Other disorders of wrist and hand

Dr. Norman B. Gaylis

De Quervain’s tendonitis is a fairly common condition that I see in my office. The patient presents with pain at the base of the thumb, which radiates up the forearm, in particular. The pinching or grasping the thumb or finger also aggravates the condition. Any up and down movement of the wrist causes exquisite pain in the tendon at the base of the thumb. There is appositive test known as the Finkelstein Test, which essentially stretches the tendon, and performing this test will illicit severe pain from the patient.

The treatment for this condition will consist of the use of ice, nonsteroidal anti-inflammatory drugs and rest. In the absence of this being sufficient, a local anti-inflammatory steroid injection is very effective when injected into the tendon sheath. Very rarely surgery may be indicated to reduce the pain.

Another very common condition seen in my practice is the so-called trigger thumb or finder. The patient will notice, especially in the morning, that he/she has difficulty straightening their thumb or fingers completely or will have them snap when straightened out. On examination, these patients will have tenderness in the palm side of the hand over the tendon sheath and this can be palpated. This is equivalent to having a rusty pulley where the tendon sheath runs over the bones in the hand. This results in trigger fingers or tendonitis of the fingers and thumbs. The management consists of the use of anti-inflammatory steroid injections of the flexor tendon sheath, which is very effective and very rarely, if this does not cause relief, the use of surgery is successful.

In the hand, we also see a relatively common condition called Dupuytren’s contracture, which is characterized by the thickening and hardening of the palmar fascia along the outer aspect of the hand, primarily affecting the 5th and 4th fingers. The patient will notice progressive tightening of the skin in that area with progressive difficulty in straightening the 5th and 4th fingers. This has been seen in families and is often noted in both hands. It is more commonly seen in patients with diabetes. The condition runs a variable course, sometimes remaining unchanged over a period of years while other times rapidly resulting in severe deformity of the hand. The treatment depends on how rapidly the condition is progressing.

Initially, treatment with heat, stretching exercises and the use of protective gloves is helpful. At times, if the condition progresses too rapidly, a surgical release of the fibrous tissue causing the contraction is necessary.