Trigger Finger

Trigger Finger
Trigger Finger (Stenosing Tenosynovitis): Causes, Symptoms, and Treatment

Stenosing tenosynovitis, commonly known as trigger finger or trigger thumb, occurs when a finger or thumb gets stuck in a bent position and then “pops” out when released, much like releasing a trigger. This condition involves the tendons in the hand that bend the finger. The tendons act like a pulley system, with “ropes” connecting the forearm muscles to the bones of the fingers and thumb. If the pulley at the base of the finger becomes too thick or constricted, it can prevent the tendon from moving freely, causing the finger to get stuck and snap back when it is freed. This cycle can lead to inflammation, pain, and difficulty in straightening or bending the finger.

What Causes Trigger Finger?

The exact cause of trigger finger is not fully understood, but several factors can contribute to its development. These include:

  • Rheumatoid arthritis: A condition that can cause inflammation of the joints, including the tendons in the fingers.
  • Gout: A form of arthritis that may affect the tendons and joints in the fingers.
  • Diabetes: People with diabetes may be more prone to developing trigger finger.
  • Local trauma: Injury or repetitive stress to the area may also trigger the onset of this condition.
Symptoms of Trigger Finger

Common symptoms of trigger finger include:

  • Discomfort at the base of the finger or thumb
  • Tenderness upon localized pressure
  • Inflammation of the affected finger or thumb
  • Stiffness, making movement difficult
  • A nodule (lump) may appear on the middle finger or tip knuckle of the thumb
Treatment for Trigger Finger

The goal of treatment is to alleviate the catching of the finger and allow for full movement without discomfort. Treatment options may include:

  • Splinting: Wearing a splint to immobilize the affected finger or thumb.
  • Anti-inflammatory medication: To reduce inflammation in the area.
  • Activity modification: Changing activities to reduce further swelling and irritation.
  • Surgery: If non-invasive treatments do not relieve symptoms, surgery may be recommended to release the constricted tendon.

If you suspect that you have trigger finger, it is important to seek treatment from a specialist at South Florida Hand and Orthopaedic Center as soon as possible to prevent further pain or injury.

Metacarpophalangeal Joint Arthritis

Elderly woman with Arthritis in her hands
Metacarpophalangeal (MP) Joint Arthritis: Causes, Diagnosis, and Treatment

The metacarpophalangeal (MP or MCP) joints are large joints at the base of each finger. These complex hinge joints play an important role in both power grip and pinch activities.

Causes of Metacarpophalangeal Joint Arthritis

The MP joints are less commonly affected by arthritis than smaller hand joints or the joints where the thumb meets the wrist (CMC). However, several conditions can affect the MP joints, including:

  • Rheumatoid arthritis: The most common arthritic condition affecting the MP joints. It causes inflammation of the joint lining (synovium), leading to cartilage and soft tissue destruction, resulting in ulnar drift of the fingers toward the little finger.
  • Post-traumatic arthritis: Occurs after injury, leading to gradual loss of cartilage and progressive pain and stiffness.
  • Osteoarthritis: A form of arthritis that affects the MP joints, causing pain and stiffness, particularly in the thumb, index, and middle fingers.
  • Gout, psoriasis, and infection: Less common causes of MP joint arthritis.
Diagnosis of Metacarpophalangeal Joint Arthritis

The symptoms of MP joint arthritis vary based on the underlying cause:

  • Rheumatoid arthritis: Characterized by pain, swelling, and deformity in multiple joints, with an ulnar drift of the fingers and loss of motion, especially in extending (straightening) the fingers.
  • Osteoarthritis and post-traumatic arthritis: Involves deep, aching joint pain, particularly with grip and pinch activities. Swelling, especially between large knuckles, may also be present.

The doctor can confirm the presence of MP arthritis through x-rays, and special x-rays may be necessary to assess the metacarpal head in milder cases.

Treatment Options for MP Arthritis

There are various treatment options depending on the severity of joint destruction and the symptoms experienced:

  • Rheumatoid arthritis: Medications to combat the inflammatory process are typically the first line of treatment. If medications are ineffective, synovectomy (removal of the inflamed synovium) may be considered to slow the destructive process and preserve cartilage.
  • Post-traumatic arthritis: Anti-inflammatory medications, activity modification, and splints may offer relief. If symptoms worsen, surgical treatment may be necessary.
MP Joint Fusion or Replacement

For severe joint destruction, patients may benefit from joint fusion or replacement. Key options include:

  • Joint fusion: While effective for the thumb, joint fusion can result in a loss of motion in the fingers.
  • Joint replacement: Typically preferred over fusion, especially in younger or more active patients.
  • Salastic hinged implants: Provide reasonable pain relief and are often used in older, less active patients.
  • Advanced implants: Newer implants that replicate joint surfaces may offer improved outcomes for younger, more active individuals.

