Hand and Wrist Injuries and Conditions

There are several causes that could lead to pain in the hand or wrist. Here are some of the most common conditions and how they are treated.

Trigger Finger

What is Trigger Finger?
Trigger finger is a condition that causes pain, stiffness and a sensation of locking or catching when you bend or straighten your finger or thumb. The condition is also known as stenosing tenosynovitis. The ring finger and thumb are most often affected by trigger finger, but it can occur in any finger and sometimes multiple fingers at the same time.

The flexor tendons of our fingers are long cord-like structures that attach the muscles of the forearm to the bones of the fingers. These tendons allow us to bend our fingers. Each of the flexor tendons passes through a tunnel in the palm and fingers that allows it to glide smoothly as the finger is moved. This tunnel is called the “tendon sheath.” Along the tendon sheath, bands of tissue called “pulleys” hold the flexor tendons closely to the bones. The tendon passes through the pulley as the finger moves. The pulley at the base of the finger is the “A1 pulley.”

In a patient with trigger finger, the A1 pulley becomes inflamed or thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may also become inflamed and thickened. When the finger flexes and the thickened tendon tries to pass through the thickened pulley, there is a sensation of catching or popping. This can be painful.

How does trigger finger occur?
The causes of trigger finger are not well known. However, trigger finger issues are more common in people with diabetes and rheumatoid arthritis. It is also seen when people routinely do forceful hand activities.

How is trigger finger treated?
Initially trigger finger can be treated by resting your hand and avoiding activities that make it worse. A splint while you sleep might be helpful as well.. Gentle stretching may improve range of motion and decrease stiffness. Over-the-counter medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS), can help with pain and inflammation. Steroid injections act as an anti-inflammatory agent and can decrease pain and inflammation. They are injected at the base of the finger near the A1 pulley. Injections can be repeated. If your finger does not improve with nonsurgical treatment, you may wish to proceed with surgery.
Surgery involves the release of the A1 pulley. This allows the flexor tendon to glide freely again.

Cubital Tunnel Syndrome

What is Cubital Tunnel Syndrome?
Cubital Tunnel Syndrome is when the ulnar nerve becomes compressed or irritated around the elbow area. The ulnar nerve is one of three main nerves in your arm. It travels from your neck region to your fingers and can be compressed at multiple locations, with the elbow being the most common. The ulnar nerve runs behind the inside bone of the elbow, near the skin. When you bump it at the elbow you may experience a shock-like feeling down the arm that is called “hitting my funny bone.”  If the ulnar nerve is compressed or irritated, you may experience numbness or tingling into your hand. Specifically of the small finger and the ring finger. You may also have weakness in grip and difficulty with coordination of the fingers.

How does Cubital Tunnel Syndrome occur?
Cubital tunnel syndrome is caused by compression near the elbow area. There are several ways that this can occur. When you bend the elbow, the ulnar nerve must stretch around the boney aspect of the elbow. If the elbow is held there for prolonged periods of time or repeatedly bent, this can cause irritation of the nerve. Many people do this while sleeping and may wake up with numbness.
In some people, the nerve slides out of its typical spot behind the elbow and becomes irritated because it rubs on the boney aspect of the elbow. Leaning on your elbow for long periods of time can increase pressure on the nerve as well. “Hitting your funny bone” could irritate the nerve. Structures from around the elbow may place further compression on the nerve, such as arthritis in the elbow joint or prior fracture or dislocation of the elbow.

How is Cubital Tunnel Syndrome treated?
Avoiding positions that increase compression on the ulnar nerve is the initial treatment. This includes avoiding activities that keep the elbow bent for prolonged periods of time. Avoiding leaning on the elbow or forearm. This is commonly done when driving or working on a computer. Also, keeping your arm straight when you go to sleep. Wrapping a towel around the elbow or using an elbow pad backwards can help prevent the elbow from bending. Non-steroidal anti-inflammatory medicines may help if the nerve is irritated or the structures around the nerve are inflamed. A brace or splint at night may be prescribed.

If symptoms persist, weakness is found in the hand, or the compression is severe an orthopaedic surgeon may recommend surgery to relieve the pressure. The surgery could involve release of the nerve at the elbow or relocating the nerve from behind the elbow to an area in front of the elbow. Typically these surgeries are done in the outpatient setting. The results are generally good but do depend on the severity of the nerve compression. It may take several months for the nerve to recover from being compressed and sometimes the nerve has sustained permanent damage that does not fully recover.

Ganglion Cyst

What is a ganglion cyst of the wrist and hand?
Ganglion cysts, are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They can appear in many areas around the wrist, hand and fingers. These fluid-filled cysts can quickly appear, disappear and change sizes. A ganglion cyst rises out of a joint, like a balloon on a stalk. It grows out of the tissue surrounding a joint. Inside the balloon of tissue is a thick, gelatinous fluid, similar to the fluid that lubricates the joint.

Ganglion cysts can vary in location and size. They can enlarge with activity and shrink with rest. Some form a visible or palpable lump. Some can be painful or uncomfortable, but some remain pain free.

How does a ganglion cyst occur?
It is not known what triggers the formation of a ganglion. They are more common in people between the ages of 15 and 40 years old. Women are affected more than men. Ganglion cysts that develop at the end joint of a finger are typically associated with arthritis in that joint and are more common between the ages of 40 and 70 years old.

How are ganglion cysts treated?
Because the ganglion cyst is not cancerous and may disappear in time, if you do not have symptoms, your doctor may recommend just waiting and watching the cyst initially. Activity often causes the ganglion cyst to increase in size and cause more discomfort. A wrist brace or splint may relieve these symptoms and cause the ganglion to decrease in size. If the ganglion cyst limits activities or causes pain, in some cases the fluid may be drained. This procedure is called an aspiration and usually done in the office under local anesthetic. Aspiration frequently fails to eliminate the ganglion as the stalk or “root” that connects the balloon to the joint remains and can refill with time.

Surgery is also an option. The goal of surgery is to remove both the cyst and its stalk. This is called an excision. There is a small chance the ganglion returns even after excision. This is done as an outpatient procedure. There typically is some discomfort, tenderness and swelling after this surgery with expected return to normal activities after a few weeks.

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Request an online appointment or call 630-692-5576 to see an orthopaedic specialist with the Hand and Upper Extremity Center.

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