Anatomy:

  • Each hand and wrist is made of 29 bones: 
2 in the forearm, 8 in the wrist, 19 in the hand and fingers.
  • Joints allow movement where 2 or more bones connect, held together with strong bands called ligaments.
  • Cartilage covers the ends of the bones and provides a strong, smooth bearing surface.
  • Most of the muscles that stabilize and move the hand are located in the forearm, attached to the bones by long, cord-like tendons. Muscles on the back of the forearm extend (straighten) the wrist and fingers; those on the palm side cause flexion (bending).
  • The joints and tendons are lined with synovium, a thin slippery membrane that lets moving parts glide easily.
  • Bands of tissue across the back of the wrist and palm side of the fingers form sheaths to stabilize the tendons that pass under them.

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What causes it?

  • Overuse, misuse or an injury can cause tendonitis or trigger fingers.
  • Tendonitis (aka “tenosynovitis”) occurs when friction on the tendon within the sheath causes inflammation in the synovium or fraying of the tendon, making it painful to grasp or lift anything.
    • DeQuervain’s tendonitis involves the sheath that’s rubbing on 2 tendons that control your thumb
    • Trigger fingers occur when an inflamed nodule on the flexor tendon of a finger or thumb gets trapped in the tendon sheath, causing it to click, lock or just hurt.
    • Trigger fingers are more common in diabetic patients.
    • You could have one trigger finger, or develop symptoms in more than one finger over time.
  • As the tendon sheath gets more inflamed, it gets more swollen and narrowed, increasing friction and locking in a vicious cycle.
  • The goal of treatment is to quiet inflammation around the tendon, restore smoothly-gliding tendons and preserve hand function.

Evaluation

  • History: What are your symptoms, any prior injury, pain patterns, activities that aggravate the problem? Is it your dominant or non-dominant hand? How does it affect your job or other important tasks? Treatments you’ve already tried, and if they helped? Your general health and medicines you take?
  • Physical Exam: How do you and your arms, wrists and hands look and move? Tenderness, swelling, deformity or discoloration in a specific structure?
  • Tests: X-rays define the bony structures and condition of the joints. You may need a consultation with a neurologist and a nerve test/electromyogram (EMG) if your hands are also numb, or other symptoms to suggest a nerve problem in addition to the tendonitis.

Tendonitis/Trigger Fingers

Treatment

    • There are different treatments available to help relieve tendonitis and trigger fingers. Each is designed to correct the cause: quiet inflammation around the tendons.
    • Start simple, and then add something else if needed. You can cut back when you start to feel better.

    • Exercises: keep your wrists/hands limber and move excess fluid out
      1. Adjust your work area to avoid strain on your body
      2. Take breaks for 1-2 minutes; get up every 30 minutes to rest, change positions and stretch
      3. Roll your neck and shoulders; bend and straighten your elbows
      4. Squeeze a soft rubber ball and release, 20 times, 3 times a day

  • Wear a brace to support the painful tendon or splint your finger.
    1. At night so you don’t clench your fists while you sleep.
    2. While doing heavy or repetitive work.
    3. There are a lot of styles on the market; big drugstores and Wal-Mart have a good selection. Any one that’s comfortable and supports the painful area is a good one.
    4. Buy several: one for the car, workshop, nightstand and sewing basket so it’s there when you need it.
  • Medicine:
    1. Anti-inflammatory pills like Advil (ibuprofen) OR Aleve (naproxen) as needed, if you can take them.
    2. Tylenol (acetaminophen) is not an anti-inflammatory, but relieves pain and does not cause stomach, kidney or blood-pressure problems.
  • Cortisone Shot: shrinks inflamed tissue that’s crowding the tendon sheath.
    1. Works best if you’ve suddenly developed tendonitis from an unusually busy project.
    2. Better than 50/50 chance of curing the problem.
    3. You could have 1 or 2 shots in a particular tendon sheath, but if pain or locking keep coming back, you need surgery to decompress the sheath and solve the problem.
  • Surgery
    1. If your pain/locking continues despite the brace and a shot, especially if you have multiple trigger fingers.
    2. Outpatient, with local anesthesia; takes about 10 minutes. Some patients need sedation; many do not. We’ll talk about what’s best for you.
    3. A small incision in the crease of your palm or side of your wrist divides the tendon sheath and relieves friction.
    4. If you have 2 or more trigger fingers, I might recommend that we release all 5 fingers on that hand.
    5. Soreness around the scar resolves in a few weeks.
    6. Recurrence after surgery is rare.
    7. Time out of work after surgery depends on the type of work that you do. Patients with a desk job can go back to the office within a day or so, with minimal use of the hand at first. If you have a physically heavy job, or need to use your hand for repetitive work, you could be out for up to 6 weeks. Talk to your employer about this, and ask about returning to work with restrictions for the first few weeks.

For more information about hand surgery and other orthopaedic treatments with Dr. Siegrist, visit www.knowyourbones.com