psUpper LimbComments Off on Mallet Finger (Long Extensor Tendon)
Brief Outline of Mallet Finger
Extensor tendons are vulnerable to injury, lying just below the skin surface directly on the bones of the back of the hand and fingers. Such tendons may be torn apart when a finger is jammed, separating the tendons from their attachment to bone. The injury is common at the start of baseball season, often caused by a ball hitting the fingertip, bending it sharply downard and tearing the extensor tendon. Cuts to the hand or fingers can also damage the extensor tendons.
Anatomy and physiology
Extensor tendons are small muscle tendons in the hand and fingers, which provide for delicate movements and hand coordination. They are located on the dorsal aspect of the hand and fingers, allowing the athlete to extend and straighten the fingers and thumb. Extensor tendons attach to muscles in the forearm. When an object hits the fingertip, the forceful flexion of the distal phalanx avulses the lateral bands of the extensor mechanism from its distal attachment.
Cause of Mallet Finger Injury
Cuts or lacerations affecting the extensor tendons. Baseball, volleyball, football, basketball or other object striking the fingertips while the extensor tendon is taut. Jamming the finger against a wall, door or other immovable object.
Signs and symptoms of Mallet Finger Injury
Inability to extend the finger. Bruising, pain, and swelling of the affected finger. Drooping fingertip.
Complications if left unattended
Left untreated, mallet finger may cause permanent cosmetic deformity in the finger, though often without further complication. Without splinting however, some residual stiffness and loss of finger extension may result.
Immobilisation with a splint is a conservative method to treat mallet finger. However, for easier and more comfortable method, surgical intervention is advised.
Rehabilitation and prevention
Generally, a splint must be worn continuously until the extensor tendon is fully healed. It will often require several months for local swelling and erythema to fully subside. Special care to the fingertips should always be taken in sports involving fat-moving balls, as well as when handling cutting implements.
With attention to post-injury care including immobilisation of the injured finger, most athletes achieve full restoration of movement and appearance of the digit.
Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat your mallet finger injury today.
De Quervain’s disease is an inflammation to the tendon of the wrist. You will experience pain at the side of your wrist and the bottom of your thumb.
What causes de Quervain’s disease?
You may get de Quervain’s disease when you use the thumb or wrist too much. It is also commonly known as “mummy’s wrist” as de Quervain’s disease usually happens to mothers who often carries the baby and injured the tendon.
Activities that may cause de Quervain’s disease are:
Wringing out wet clothes.
Lifting heavy objects such as a jug of milk or lifting a baby.
People who are more prone to de Quervain’s disease:
Air-steward and air-stewardess
Waiter and waitress
Parents and Grandparent if they are taking care of a newborn baby
Women are more likely to get de Quervain’s disease more than men. De Quervain’s disease affects people between the age of 30 and 50.
What are the symptoms of de Quervain’s disease?
If you are having de Quervain’s disease, you will feel extreme pain when you try to twist your wrist. The pain is worse if you grab something between your thumb and finger.
The bottom of the thumb or the side of the wrist may get swollen. Moving your thumb or wrist may increase pain. If you ignore, the pain can radiate to your forearm or down to your thumb.
How is de Quervain’s disease diagnosed?
Physically examination will include checking for swelling or tenderness around the base of your thumb.
Finkelstein test will help to diagnose de Quervain’s disease.
How is de Quervain’s disease treated?
The treatment for de Quervain’s disease is to help to reduce the pain and you can resume back to your daily activities pain free.
Oral anti-inflammatory medicine.
Wearing a Wrist splint
If your symptoms are not better after the above conservative treatments. Surgical intervention maybe needed to to release the tendon sheath.
Call +65 6471 2674 to make an appointment to see our orthopaedic specialist for your de Quervain’s disease.
Also known as as stenosing tenosynovitis, trigger fingers are painful conditions of the fingers and thumbs where they get stuck in a bent position and then straighten with a “click” or a snap – kind of like a trigger being pulled and released. If a trigger finger is severe, you may find your finger locked in a bent position, unable to straighten.
What happens is the protective covering, the tendon sheath that surrounds the tendon of the affected finger, becomes narrow because of inflammation. This usually happens to people who have work or hobbies that require repetitive gripping actions, though they are more common in women and anyone who has diabetes.
How would you know you have trigger fingers?
