A Family Doctor's Tale - TRIGGER FINGER

DOC I HAVE TRIGGER FINGER

TRIGGER FINGER is the compression of the tendon sheath of one of the tendon to the fingers or thumb(trigger thumb)
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the finger's bones especially at the joints.

TRIGGER FINGER occur as a result of narrowing of the tendon sheath and the inflammation of the tendon.

When the tendon gets caught in the sheath, the finger becomes locked in the narrowed tendon sheath until the tendon is freed from the tight area from forced movement of the locked finger using the other hand.

If left untreated an affected finger can become permanently bent inwards.

Women are affected more than men.

Causes of Trigger Finger:
1.trauma of the tendon sheath especially carrying heavy plastic bags and other bags

2.pressure on the tendon sheath from exertion of pressure through use of chopper knife and tools on the tendon sheath

3.repetitive use of the fingers such as computer keyboard or mouse

4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift preventing movement of finger.

5.common among middle-aged, taxi drivers gripping the wheel for long hours every day, housewifes and those who often use their fingers in a gripping motion.

6.Also common among people who use the computer or mobile phones

Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the finger which causes the patient to seek treatment:

1.Finger is unable to extend after bending.
As you try harder to straighten the finger, it snaps open as the swollen tendon that was restrained is freed suddenly

2.pain at the base of the affected finger on the palm

Physical examination
1.tendon nodules in flexor tendon at metacarpal head that moves with the tendon

2.no active finger flexion

3.finger locks in flexion in active movement;
extension only can be performed passively
slight pain occurs with clicking sound when passively moved

4.diagnosis is confirmed with CAT scan or MRI

Treatment of Trigger Finger:
1.Rest and splinting of affected finger

2.finger exercise usually good.

3.Non-steroidal anti-inflammatory drugs for inflammation and pain

4.Corticosteroid injection to reduce inflammation under the narrowed sheath

5.Surgery as last resort to release the tendon by cutting the top part of the  narrowed inflammed sheath

Prognosis of Trigger Finger:
1.usually good with injection of corticosteroid

2.recurrence may occur after injection in which case surgery should be done

Prevention:
1.Avoid forceful use of the fingers

2.Avoid carrying heavy plastic bags

3.Avoid repetitive movement of the fingers.

A Family Doctor's Tale - TENDONSYNOVITIS

DOC I HAVE A PAINFUL TENDON

Tenosynovitis is fairly common more in women than in men. One of the most common tenosynovitis is tennis or golf elbow due to strain of the tendon at the elbow region. 
The other common tenosynovitis are trigger finger at the palm of the hand and De Quarvain's Disease which affects the tendons of the wrist. 
In most cases a single injection of lignocaine and hydrocortisone will clear the  inflammation and swelling of the tendon sheath. Recurrence however is common. Patients are advised to avoid pressure on their tendon sheaths and strain on their tendons. 
Very rarely is there any need to go for surgery

Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.


It can occur together with tendinitis(inflammation of the tendons).


It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).


The cause of Tenosynovitis is unknown.

Some possible causes are:
1.Injury or trauma to the tendon


2.Repetitive usage of finger and wrist joints 


3.Arthritis of the joints may predispose to tenosynovitis


4.Systemic diseases such as multiple sclerosis , amyloidosis, rheumatoid arthritis


5.Tenosynovitis occurs in families, and is generally seen more often in males than in females


Symptoms:
1.Pain on movement of the tendon


2.Swelling of part of the tendon affected


3.Stenosis of the tendon sheath may be present


4.Stiffness of the tendon - inability to stretch


5.Pain is felt most beneath the bone of involved joints


Signs:

1.swelling over the involved tendon


2.Passive stretching of the tendon is painful.


3.There may be local tenderness of the inflamed tendon.


4.The tendons sheaths are usually swollen and thickened


5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)


6.There may be crepitation over the tendon as it moves across the sheaths



Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.


Conservative treatment:

1.rest of the tendon


2.Cold or ice may help reduce inflammation


3.Splints over the hand, wrist and elbow may help to rest the tendons


4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain


5.Muscle relaxant to relax muscles


6.Injection of local anesthetic and long acting steroid into the affected sheath or tendon nodule may help to reduce inflammation


7.Surgery :

Surgical opening of the synovial sheath may be necessary for tendon release.


Prognosis is usually good although recurrence may occur after cortisone injection.


Surgery usually give excellent results.