If you’re suffering from metacarpophalangeal joint arthritis, make an appointment with South Florida Hand and Orthopaedic Center.

Nail Bed Injuries

Nail Bed Injuries
Nail Bed Injuries: Causes, Symptoms, and Treatment

Nail bed injuries are often linked to damage to surrounding structures, including:

  • Bone fractures: Typically involving the distal phalanx.
  • Nail bed or fingertip skin (pulp) cuts.
  • Tendons: Those responsible for straightening or bending the fingertip.
  • Nerve endings.

These injuries often result from crushing incidents, such as getting the fingertip caught in a door. Any type of pinching, crushing, or sharp cut to the fingertip can lead to a nail bed injury.

Identifying a Nail Bed Injury

A simple fingertip crush can cause a painful collection of blood (hematoma) under the nail. More severe injuries may cause the nail to crack into pieces or result in the nail and/or fingertip tearing off, potentially injuring nearby structures.

Diagnosis of Nail Bed Injuries

The doctor will begin by asking for details about the injury’s cause. X-rays may be recommended to check for associated fractures that may need treatment. The full extent of the injury may not be apparent until the nail bed is examined with magnification.

Nail Bed Injury Treatment

Treatment aims to restore the anatomy of the nail and surrounding structures. Treatment options may include:

  • Hematoma drainage: A small hole is made in the nail to relieve pressure and reduce pain.
  • Repairs for cuts: The affected areas are realigned to their proper position.
  • Bone alignment: If bone fragments are present, alignment and restoration of the fingertip fractures may be required. Larger bone fragments may need pins or splints to heal.
  • Nail bed grafts: Missing nail bed areas may be grafted from the same finger or other digits.
  • Tendon injuries: Tendon damage may require splinting or pinning.
  • Skin flaps: Local skin flaps can replace missing skin, or the area may heal naturally or with a skin graft.

The final appearance and function of the nail and fingertip depend on the restoration of the anatomy. If the injury is sharp and can be repaired, the nail can be restored to normal. However, severe crushing of the nail bed can result in scarring and deformity. Damage to the germinal matrix (the crescent-shaped area at the base of the nail) may lead to deformed nail growth. It generally takes three to six months for the nail to grow from the cuticle to the fingertip.

Flexor Tendon Injuries

Flexor Tendon
Flexor Tendon Injuries: Causes, Symptoms, and Treatment

Flexor tendons are cord-like structures that connect the flexor muscles to the bones, enabling the bending or flexing of the fingers. These tendons run from the elbow and forearm, pass through the wrist, and attach to the bones of the fingers. They move through fibrous rings, known as pulleys, which guide and keep the tendons close to the bones for efficient movement of the joints.

Flexor Tendon Injuries

Deep cuts to the palm side of the wrist, hand, or fingers can damage the flexor tendons, as well as the surrounding nerves and blood vessels. While the external injury may appear minor, it can be quite complex internally. When a tendon is cut, its ends act like a rubber band, pulling apart. If a tendon is not fully severed, the finger may still bend but may cause pain, catching, or eventually tear completely. If the tendon is entirely cut, the finger joint will be unable to bend on its own.

Treating Flexor Tendon Injuries

Since the tendon ends typically separate after a cut, they will not heal properly without surgical intervention. Your doctor will guide you on the urgency of the surgery based on the severity of the injury. Various repair techniques may be used, depending on the type of tendon injury, and special attention is required to preserve the pulleys of the finger.

  • Post-surgery care: After surgery, the injured area may be protected from movement or placed on a controlled limited-movement regimen for several weeks, based on the nature of the injury.
  • Hand therapy: Your surgeon may recommend hand therapy after surgery to assist in recovery.
  • Rehabilitation: After four to six weeks, you may begin to move your finger slowly, without resistance, to regain mobility.

It is crucial to follow your surgeon’s guidance closely to ensure the best possible recovery and preserve the functionality of your finger.

Fingertip Injuries

Fingertip Injuries
Fingertip Injuries: Causes, Evaluation, and Treatment

Fingertip injuries encompass a wide range of damage to the skin, bone, nail, nail bed, tendon, or the pulp of the fingertip. These injuries can affect both the functionality and appearance of the finger, often requiring immediate care to prevent complications.