Most of the time, trigger fingers or thumbs happens more frequently in your dominant hand, and mostly affects the thumb, index or ring finger. Sometimes, more than one finger is affected at the same time, and sometimes fingers on both hands may be involved. Triggering incidents are usually more often in the morning, or firmly gripping an object or when you bend and straighten the affected finger.
The common tell-tale signs and symptoms of trigger finger, in progression from mild to severe:
Stiffness in the finger, especially in morning or after periods of rest
A clicking and snapping sensation as you bend and straighten your finger
A “bump” (nodule) that is sensitive or tender at the base of the affected finger
Finger “catches” or “locks” frequently, followed by suddenly popping straight again
Finger becomes locked in a bent position, and you’re unable to straighten without pain
When you should see a doctor?
If you find that you have any of the signs above, for example, stiffness, tenderness at the base of your finger or catching in your finger joints, visit your doctor as soon as you can so that he or she can review your symptoms and do a physical evaluation of your hand. If you find that your finger joint is hot and swollen, get medical care as soon as you can, as those signs indicate possible infection.
What are the main causes of trigger fingers?
The culprit is the narrowing of the tendon sheath that surrounds the tendon in the affected finger. Tendons are thick, fibrous cords that attach muscles to bones; and each tendon is surrounded by a tendon sheath, which is lined with a substance called tenosynovium. This functions as a disperser of the lubrication which allows the tendon to glide smoothly in the protective sheath as you bend and straighten your finger, like a rope through a lubricated container.
But if the tenosynovium becomes inflamed often or for long periods, the space inside the tendon sheath becomes tight, making it difficult for the tendon to glide. The “catch” is when the tendon kinks in a bent position before popping straight . Every time the tendon kinks and snaps, the tendon becomes more irritated and inflamed, further worsening the problem. If the problem is prolonged and more inflammation occurs, the tendon can develop scars and thicken (fibrosis), and cause the tender bumps (nodules) to form.
Testing and diagnosing trigger fingers
It often doesn’t require in-depth or elaborate testing to confirm diagnosis of trigger finger. Usually your doctor will make the diagnosis based on your medical history and a hand physical exam. During the physical exam, your doctor will ask you to bend or straighten your finger, check the base of your finger for tender bumps / nodules, how smooth your finger move, and look out for the evidence of joint catching.
Treatment for trigger fingers
Avoiding repetitive gripping. For at least four to six weeks, avoid activities that require repetitive gripping or any forms of movements or activities that aggravate the problem, repeated grasping or the prolonged use of vibrating hand-held machinery.
Splinting. Your doctor may require you to wear a finger extension splint for up to six weeks to protect the injury and allow the tendon and the tendon sheath to heal. It’s especially useful to prevent you from bending your finger when you sleep, which is often painful enough to wake you up.
Finger exercises. Protected exercises – Be seated comfortably, with your hand supported. Use your unaffected fingers to bend the affected finger joints without causing the joint to click and snap. Repeat for five minutes. Gently massage the nodule at the base of your finger for five minutes. You may be referred to a hand therapist who will teach you protected mobilisation exercises to maintain mobility in your finger.
Anti-inflammatory injection. Another faster and effective way is to inject anti-inflammatory medication to the affected tendon sheath. The medicine will help to reduce the inflammation and swelling of the tendon sheath gradually.
Surgery. If your trigger finger is severe and does not respond well to conservative treatment. Surgery – trigger finger release may be another option. It is a minor day surgery and it is done under local anaesthesia.
See a doctor to treat your trigger finger
If you find that preventive or self-management measure aren’t working, see a doctor as soon as possible. Prompt medical attention can mean the difference between a quick recovery and a lifetime of suffering. And, by all means, be sure the doctor you choose is familiar with these disorders.
Who are at risk for trigger fingers?
There are three main risk factors:
Repeated gripping – if your work or hobbies require you to routinely grip objects, such as power tools or musical instruments for a prolonged duration, you may be more prone to trigger fingers.
Certain health problems – you have higher risks if you have certain medical problems such as rheumatoid arthritis, diabetes, amyloidosis, and certain infections.
Gender – trigger fingers are more prevalent in women than in men.
Call +65 6471 2674 (24 hrs) for an appointment to see our doctor to treat your trigger finger today.
Trigger finger is a common disorder of the hand which causes painful snapping or locking of the fingers or thumb.
Trigger Finger Video
What are the causes of trigger finger?
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 for trigger finger?
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.