Hand/Wrist Conditions

Hand/Wrist Conditions

De Quervain’s Tenosynovitis

Overview: De Quervain’s tenosynovitis occurs when the main tendons of the thumb become constricted due to local irritation of the tendons and their surrounding synovial layers. This can cause swelling of the tendon and the synovial layers.

Causes: Overuse of the thumb tendons is the main cause of De Quervain’s tenosynovitis. It can also be seen during pregnancy and autoimmune disorders.

Symptoms: Pain over the thumb side of the wrist is typical. The pain can gradually worsen and travel up into the forearm when grasping objects or twisting the wrist. A snapping sensation can be felt when moving the thumb and the pain may make moving the thumb difficult.

Treatment: Anti-inflammatory medications and topical agents can be effective. Bracing can allow the tendons to rest and help reduce symptoms. Checking the equipment that is being used at work or during sports can help to prevent additional symptoms. Occupational therapy can provide education on how to appropriately stretch and strengthen the thumb tendons. A local steroid injection into the region can be performed. Another newer option is to place platelet-rich plasma into the damaged portion of the tendon to promote healing and reduce inflammation and pain. Surgical decompression of the tendons is reserved for patients that fail more conservative measures.

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Trigger Finger

Overview: Trigger finger occurs when tendons of the fingers or thumb become inflamed. These tendons are a part of a pulley system to flex and extend the finger or thumb. When the tendon becomes inflamed, it can become difficult and painful to extend the finger or thumb.

Causes: Repetitive or forceful movements of the fingers or thumb can cause tendon inflammation that leads to trigger finger. Grasping objects such as power tools can also be a risk factor. Rheumatoid arthritis, gout and diabetes are also known risk factors.

Symptoms: Initially, soreness at the base of the finger or thumb is felt followed by a painful catching or locking of the digit, at which point straightening the finger becomes difficult.

Treatment: Anti-inflammatory medications and topical agents can be effective. Bracing can allow the tendons to rest and help reduce symptoms. Occupational therapy can provide education on how to appropriately stretch and strengthen the thumb tendons. A local steroid injection into the region can be performed. A safer option is to place platelet-rich plasma into the inflamed portion of the tendon and sheath complex to promote healing and reduce inflammation and pain. Surgical decompression of the tendons is reserved for patients that fail more conservative measures.

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Ganglion Cyst

Overview: A ganglion cyst is a sac of fluid that arises from a joint space or tendon. A ganglion cyst of the wrist is most commonly seen on the back part of the wrist and appears as a bump under the skin.

Causes: The cyst is created when fluid from a weak part of the joint leaks into the surrounding tissue. This can be caused by repetitive motions of the wrist, trauma or autoimmune disorders.

Symptoms: The cysts are typically painless. However, when the cyst is located close to a nerve, pain, numbness and tingling may begin to occur.

Treatment: Most cysts can be monitored if they are not causing any symptoms. Cysts that are painful can be aspirated under ultrasound guidance, followed by a PRF or steroid injection into the site to limit the recurrence of the cyst.

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