What is trigger finger?
Trigger finger and thumb are painful conditions that cause the fingers or thumb to catch or "lock" in a bent position. The problems often stem from inflammation of tendons located within a protective covering called the tendon sheath.
The affected tendons are tough, 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 flex and extend your fingers and thumb, for example when making a fist.
A tendon usually glides quite easily through its sheath, due to a lubricating membrane called synovium. Occasionally a tendon may become inflamed and swollen or nodular. When this happens, moving 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?
One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected finger. In some cases the finger or thumb that is affected locks in a flexed position, or in an extended position as the condition becomes more severe, and must be gently straightened with the other hand. Joint contractures may eventually occur.
What causes trigger finger?
Trigger finger may be caused by highly repetitive or forceful use of the finger and thumb. Medical conditions that cause changes in tissues--such as rheumatoid arthritis, gout or diabetes--may also result in trigger finger. Prolonged, strenuous grasping, such as with power tools, may also aggravate the condition.
What is de Quervain's disease?
De Quervain's disease is a painful inflammation of specific tendons of the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain just below the base of the thumb. It is one of the most common types of tendon lining inflammation.
What are the symptoms of de Quervain's?
Pain along the back of the thumb, directly over two thumb tendons is common in cases 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 feel pain if direct pressure is applied to the area.
What causes de Quervain's?
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 eight to 10 times more often than men.
How is de Quervain's diagnosed?
The test most frequently used to diagnose De Quervain's disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed in your palm. when the wrist is suddenly bent toward the outside, the swollen tendons are pulled throughout the tight space. If this movement is painful, you may have De Quervain's disease.
How is de Quervain's treated?
Treatment usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the affected area and refraining from any activities that aggravate the condition. Ice may be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication such as naproxen or ibuprofen, to decrease swelling. If de Quervain's disease does not respond to conservative medical treatment, surgery may also be recommended.
Surgery for de Quervain's disease is an outpatient procedure done under local anesthesia. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, restoring the tendons' smooth gliding capability. Upon recovery, your physician will recommend an exercise program to strengthen your thumb and wrist. Recovery times vary, depending on your age, general health and long the symptoms have been present.
In cases that have developed gradually, the disease is usually more resistant to management and improvement in function. It may take longer to achieve symptom relief in these cases.
Trigger finger frequently affects farmers, industrial workers, and musicians who rely on their fingers or thumbs for multiple repetitive movements
How is trigger finger treated?
The first step to recovery is to limit activities that aggravate the condition. Occasionally, your physician may put a splint on the affected digit to restrict the joint movement. If symptoms continue, anti-inflammatory medications, such as ibuprofen or naproxen, may be prescribed or steroid injection my be considered. If the condition does not respond to conservative measures or consistently recurs, surgery may be recommended to release the tendon sheath and restore movement.
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