Evaluating a Fingertip Injury

The way in which the injury occurred and any pre-existing medical conditions are crucial factors in determining the most effective treatment. Your hand doctor will:

  • Examine the extent and size of the tissue injury.
  • Assess the sensation and circulation in the fingertip.
  • Check the mobility of the fingertip, as tendon injuries can affect the ability to bend or straighten the finger.
  • Possibly perform an X-ray to determine if the bone has been injured.
Fingertip Injury Treatment

For fingertip injuries, treatment will depend on the severity of the damage.

  • Minor injuries: If only the skin is affected and the defect is less than a centimeter in diameter, treatment may involve simple dressing changes.
  • Exposure of bone: If the injury exposes bone, your doctor may trim the bone back slightly and treat it with a dressing.
  • Larger skin defects: In cases where more significant skin loss occurs, skin grafting may be necessary. Smaller grafts can be taken from the little finger side of the hand, while larger grafts may be harvested from the forearm or groin.

Due to the fingertip’s highly sensitive and specialized skin, restoring full function and sensation can be a complex process, but with the proper treatment, many injuries can heal successfully.

Fingertip Infections

Fingertip Infections
Fingertip Infections: Causes, Symptoms, and Common Types

Fingertip infections are a common health issue due to the frequent use of our hands in everyday activities. Any opening in the skin around the fingertip can allow harmful bacteria, viruses, or fungi to enter, leading to infection. If left untreated, fingertip infections can result in permanent damage or even the loss of a finger.

Common Causes of Fingertip Infections

Fingertip infections can result from numerous factors, including:

  • Biting nails
  • Picking cuticles
  • Working with sharp or rough objects
  • Handling animals

Any of these activities can lead to cuts or breaks in the skin, creating an entry point for infections. Below are some of the most common types of fingertip infections:

Types of Fingertip Infections
  • Felon: A bacterial infection located in the fingertip pad, often caused by staphylococcal or streptococcal bacteria. It typically enters through a puncture wound, leading to swelling and pain in the fingertip. The infection is localized, forming a pocket of pus.
  • Herpetic Whitlow: A herpes simplex virus infection commonly seen in healthcare professionals or individuals who have herpes. This infection causes redness, tenderness, and a burning or itching sensation in the fingertip.
  • Cellulitis: The most common fingertip infection, cellulitis is a staphylococcal or streptococcal infection that occurs due to an open wound. The infected area becomes red, warm, swollen, and tender, and can spread to surrounding tissues or enter the bloodstream if untreated.
  • Infectious Flexor Tenosynovitis: Caused by deep, penetrating trauma, this infection affects the tendon sheaths in the fingertip. It causes swelling, tenderness in the underside of the finger, and pain when trying to bend the finger. The infection can spread easily along the tendon sheath.
  • Paronychia: A bacterial or fungal infection near the fingernail, often caused by biting hangnails. The affected area becomes red, swollen, and may develop pus.
Preventing Fingertip Infections

To prevent fingertip infections, it is important to avoid activities that break the skin on your fingers, such as nail biting and cuticle picking. Always clean wounds promptly and avoid putting your hands in potentially contaminated areas. If an infection does occur, seek treatment to prevent complications.

Extensor Tendon Injuries

South Florida Hand and Orthopaedic 07
Understanding Extensor Tendon Injuries: Causes, Types, and Treatment

Located on the back of the hand and fingers, the extensor tendons are responsible for allowing you to straighten your fingers and thumb. These tendons are attached to muscles in your forearm and become flat and thin as they extend into the fingers. Smaller tendons from the hand muscles contribute to delicate finger motions and coordination.

Common Types of Extensor Tendon Injuries

Extensor tendons are located just beneath the skin, directly on the bone, making them highly vulnerable to injury, even from minor cuts. A jamming injury can tear these tendons away from the bone, resulting in difficulty straightening one or more joints. Common types of extensor tendon injuries include:

  • Mallet Finger: This occurs when the tendon at the end joint is cut or separated from the bone, causing the fingertip to droop.
  • Boutonniere Deformity: This condition results in a bent-down (flexed) middle joint of the finger due to a tear or cut of the extensor tendon.
  • Lacerations: Cuts on the back of the hand can damage the extensor tendons.
Treatment for Extensor Tendon Injuries

The treatment for extensor tendon injuries depends on the type and severity of the injury. Here’s what you can expect:

  • Cuts or Lacerations: A tendon cut may require stitches to repair the injury.
  • Jamming Injuries: Tears caused by jamming injuries are typically treated with splints that prevent the healing tendon from pulling apart.
  • Splinting: The doctor will apply the splint to the correct area and provide instructions on how long it should be worn. In some cases, a pin may be inserted through the bone to serve as an internal splint.

