Hand
Mallet Finger Trigger Finger Tendon/Ligament Injuries to Fingers
Description: When you think about how much we use our hands, it's not hard to understand why injuries to the fingers are common. Most of these injuries heal without significant problems. One such injury is an injury to the distal interphalangeal, or DIP, joint of the finger. This joint is commonly injured during sporting activities such as baseball. If the tip of the finger is struck with the ball, the tendon that attaches to the small bone underneath can be injured. Untreated, this can cause the end of the finger to fail to straighten completely. A mallet finger results when the extensor tendon is torn from the attachment on the bone. When this occurs, a small fragment of bone may be pulled, or avulsed, from the distal phalanx. The result is the same in both cases--the end of the finger droops down and cannot be straightened.
Symptoms: Initially, the finger is painful and swollen around the DIP joint. The end of the finger is bent and cannot be straightened voluntarily. The finger can be straightened easily with help from the other hand.
Treatment: Treatment for mallet finger is usually nonsurgical. If there is no fracture, then the assumption is that the end of the tendon has been ruptured, allowing the end of the finger to droop. Usually an occupational therapist will make splint for the finger. Continuous splinting for six weeks followed by six weeks of nighttime splinting will result in satisfactory healing and allow the finger to extend. The key is continuous splinting for the first six weeks. The splint holds the DIP joint in full extension and allows the ends of the tendon to move as close together as possible. As healing occurs, scar formation repairs the tendon. If the splint is removed and the finger is allowed to bend, the process is disrupted and must start all over again. The splint must remain on at all times--even in the shower.
Splinting will even work when the injury is quite old. Most doctors will try a six week trial of splinting to see if the drooping lessens to a tolerable limit before considering surgery. Surgical treatment is reserved for unique cases. The first is when the result of conservative treatment is intolerable. If the finger droops too much, the tip of the finger gets caught as you try to put your hand in a pocket. This can be quite a nuisance. If this occurs, the tendon can be repaired surgically, or the joint can be fused in a fixed position. The other case is when there is a fracture associated with the mallet finger. If the fracture involves enough of the joint, it may need to be repaired. This may require pinning the fracture. If the damage is too severe, it may require fusing the joint in a fixed position.
Rehabilitation during and following treatment for a mallet finger focuses mainly on keeping the other joints mobile and preventing stiffness from disuse. An occupational therapist may be consulted to teach you home exercises and make sure the other joints do not become stiff. Once the mallet finger has healed sufficiently, exercises may be instituted to strengthen the finger involved and increase flexibility.
Description: Trigger finger and trigger thumb are conditions affecting the movement of the tendons as they bend the fingers or thumb toward the palm of the hand. This movement is called flexion. The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone. To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the flexor tendons to glide through the tunnel formed by the pulleys as the hand is used to grasp objects. Triggering is usually the result of a thickening in the tendon that forms a nodule, or knob. The pulley ligament may thicken as well. The constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area and create the nodule. Rheumatoid arthritis, partial tendon lacerations, repeated trauma from pistol-gripped power tools, or long hours grasping a steering wheel can cause triggering. Infection or damage to the synovium causes a rounded swelling (the nodule) to form in the tendon. Triggering can also be caused by a congenital defect that forms a nodule in the tendon. The condition is not usually noticeable until infants begin to use their hands.
Symptoms: The symptoms of trigger finger or thumb include pain and a funny clicking sensation when the finger or thumb is bent. Pain usually occurs when the finger or thumb is bent and straightened. Tenderness usually occurs over the area of the nodule--at the bottom of the finger or thumb. The clicking sensation occurs when the nodule moves through the tunnel formed by the pulley ligaments. With the finger straight, the nodule is at the far edge of the surrounding ligament. When the finger is flexed, the nodule passes under the ligament and causes the clicking sensation. If the nodule becomes too large it may pass under the ligament, but becomes stuck at the near edge. The nodule cannot move back through the tunnel, and the finger is locked in the flexed trigger position.
Treatment: Unfortunately, very little can be done, short of surgery, once a finger or the thumb has developed triggering. A cortisone injection into the tendon sheath may decrease the inflammation and shrink the nodule to relieve the triggering, but the results will probably be short lived. If your problem just started and the tendon isn't triggering, a splint may be used after the injection. The splint is used to rest the tendon and attempt to get the inflammation and nodule to shrink. The usual solution for treating a trigger digit is surgery to open the pulley that is obstructing the nodule and keeping the tendon from sliding smoothly. This surgery can usually be done as an outpatient procedure, meaning you can leave the hospital the same day. After surgery, an occupational therapist may apply a special splint to get the finger or thumb to straighten. The therapist may also apply heat treatments, soft-tissue massage, and hands-on stretching to help with the range of motion. Some of the exercises you'll begin to do are to help strengthen and stabilize the muscles and joints in the hand. Other exercises are used to improve fine motor control and dexterity. You'll be given tips on ways to do your activities while avoiding extra strain on the healing tendon. You may need to return to therapy two to three sessions each week for up to six weeks.
Tendon/Ligament Injuries to Fingers
Description: Tendons in the hand connect with muscles of the forearm, enabling you to bend and extend your fingers and lift your hand at the wrist. The flexor tendons are smooth, thick flexible strings, running through six lubricated tunnels or compartments (flexor tendon sheaths). They work like bicycle brake cables to bend your fingers, sliding smoothly within the fingers as they straighten and bend. Because this is a very precise mechanism, dependant upon the muscles of the forearm and many coordinated parts, injuries to a tendon or its sheath can cause major problems in the hand.
Symptoms: The most common problem people have after a tendon injury is stiffness and an inability to fully bend or straighten the finger. If the finger has been cut, there is an open laceration.
Treatment: If you have experienced any injury of the hand or wrist, it is essential to seek medical treatment immediately. Many tissues quickly lose their elasticity, and prompt treatment is necessary to limit damage. Injuries to the hand, wrist, and forearm involve many related components and potential complications. The results of surgery are maximized if it is performed as soon as possible, within two weeks after injury at most. Flexor tendon and extensor tendon injuries require surgical repair. Sewing a cut flexor tendon together is not unlike sewing two small pieces of rope together, end to end. The special stitches used on both the inside and outside of the repair can be pulled apart if the hand is not protected after surgery by a splint. Time is needed to strengthen the repair, and the splint may be required for as long as two months. If a tendon has been cut or pulled off the bone, stitches through the bone or a special anchoring implant may be necessary. The specific location of the injury has a big influence on postoperative recovery, as do the details of impact on surrounding tissue, such as damage to associated nerves and bones. Injuries that involved crushing present particular challenges.
Surgery alone is not enough to assure recovery after flexor and extensor tendon injuries, although the hand will undoubtedly work better as a result of surgical repair. Rehabilitation is also essential, and involves learning how to rebuild strength and dexterity in the hand. Special custom splints are often devised, and an occupational therapist helps you retrain the hand and fingers, perform particular exercises, and relieve the discomfort associated with this condition. He or she will recommend specific heat treatment to be applied through the splint. Once the splint is removed, therapy and rehabilitation should continue. Ice massage is helpful before and after exercising the hand.