Trigger finger, or trigger thumb, occurs when the pulley at the base of the finger becomes too thick and constricting around the tendon, making it hard for the tendon to move freely through the pulley. Some symptoms of trigger finger/thumb include tenderness felt at base of finger or thumb, and painful popping, catching or even locking of the finger/thumb when flexed or extended. Treatment options include wearing a splint or taking an oral anti-inflammatory medication. Symptoms can often be relieved by a steroid injection into the area around the tendon and pulley.
If symptoms persist or are severe, surgery may be recommended. The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. After surgery, some patients may feel tenderness, discomfort, and swelling in the area of surgery; however, for the most part, normal use of the hand can be resumed once comfort permits. Hand therapy is sometimes required to regain better use.
Dupuytren’s contracture is an abnormal thickening of the tissue just beneath the skin of the palm and can extend in to the fingers. Symptoms usually include lumps and pits within the palm, and the possible development of thick cords that extend into one or more of the fingers causing fingers to bend or contract.
In mild cases only observation is needed; however, in more severe cases various treatment options are available in order to straighten the fingers. The goal of treatment is to improve finger position and thereby hand function. Before treatment, the doctor will discuss realistic goals, possible risks, and results.
De Quervain’s tendonitis, or tenosynovitis, is a condition in which irritation or inflammation of the wrist tendons at the base of the thumb causes the tunnel around the tendon to swell and enlarge. Symptoms include painful thumb and wrist movement, swelling over the base of the thumb, and an occasional catching when moving the thumb.
Treatment can include wearing a splint, taking an oral anti-inflammatory medication, or having a steroid injected into the tendon compartment. If symptoms are too severe or do not improve, surgery may be recommended. Surgery opens the compartment to make more room for the inflamed tendons. Normal use of the hand can usually be resumed once comfort and strength have returned.
Ganglion cysts are lumps within the hand and wrist that occur adjacent to joints or tendons. These cysts may change in size and they may or may not be painful. Frequently ganglion cysts can simply be observed, especially if they are painless, as they can disappear spontaneously. Treatment includes the use of splints and anti-inflammatory medication.
An aspiration-placing a needle into the cyst-can be performed to remove the fluid from the cyst and decompress it. Surgery is sometimes necessary and involves removing the cyst along with a portion of the joint capsule or tendon sheath. Surgical treatment is generally successful although cysts may recur.
In osteoarthritis, the cartilage layer wears out, resulting in direct contact between the bones. This contact produces pain and deformity. One of the most common joints to develop osteoarthritis is at the base of the thumb, also known as the carpometacarpal (CMC) joint.
Patients with advanced disease or who fail non-surgical treatment may need surgical reconstruction. One surgical option would be for the doctor to perform CMC Arthroplasty, a surgical procedure in which the arthritic bone is removed and the joint is reconstructed. Other surgical treatments include joint fusion, bone realignment, and even arthroscopy in select cases.