It is essential to follow the doctor’s instructions and wear the splint as prescribed to ensure proper healing and restore the functionality of the tendon. In severe cases, further intervention may be necessary to ensure full recovery.

Numbness and Tingling

Numbness and Tingling
Hand Numbness and Tingling: Causes and Diagnosis

Hand tingling and numbness are common symptoms, but they are not always caused by carpal tunnel syndrome (CTS). Compression neuropathy, which occurs when local pressure is applied to a nerve, can also result in these sensations. This pressure often causes numbness in distinct patterns based on the area supplied by the affected nerve. Additionally, muscle weakness, wasting, or twitching may occur.

Causes of Nerve Compression
  • Thickened Muscles
  • Bands of Connective Tissue
  • Enlarged Blood Vessels
  • Ganglion Cysts
  • Arthritic Spurs
Common Types of Nerve Compression

Ulnar Nerve Compression:

  • Occurs at the wrist or elbow.
  • Causes numbness and tingling in the little finger, part of the ring finger, and the ulnar side of the palm.
  • Ulnar nerve pressure at the elbow also causes numbness on the back of the ulnar side of the hand.

Radial Nerve Compression:

  • Occurs in the forearm or above the wrist.
  • Results in numbness over the back of the thumb, index finger, and the web between these two digits.

Median Nerve Compression:

  • Occurs at or below the elbow.
  • Causes numbness similar to carpal tunnel syndrome but also affects the palm at the base of the thumb.
Other Causes of Hand Numbness and Tingling

In addition to compression neuropathies, several other factors may cause numbness and tingling in the hand:

Pressure on Nerves in the Neck:

  • Nerves in the hand and forearm originate from the neck, and pressure on these nerves can lead to symptoms in the arm, forearm, or hand.
  • Conditions such as arthritis, degenerating discs, or narrowing of the spinal canal can cause nerve compression.

Diseases of the Central Nervous System:

  • Conditions like multiple sclerosis or a stroke can cause numbness, tingling, or aching in the arm, forearm, or hand.

Infections, Blood Vessel Abnormalities, or Spinal Cord Conditions:

  • These can also cause pressure on the nerves, leading to hand numbness or tingling.

Double Crush Syndrome:

  • A condition where a nerve is compressed in two different areas (e.g., in the neck and wrist), exacerbating symptoms.
Peripheral Neuropathy

If the symptoms are more generalized and occur in both the hands and forearms (as well as the legs and feet), peripheral neuropathy may be the cause. This condition causes a glove-like pattern of numbness, which can be constant and may or may not include pain. Common causes include:

  • Diabetes
  • Alcoholism
  • Old Age
  • Poisoning from metals or industrial compounds
Other Causes of Hand Numbness and Tingling
  • Medications: Some medications, such as those used in cancer treatment, can cause numbness and tingling, though these usually resolve after chemotherapy.
  • Nutritional Deficiencies: Deficiencies, such as a lack of vitamin B1, can also cause these symptoms.
Diagnosing Hand Numbness and Tingling

To determine the cause of your symptoms, your doctor will evaluate the pattern and distribution of numbness and tingling. They may consider factors such as nerve compression, disease, medication use, or other underlying conditions.

Further diagnostic testing may include:

  • X-rays or MRIs to assess bone or soft tissue involvement.
  • EMG (electromyography) nerve tests to evaluate nerve function.
  • Blood tests to check for conditions like diabetes or vitamin deficiencies.

Once a diagnosis is confirmed, your doctor will discuss appropriate treatment options to address the cause of the numbness and tingling in your hand.

Mallet Finger

Mallet Finger
Mallet Finger or Baseball Finger

Mallet finger, also known as baseball finger, is an injury to the relatively thin tendon that straightens the end joint of your finger and thumb. With mallet finger, the end joint of your fingertips will bend but will not straighten by itself. You may be able to physically push your finger straight, but it will not naturally hold this position.

What Causes Mallet Finger and Baseball Finger?

