Hand Conditions

Trigger Finger

Trigger

Trigger finger occurs when a finger flexor tendon catches in its sheath resulting in a snapping/catching condition. It is also known as stenosing tendovaginitis (i.e narrowing due to inflamed tendon sheath).

Cause:
Triggering of a finger may be caused by inflammation as seen in connection with arthritis. It may also be caused by local inflammation brought on by trauma or over-use.


Presentation:
The trigger finger (commonly the ring, middle or index finger) gets stuck in a bent position and may require a pull by the other hand to straighten it. This often happens in the morning and may be less common during the cause of the day. The finger never gets stuck in a straight position.


Treatment:
Anti-inflammatory medication may settle the symptoms.
A steroid injection into the tendon sheath is often successful but no more than 2 injections should be given if the first is unsuccessful.

Surgery, done in Local Anaesthesia, involves splitting the tendon sheath. This is normally successful and recurrence is rare.


Complications to surgery are rare but may involve infection, nerve irritation, swelling and stiffness.

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Carpal Tunnel Syndrome

Carpal Tunnel

Carpal Tunnel Syndrome is a condition caused by irritation to one of the main nerves to the hand, the Median nerve, where it travels underneath the Carpal Ligament along with 9 tendons (Apollo and the 9 muses).

Cause: The condition is more common in women than in men and is mainly seen above the age of 30 yrs.
The majority of cases are idiopathic (without any known cause) but symptoms may be seen in connection with repetitive hand motions or following trauma to the base of the hand/wrist.
I may also occur in connection with medical conditions such as thyroid disorders or diabetes.


Presentation:
Numbness and tingling of the thumb, index, middle and half of the ring finger (the fingers innervated by the median nerve).
The symptoms commonly occur during the night and also during activities such as driving, writing, or holding on to tools. The symptoms may become permanent suggesting significant and possible irreversible damage to the nerve.
Wasting of the thumb muscles may be seen when the nerve damage is significant.
The condition can be diagnosed by various clinical tests but may occasionally require a Nerve Conduction Study.
Treatment:
Avoiding activities bringing on the symptoms or modifying lifestyle.

Night-time splintage.
Steroid injections into or close to the Carpal Tunnel.
Surgery: Transecting the Carpal Ligament relieves the pressure on the nerve and generally results in almost full symptomatic relief. But if the nerve has been severely and permanently damaged before surgery the aim of surgery is to prevent further damage and possibly obtain some relief.
Surgery may be associated with complications such as infection, delayed wound healing, finger and wrist stiffness, nerve damage, tenderness corresponding to the scar, and Regional Pain Syndrome.

Ganglion

Ganglion

Ganglions are cysts often located near joints or tendons. They contain fluid produced as a result of local irritation.

Cause:
Ganglions are caused by generally unspecific irritation to a tendon or a joint. When irritated an increase in fluid production happens and this tends to work its way towards the nearest surface producing a swelling, i.e. a cyst or a ganglion.


Presentation:
A soft often pain-free swelling over the back of the hand, wrist or foot. It may also be seen on the palm of the hand at the base of the fingers (a so-called seed ganglion or Volar Inclusion Cyst) or next to the Radial Artery over the front of the wrist. Pain felt in connection with ganglions or cysts usually comes from the underlying inflammation and not from the ganglion itself. An exception is the Volar Retinacular Cyst which is often associated with pain when lifting a bag or holding on to the steering wheel.


Treatment:
As most ganglions are caused by an underlying irritation they disappear when this irritation settles. Resting the wrist or modifying activities, possibly taking anti-inflammatory medication may settle the symptoms.
Ganglions over the back of the hand or the front of the wrist may respond favourably to the “whack” of something heavy – in the old days the family Bible was used but any heavy book may do the trick (but do not use metallic or sharp objects!).

Surgery is rarely indicated apart from in the case of the Volar Retinacular cysts: injecting these with local anaesthetic causing them to “explode” is often successful; if not surgical excision may be appropriate and virtually always successful.

Dupurytren's Contracture

Dupy

Dupuytren’s contracture is a condition where the fingers are contracted because of scar formation in the underlying soft tissue membrane (the palmar fascia or aponeurosis).
It is named after the French anatomisy Baron Guillaume Dupuytren (1777-1835) who described the condition but did not treat it.

Cause:
The aetiology of the condition is unknown. It mainly occurs in people of Scandinavian or Northern European origin and often above the age of 40 .
There may be a family disposition.
As there is a genetic element to the condition it often occurs bilaterally.
It may also be associated with scar formation of the fascia of the feet (Lederhosen disease) or of scar formation causing curvature of the penis (Peyronie’s disease).


Presentation:
Dupuytren’s contracture often starts with a lump in the palm of the hand, usually on the little finger side. The lump may ache but is often pain free. As the condition progresses bands of scar tissue may form reaching out towards the fingers. It .mainly affects the little and ring fingers but occasionally the other fingers although only very rarely the thumb ; it may cause tightening of the web-space between the thumb and the index finger. With time the fingers may curl up into the palm making it impossible to straighten the fingers actively or passively.
The condition may also be associated with so-called knuckle pads – scar formation over the knuckles


Treatment:
Once the condition has progressed to cause a finger contracture of 30 ° or more it may be indicated to consider treatment. There is no treatment available that can cure the condition; the purpose of treatment is to reduce the symptoms.

Steroid injections may soften the contractures temporarily.
Injection with an enzyme breaking down the scar tissue (collagen) may be beneficial but as the substance injected does not distinguish between diseased and healthy tissue complications may be seen. As with all invasive treatment there is a risk of complications as seen with surgery.
Surgery involves excising the diseased tissue and can in most cases successfully restore finger function. But surgery may also be associated with complications such as nerve or vascular damage, infection, regional pain syndrome, wound or scar problems.


Regardless of treatment the main risk is recurrence of the disease.

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