son didn’t wear the splint consistently.

Wearing a splint on your finger is not comfortable, but the treatment period will not be as long and it will be more effective if the all the recommendations are followed, particularly the constant wearing of the splint.

Many years ago, teens and young adults began developing pain in their thumbs from playing too many video games. The doctors found that this was just a form of repetitive stress injury brought on by overuse. Now that the texting age is upon is, people are seeing doctors for the same type of thumb pain as they did when they were playing video games, but now it is often from overuse in texting.

The thumb isn’t meant to have that much repetition. It’s a hard worker, but it’s not used to the stress that frequent and constant texting puts on it. If the pain is bad, your son should likely take a break from texting and even visit a doctor to be sure it is nothing more serious.

When a doctor chooses to treat a finger joint with a splint, the goal is usually to help relieve the pain and protect the joint during a painful flare-up. As you say, some splints are awkward, even bulky, and can make it difficult to do every day tasks. What often happens is the patients end up taking off the splints, therefore not benefitting from them.

There are newer splints that have been designed to help avoid this problem. They are generally made of plastic, are thinner and lightweight, and maybe most importantly, they don’t cover the fingertip. It may be best if your mother speaks to her doctor about trying alternate types of splints.

Dislocated joints can range from mild injury to severe injury. If a joint comes out of place but goes back into place without causing any damage to tissue around it, then the worst part is likely the pain and the recovery time. However, if a joint comes out of place and affects the blood flow around the joint or it damages the tissue, then surgery may be needed to prevent complications.

As well, even if a joint dislocation doesn’t seem serious, if the ligaments have been torn, there is a chance that they don’t heal properly. In this case, surgery may be recommended down the road.

Can dislocated joints dislocate more easily again? There is evidence that this happens to many people, but it depends on the severity of the dislocation and how much damage was done.

When you dislocate a joint, the bones are moved out of place, causing pain – often severe pain. Putting the joint back into place does usually relieve a significant part of the pain. But, while the intensity may be lower, pain that remains is usually due to the damage done around the joint. When the bone dislocates, ligaments may be stretched or torn and muscles go into spasm to try to protect the joint.

If the dislocation was severe, the joint is likely not stable for a while afterwards and certain movements will cause pain and discomfort, until the joint becomes strong again.

After the patient is anesthetized and asleep, the affected arm is held in traction to separate the bones at the fracture site. This is done when the X-ray shows that the fractured piece is compressed up against the rest of the bone or if the fractured fragment has rotated and must be freed, turned, and put back in place.

A special traction unit is used that holds the hand, wrist, and arm steady while the surgeon works on it. The thumb is placed in a finger trap that is much like the Chinese finger traps we played with as children. The more pressure that is applied, the tighter the trap becomes. In the case of a surgical finger trap, the tension applied is just enough to stabilize the thumb without compromising circulation.

As you will probably see from the video of the procedure, the surgeon can use a small-joint arthroscope to work inside the thumb. The availability of this surgical tool makes it possible now to reduce the fracture in an anatomically correct position. Reduction refers to putting the broken pieces of bone back together so that the bone surfaces line up exactly and the carpometacarpal joint is fully restored.

Before thumb arthroscopy was available, traction and fluoroscopy (real-time 3-D X-rays) were used to make sure the bones was reduced properly. But it turns out that this method wasn’t always reliable. Sometimes it looked like the bone was reduced and properly in place when it wasn’t.

Even a slight rotation of the bone can make a difference. Without an exact anatomic reduction, patients can end up with a painful, arthritic thumb. Combining arthroscopy with the fluoroscopy has changed all that. Now the hand surgeon can replace the bone fragments where they belog, apply the appropriate fixation, and make sure everything is lined up perfectly before putting the hand in a splint.

It’s quite true that there isn’t evidence to support the notion that carpal tunnel syndrome is the result of keyboarding or other routine desk/office tasks. This is true even if these hand activities are repeated daily for hours. The idea that there’s a cause and effect link between the two has been debunked (disproven) but the idea seems to persist in the mind of the public.

We know for sure that regular, prolonged use of handheld vibratory tools like jackhammers and forcefully gripping tools like drills can contribute to carpal tunnel syndrome from pressure on the median nerve. But that’s the extent of our scientific evidence that the work place is to blame.

There may be genetic and/or structural (anatomical) reasons why some people develop carpal tunnel syndrome while others engaging in the same repetitive activities do not. It could turn out to be a multifactorial (many different factors combined together) problem.