The most common cause of mallet finger is when an unyielding object (such as a baseball) hits your thumb or finger and causes it to bend back further than intended. When this happens, the force of the blow tears your extensor tendon. Mallet finger can also occur with a minor force, such as tucking in a bed sheet. After the force or impact has occurred, patients are unable to straighten the thumb or fingertip on their own.

What Happens When You Have Mallet Finger?

A mallet finger injury can either pull the tendon away from where it attaches to the finger bone or outright rupture the tendon. In some instances, a tiny piece of your bone is jerked away with the tendon, which is called an avulsion injury. The most common fingers to be injured are the small finger, ring finger, and long finger on your dominant hand.

Symptoms of Baseball Finger or Mallet Finger

If you have mallet finger, your finger may be bruised, swollen, and painful. Your fingertip will noticeably droop and will only straighten if you push it in place with your other hand. If your nail is detached or if there is blood beneath the nail, it’s vital to seek medical attention to avoid infection. These may be indicators of a cut in the nail bed or a broken finger bone with an open fracture. Each of these injuries places you at risk of infection.

Treatments for Mallet Finger

A mallet finger injury requires the attention of a hand surgeon or hand specialist. Your visit will include a physical examination and an X-ray to determine if the injury forced your bones out of alignment. If you leave this condition untreated, it may result in deformity and stiffness. In children, mallet finger can affect the cartilage, which controls bone growth.

In either case, the hand experts at South Florida Hand and Orthopaedic Center can treat most mallet finger conditions with non-surgical treatments, such as a splint. If your joints are out of line or if there is a large fracture fragment, your physician may consider surgical repair.

Schedule an Appointment with South Florida Hand and Orthopaedic Center

Mallet finger or baseball finger can be frustrating and painful, but South Florida Hand and Orthopaedic Center offers multiple treatment options to remedy this condition. The physicians and staff at South Florida Hand and Orthopaedic Center provide innovative solutions for a wide range of conditions affecting your hands, arms, fingers, and thumb. We treat patients of all ages.

Swan-Neck Deformity

Swan Neck Deformity
Swan-Neck Deformity

Swan-neck deformity is a condition explaining the deformed position of your finger. This condition is a complex ailment where the proximal IP (PIP) joint over straightens because of a lax ligament on the palmar side of the joint. The ligament on the palmar side of the joint is called the volar plate, which is designed to prevent over straightening. When a patient is experiencing a swan-neck deformity, the finger will have a hyperextended PIP joint and a bent distal IP (DIP) joint, making the finger appear in a position that resembles a swan’s neck.

What Causes Swan-Neck Deformity?

The most common cause of swan-neck deformity is rheumatoid arthritis. The chronic inflammation on the PIP joint stretches the volar plate. As the volar plate becomes stretched and weakened, the PIP joint begins to hyperextend. This causes the extensor tendon to get out of balance, which makes the DIP joint get pulled down toward the flexion.

Swan-neck deformity commonly results from an overlooked injury in childhood, adolescence, or young adulthood. The finger can begin bending downward on its own and stay in a fixed over-straightening position. If this happens, this condition can be extremely debilitating. Other causes of swan-neck deformity include:

  • Untreated mallet finger
  • Looseness of the fibrous plate
  • Looseness of the finger ligaments
  • Chronic muscle spasms caused by nerve damage
  • Other types of arthritis
  • Ruptured finger tendon
  • Misalignment
Diagnosis and Treatment of Swan-Neck Deformity

In most instances, swan-neck deformity can be diagnosed from a physical examination. However, an X-ray may be ordered to allow the physician to examine joint alignment, check the condition of joint surfaces, and determine if a fracture is present. After diagnosis is complete, physicians can use either non-surgical or surgical treatment options.

Non-surgical Treatments

Non-surgical treatments are based on restoring balance in the fingers and hand. The goal of non-surgical treatment is to realign the PIP joint and prevent hyperextension, which should restore DIP extension. Stints are commonly used to protect the joint from hyperextending and line PIP joints up.

Physicians may also prescribe physical and occupational therapy in order to restore function and alignment.

Surgical Treatments

If non-surgical techniques are unable to treat the swan-neck case, surgery may be used to reconstruct the hand around the PIP joint. Your physician may use soft tissue repair, PIP joint arthroplasty, and/or finger joint fusion to remedy your swan-neck deformity.

Schedule an Appointment with South Florida Hand and Orthopaedic Center

Swan-neck deformity is a debilitating condition that can affect every area of your life. The experts at South Florida Hand and Orthopaedic Center offer several years of experience treating this condition and other conditions of the hands and fingers. We treat patients of all ages.