What are trigger finger and thumb?
Trigger finger and thumb are painful conditions that cause the fingers or thumb to catch or "lock" in a bent position. Rarely, the fingers are locked in a straight posture. The problems often stem from inflammation around tendons located within a protective covering (called the tendon sheath) or nodularity of the tendons themselves.
The affected tendons are fibrous bands of tissue that connect the muscles of the forearm to your finger and thumb bones. Together, the tendons and muscles allow you to bend and extend your fingers and thumb (for example, when making a fist).
A tendon usually glides quite easily through its sheath, thanks to a lubricating membrane called synovium. Occasionally, a tendon may become inflamed, swollen, or nodular. When this happens, bending the finger or thumb may pull the inflamed portion through a constricted tendon sheath, making it snap or pop.
What are the symptoms of trigger finger and thumb?
One of the most common symptoms of trigger finger is soreness in the palmer aspect of the finger or thumb. The most striking symptom in many patients is a painful clicking or snapping ("trigger finger") when attempting to flex or extend the affected digit. In some cases, the finger or thumb locks in a flexed or extended position and must be gently straightened with the other hand. Joint stiffness may eventually develop if the bent posture persists.
What are the causes of trigger finger and thumb?
Trigger finger and thumb may be caused by highly repetitive or forceful use of the digits. Medical conditions that cause changes in tissues, such as rheumatoid arthritis, gout, or diabetes, may also result in symptoms.
Prolonged, forceful grasping of power tools or golf clubs, for instance, also may aggravate the condition.
Farmers, industrial workers, and musicians who rely on their fingers or thumbs for multiple, repetitive movements are among those most frequently affected. Yet, in some cases, no cause can be found.
How are trigger finger and thumb treated?
The majority of trigger finger and thumb problems respond to conservative treatment. Restricting activities that aggravate the condition is usually the first step.
Occasionally, your doctor will put a splint on the affected hand to restrict joint movement. If symptoms continue, anti-inflammatory medications may be given orally or may be injected into the tendon sheath to reduce inflammation and pain. If the condition doesn't respond to these measures or recurs, you may need surgery to release the tendon sheath and restore movement.
Surgery is performed on an outpatient basis under local anesthesia. After 10 to 14 days, sutures are removed and hand and finger use is typically on its way to comfortable function for everyday activities. No special therapy is required after surgery, but heavier activities with the affected hand should be deferred until comfortable.
While hand function for most people improves with conservative treatment or simple surgical release, some trigger finger and thumb conditions require more complex surgery, particularly when joint stiffness has developed with long-standing flexed posture.
In tennis elbow, the affected muscle mass includes the muscles used to extend your wrist and fingers (lateral epicondylitis). In golfer's elbow, the wrist and finger flexors are affected (medial epicondylitis).
Tennis elbow and golfer's elbow are inflammatory processes of the tendons that attach the large muscle mass of the forearm to the lateral or medial epicondyle -- the bony prominences on the sides of the elbow.
What are the symptoms of tennis elbow and golfer's elbow?
A key symptom in either epicondylitis is pain directly around the bony prominences on the sides of the elbow. Some people also perceive a weakness which occurs during certain hand and wrist activities that require use of the inflamed muscles.
What causes tennis elbow and golfer's elbow?
Contrary to popular belief, these pathologies are not limited to the athletic participation for which they are named. Repetitive use of the forearm, especially forceful wrist and finger motions, are the most frequent causes of the disorder.
Activities that may aggravate the conditions range from sweeping floors to golfing or playing tennis. Tennis elbow or golfer's elbow also may flare up after a single, intense period of overuse.
How are tennis elbow and golfer's elbow diagnosed?
Diagnosis generally starts with a discussion of your condition, focusing on any activities that exacerbate and alleviate your symptoms. Pressure applied to the affected area can cause pain, indicating inflammation.
Another diagnostic method is the "chair pick-up" test, in which your doctor asks you to lift a chair in a certain way. This maneuver generally causes discomfort in the area of the lateral epicondyle in people who have tennis elbow.
For people who have golfer's elbow, forceful hand shakes or turning a locked doorknob are alternative diagnostic methods.
How are tennis elbow and golfer's elbow treated?
Treatment usually starts with restricting any activities that aggravate the condition. Often, your doctor also will splint or brace the elbow and wrist to prevent movement. Ice packs may diminish inflammation and massage may bring relief.
If symptoms continue, anti-inflammatory medication may be given orally or by injection. Surgery is seldom recommended, only when the elbow problem does not respond to conservative treatment after several months.
Surgery for tennis and golfer's elbow is performed in an outpatient setting, and is usually done under regional anesthesia. An incision is made on the outside of the elbow (to treat tennis elbow) or inside of the elbow (to treat golfer's elbow) through which the doctor removes the diseased tissue. Healthier tissue then begins to heal back to the bone. A portion of the bony prominences (epicondyles) also may be removed as part of the operation. A minimally invasive technique, called arthroscopic surgery, allows the surgeon to perform surgery without making the larger incisions that may be required in traditional surgery.
After surgery, your wrist and elbow may be immobilized with a splint for two to three weeks. Range of motion exercises are recommended on an individual basis, followed by exercises to strengthen arm muscles.
Recovery times vary, depending on age, general health and the length of time elbow symptoms have been present. In general, patients improve with strengthening programs over several months and return to their desired activities.
What is de Quervain's disease
de Quervain's disease is a painful inflammation of specific tendons to the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain at the thumb base and along the side of the wrist.
de Quervain's, which is named after the Swiss surgeon who first described the condition in 1895, is one of the most common types of tendon lining inflammation (also called tenosynovitis).
What are the symptoms of de Quervain's disease?
Pain along the back of the thumb, directly over the two thumb tendons -- the extensor pollicis brevis and the abductor pollicis longus -- is typical of de Quervain's. The condition can occur gradually or suddenly. In either case, the pain may travel into the thumb or up the forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects.
Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people also feel pain if direct pressure is applied to the area.
What causes de Quervain's disease?
Overuse, a direct blow to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports and various workplace tasks are some activities that may aggravate the condition. Often, its cause is unknown. de Quervain's affects women more often than men.
How is de Quervain's diagnosed?
The test most frequently used to diagnose de Quervain's disease is the Finkelstein maneuver. Your doctor will ask you to make a fist with your thumb placed in your palm. When the wrist is suddenly bent to the little finger side, the swollen tendons are pulled through the tight space. If this maneuver is very painful, it may indicate that you have de Quervain's disease.
How is de Quervain's treated?
Treatment usually involves wearing a splint for several weeks to immobilize the affected area, and refraining from any activities that aggravate the condition. Ice also may be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication -- which may be taken orally or injected -- to diminish swelling. If de Quervain's disease does not respond to conservative medical treatment, surgery may be recommended.
Surgery for de Quervain's is an outpatient procedure. It is usually done under regional anesthesia. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, thus restoring the tendons' smooth gliding capability.
After surgery and splinting, your doctor will recommend an exercise program for your thumb and wrist. Recovery times vary, depending on your age, general health and how long the symptoms have been present, but patients typically return to full activity within 4 to 6 weeks from the time of surgery.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/21/2005...#4223
