FAQ Category: Hand

Mucous cysts are typically found in patients with osteoarthritis who are between 50 and 70 years old. Doctors do not know why mucous cysts develop, nor do they understand exactly how these cysts form. One theory suggests that mucous cysts are formed when connective tissue degenerates, or wears away. Collagen is a protein found in connective tissue. The leftover collagen is thought to collect in pools, and the pools form cysts. Fluid seems to move from the joint into the cyst, but not the other way.

A mallet finger results when the extensor tendon is torn from the attachment on the bone. This most often occurs from trauma, such as closing the finger in a door. When the extensor tendon is torn, a small fragment of bone may be pulled, or avulsed, from the distal phalanx. The result is the same in both cases–the end of the finger droops down and cannot be straightened.

It may be worth your effort to have it treated. A simple form of treatment using a splint may even work when the injury is quite old. Usually continuous splinting for six weeks followed by six weeks of nighttime splinting will result in satisfactory healing and allow the finger to extend.

The key is continuous splinting for six weeks. The splint holds the distal interphalangeal joint in full extension and allows the ends of the tendon to move as close together as possible. As healing occurs, scar formation repairs the tendon. If the splint is removed and the finger is allowed to bend, the process is disrupted and must start all over again. The splint must remain on at all times–even in the shower.

After leaving the side of the neck, the ulnar nerve travels through the arm pit and down the arm to the hand and fingers. As it crosses the wrist, the ulnar nerve and ulnar artery run through the tunnel known as Guyon’s canal. This tunnel is formed by two bones–the pisiform and hamate–and the ligament that connects them. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger. Branches of this nerve also supply the small muscles in the palm and the muscle that pulls the thumb toward the palm.

Injury to the volar plate can occur when the finger joint is hyperextended (bent back too far). If a complete tear occurs, the ligament usually ruptures or tears from its attachment on the middle phalanx. There may be a small piece of bone avulsed or broken from the middle phalanx when this occurs. If it is small it is usually of no consequence, but if it is large and involves a significant amount of the joint surface it may require surgery to fix the fragment and restore the joint surface.

Initially, the finger is painful and swollen around the proximal interphalangeal joint. If the joint has completely dislocated it will appear clearly deformed.

Injury to the collateral ligaments can occur when the joint is forced to bend too far sideways until one of the collateral ligaments ruptures. These ligaments can also be injured if the proximal interphalangeal (PIP) joint is actually dislocated, with the middle phalanx dislocating behind the proximal phalanx.

When the ulnar collateral ligament in the thumb is injured, the middle thumb joint becomes painful and swollen, and the thumb feels weak when you pinch or grasp. You may see bruise-like discolorations on the skin around the joint. The loose end of the torn ligament may form a bump that can be felt along the edge of the thumb near the palm of the hand. A torn ligament makes it difficult to hold or squeeze things between your thumb and index finger.

Initially, the finger is painful and swollen around the distal interphalangeal (DIP) joint. The end of the finger is bent and cannot be straightened voluntarily. The finger can be straightened easily with help from the other hand.

Today, most cases of ligament damage in the middle thumb joint are caused from sports injuries. Now doctors tend to refer to the condition as “skier’s thumb,” since it happens so often in downhill ski accidents.

Any extreme force (valgus force) on the thumb can damage the ligaments. The most common way for this to happen is to fall on your hand with your thumb stretched out. When a skier falls down while holding a ski pole, the thumb may get bent out and back, leading to an injury in the ulnar collateral ligament.

Arthritic finger joints cause pain and make it difficult to perform normal movements, such as grasping and pinching. Advanced arthritis can also loosen the joint and may begin to cause joint deformity. Joint fusion is a procedure that binds the two joint surfaces of the finger together, keeping them from rubbing on one another. Fusing the joint together eases pain, makes the joint stable, and prevents additional joint deformity.

Unfortunately, very little can be done, short of surgery, once a finger or the thumb has developed triggering. A cortisone injection into the tendon sheath may decrease the inflammation and shrink the nodule to relieve the triggering, but the results will probably be short lived. If your problem just started and the tendon isn’t triggering, a splint may be used after the injection. The splint is used to rest the tendon and attempt to get the inflammation and nodule to shrink.

