WHAT IS TRIGGER FINGER AND THUMB?

Trigger finger is a common disorder of the hand which causes painful snapping or locking of the fingers or thumb.

WHAT ARE THE CAUSES?

The exact cause of trigger finger or thumb is not readily evident. In many cases, the condition may be the result of repetitive strain of the area due to work or hobby activities. Tasks that require monotonous grasping or prolonged use of tools for example scissors, screwdrivers, etc. which press firmly on the tendon sheath at the base of the finger or thumb may irritate the tendons and result in thickening of the tendons themselves or the tendon sheath. Trigger finger may also be associated with conditions such as rheumatoid arthritis, gout or metabolic disorders such as diabetes that produce changes in the connective tissues and synovium.

WHAT ARE THE TREATMENTS?

Conservative non-surgical treatment involves avoiding or modifying the activities that have caused the inflammation. Oral anti-inflammatory medications are used to reduce the inflammation or discomfort. Steroid injection may be administered directly into the tendon sheath to reduce the soft tissue swelling. In the event when it does not respond to conservative treatment, surgery may be recommended. Surgery is performed where a horizontal incision is made in the palm at the base of the affected finger or thumb. The surgeon will release the first annular band, relieving the constriction of the tendon as it passes through the sheath.

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WHAT IS OSTEOARTHRITIS OF THE FINGERS AND THUMB?

Osteoarthritis of the fingers and thumb is characterized as chronic and often disabling pain and stiffness of one or more joints. Most people who are affected by osteoarthritis of the fingers and thumb are middle-aged or older.

HOW IS OSTEOARTHRITIS OF THE FINGERS AND THUMB DIAGNOSED?

A physical examination can reveal abnormal range of motion in the joints, swelling, and pain or tenderness over the joints, in particular at the base of the thumb.

X-rays can show joint damage, but pain usually precedes x-ray evidence. X-rays or other imaging studies also can detect osteophytes (bone spurs).

WHAT ARE THE CAUSES?

Osteoarthritis of the fingers and thumbs occurs when the tissue that cushions the ends of the bones in a joint (cartilage) degenerates. Cartilage keeps the joint flexible and provides protection between the bones. When the cartilage breaks down, the bones rub against each other, resulting in pain and loss of movement. Bony spurs may form around the joint, causing pain and inflammation. The exact causes for why the cartilage breaks down are unclear.

WHAT ARE THE TREATMENTS?

Early osteoarthritis of the thumb can be effectively treated using non-surgical treatment options, for example non-steroidal anti-inflammatory drugs to reduce inflammation and swelling, icing the joint for 5 to 15 minutes several times a day to relieve inflammation and swelling and splinting to restrict movement of the thumb.

Surgical options include carpometacarpal joint fusion (arthrodesis) an option for patients looking for pain relief who are not overly concerned about losing fine thumb motion or joint replacement where plastic or metal prostheses are used to replace the carpometacarpal joint where the prosthesis serves as a spacer after the arthritic surfaces of the bones in the carpometacarpal joint are removed.

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WHAT IS CARPAL TUNNEL SYNDROME?

Carpal tunnel syndrome occurs when the median nerve which runs from the forearm into the hand becomes pressed or squeezed at the wrist. This results in pain, weakness, or numbness in the hand and wrist, radiating up the arm.

HOW IS CARPAL TUNNEL SYNDROME DIAGNOSED?

A physical examination help determine if the syndrome are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome.

Electromyography is often used to confirm the diagnosis. This involves a fine needle being inserted into a muscle where electrical activities are viewed on a screen determining the severity of damage to the median nerve. Ultrasound imaging can also show impaired movement of the median nerve.

WHAT ARE THE CAUSES?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture. It can also be caused by medical conditions such as diabetes, arthritis, pregnancy and obesity.

WHAT ARE THE TREATMENTS?

Treatments for carpal tunnel syndrome should begin as early as possible under a doctor’s direction. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling. Surgery is recommended if symptoms last for more than 6 months. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.

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WHAT IS SHOULDER PAIN DUE TO ROTATOR CUFF INJURY?

Rotator cuff injury is the damage to the rotator cuff. This condition is one of the most common causes of shoulder pain.

HOW IS SHOULDER PAIN DUE TO ROTATOR CUFF INJURY DIAGNOSED?

Diagnosis is done through understanding the patient’s history of activities and symptoms of pain in the shoulder. Plain x-rays are also done to exclude bony injuries. The MRI scan is the best to delineate the tissues of the shoulder.

WHAT ARE THE CAUSES?

The rotator cuff can be injured due to degeneration associated with aging or inflammation of the shoulder. The rotator cuff is also commonly injured by trauma for example falling and injuring the shoulder or overuse during sports activities. Rotator cuff injury is particularly common in people who perform repetitive overhead motions that can stress the rotator cuff. These motions are frequently associated with muscle fatigue.

WHAT ARE THE TREATMENTS?

Treatment of rotator cuff injury depends on the severity of the injury to the tendons of the rotator cuff and the underlying condition of the patient. Mild rotator cuff disease is treated with ice, rest, anti-inflammatory medications and gradual exercise rehabilitation. More severe rotator cuff injury requires surgical repair.

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WHAT IS SHOULDER PAIN DUE TO FROZEN SHOULDER?

Frozen shoulder is a disorder where the connective tissue surrounding the glenohumeral joint of the shoulder becomes inflamed and stiff and abnormal bands of tissue form restricting motion and causing chronic pain.

HOW IS IT DIAGNOSED?

The joint becomes so tight and stiff that it is nearly impossible to carry out simple movements for example raising the arm. The range of movement is severely restricted.

WHAT ARE THE CAUSES?

The cause for frozen shoulder is unknown. Nonetheless, there are a number of risk factors which includes diabetes, stroke, accidents, lung disease, connective tissue disorders, and heart disease.

HOW TO PREVENT SHOULDER PAIN DUE TO FROZEN SHOULDER?

To prevent shoulder pain due to frozen shoulder, a common recommendation is to keep the shoulder joint fully moving. Often a shoulder will hurt when it begins to freeze.

WHAT ARE THE TREATMENTS?

The treatment is a combination of medication, physiotherapy and home exercise. Some patients require manipulation of the shoulder joint under anaesthesia to break down the abnormal tissue bands. Arthroscopic debridement of the scar tissue may be necessary for more severe cases.

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