The symptoms of trigger finger include pain and a funny clicking sensation when the finger is bent. Pain usually occurs when the finger is bent and straightened. Tenderness usually occurs over the area of the nodule–at the bottom of the finger. The clicking sensation occurs when the nodule moves through the tunnel formed by the pulley ligaments. With the finger straight, the nodule is at the far edge of the surrounding ligament. When the finger is flexed, the nodule passes under the ligament and causes the clicking sensation. If the nodule becomes too large it may pass under the ligament, but becomes stuck at the near edge. The nodule cannot move back through the tunnel, and the finger is locked in the flexed trigger position.

Triggering is usually the result of a thickening in the tendon that forms a nodule, or knob. The pulley ligaments that forms an arch over the tendon may thicken as well. The constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area and create the nodule. Rheumatoid arthritis, partial tendon lacerations, repeated trauma from pistol-gripped power tools, or long hours grasping a steering wheel can cause triggering. Infection or damage to the synovium causes a rounded swelling (the nodule) to form in the tendon.

Not necessarily. When the middle thumb joint is fused together with arthrodesis surgery, a person’s ability to do day-to-day tasks isn’t affected that much. This is because some people have a very small range of motion in this joint anyway. Fusing the joint keeps the joint from moving, but it also protects it from eventually becoming arthritic and painful.

Certainly. The symptoms of carpal tunnel syndrome develop when there is pressure on the median nerve where it passes under the transverse carpal ligament in the wrist. The trauma from an injury such as you’ve described can put pressure on the nerve and could lead to carpal tunnel syndrome.

Repetitive movements, such as playing piano, are thought to contribute to problems such as carpal tunnel syndrome (CTS). The rapid and repetitive movements required when playing do pose a risk for problems such as you’ve described. This is not to say the feeling of weakness you report is from CTS.

Thumb weakness is usually not the first sign of CTS. Most often, people report feelings of numbness along the thumb-side of their hand when they awaken from sleep. Numbness and possibly even pain may spread into the palm and wrist and can eventually become a nagging ache into the forearm. Eventually, weakness may develop. Changes in sensation are usually noticed before weakness. Thumb weakness, by itself, may start for a variety of reasons, such as nerve pressure in the neck or upper arm. If your thumb weakness continues, you should see your doctor.

It depends. If your problem comes from doing too much with the hand in the first place, doing exercises right now could actually make things worse. Exercises that cause the wrist to bend can put more pressure around the median nerve inside the carpal tunnel. If your symptoms are coming from extra pressure, you might need to wear a splint to rest your wrist and fingers. When your symptoms calm down, exercises can improve movement and strength.

Used in the early stages of the problem, exercises are one strategy to help prevent the problem from getting worse. However, it is not clear whether exercise alone can prevent or reverse carpal tunnel syndrome. When symptoms have gone on long enough to cause the muscles on the thumb-side of the palm to atrophy (shrink in size), it’s likely that exercises will not correct the problem.

The symptoms you feel may be a signal that your problem is getting worse, not better. Neglecting treatment may cause your condition to spiral downward. You could end up with even more pain and weakness. A bigger concern is that the pressure on the nerve can cause the muscles of the palm and thumb to weaken and shrink (atrophy).

Left untreated, the pain, numbness, and weakness will likely get worse to the point that you are challenged when using your hand for daily activities. Starting treatment before the problem “gets out of hand” will improve your chances of getting better and avoiding surgery.

Research has shown that you can set up your split keyboard in a variety of ways and still maintain the healthy wrist position that can ease wrist strain. You could, for example, separate the two halves so your hands are shoulder-distance apart. Angling the two halves outward slightly can help keep your wrists in a straight line. Either way, you may have fewer problems when the keyboard sections are positioned to keep your wrists in a straight line with your forearms. You may want to work with a physical therapist to find the keyboard setup that is best for you.