Hands and fingers

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Carpal tunnel syndrome

Carpal tunnel syndrome occurs when pressure build-up within the carpal tunnel causes nerve compression. When the compression is sufficiently high, it causes changes in nerve function, which causes numbness / tingling, pain in the hand and fingers and, consequently, muscle weakness. In most situations, numbness / tingling affects the thumb, forefinger, middle and part of the ring. The signs usually appear at night, but can appear during daily activities, such as driving or reading a newspaper. Patients notice that they have reduced grip strength and may drop objects from their hands. In the most severe cases, tenderness may be completely absent and the muscles at the base of the thumb atrophied (atrophy of the tenar eminence).

The cause is usually unknown. Fluid retention during pregnancy can in some cases cause edema in the canal, which usually disappears after delivery. Some diseases such as hypothyroidism, rheumatoid arthritis, diabetes and kidney failure can be associated with this syndrome.

 

Stenosing tenosynovitis (trigger finger)

Stenosing tenosynovitis, commonly known as a trigger finger, involves the tendons and pulleys of the flexor tendons of the fingers. The tendons work like long cords from the muscles in the forearm and through a tunnel, with a bone base and fibrous tissue ceiling, until they reach the fingers. Inside the tunnel the tendons are wrapped in a film that allows easy sliding inside the sheath and pulleys.

The trigger finger occurs when the tendon develops a lump or edema of the surrounding film. When the tendon swells, it increases in volume, and has to rub at the entrance to the tunnel (flexor tendon sheath), which causes pain, bouncing and a feeling of being trapped in the finger. When the tendon touches the sheath, there is more inflammation and more edema. This causes a vicious cycle between the trigger, inflammation and edema, which in some cases leads to a blockage, and it is not possible to bend or stretch the involved finger.

The causes for the appearance of the trigger finger are not fully understood. Trauma to the palm can irritate the flexor tendons. Some diseases such as rheumatoid arthritis, gout and diabetes are associated with the appearance of a trigger finger.

The trigger finger may start as a slight discomfort felt at the base of the finger. Thickening can be felt in this area. When the finger starts to become blocked and cause the shoulder or trigger, the problem may appear in the interphalangeal joint near the finger.

Dupuytren's disease

Dupuytren's disease is a benign pathology that is characterized by a fibrotic thickening of the palmar and digital fascia of the hand. Initially, it presents as a palpable palpable mass (Dupuytren's nodule) that can progress to contracture in flexion of the hand joints. It occurs most frequently on the 4th and 5th fingers.

The decrease in range of motion affects the patient's daily activities. The pre-tendon nodules that form in the palmar flexion folds may be painless or moderately painful. As they grow, Dupuytren's nodules develop cords that extend distally and proximally and that, once thickened, shorten and lead to contracture.

Quervain's tenosynovitis

Tenosynovitis, tendonitis, or De Quervain's syndrome is an inflammation that affects the tendons of the wrist leading to the thumb, namely the tendons of the long abductor and short extensor of the thumb, in the area where they cross a thick fibrous sheath, which constitutes the first wrist extensor compartment.

Although the causes of De Quervain's tenosynovitis are unknown, in most cases it is associated with overuse, either at home or at work, or with rheumatoid arthritis.

Any activity that involves repetitive movement of the wrist and hand such as gardening, playing golf or tennis or picking up a baby, for example, can trigger and / or aggravate the symptoms. Prolonged vicious positions or situations of overload can also be at its origin.

In addition, there are physiological conditions that predispose to the development of this pathology, such as pregnancy, the puerperium or in patients who have had a previous wrist fracture.

The main symptom of De Quervain's tendonitis is pain in the outer edge of the wrist. The pain can start suddenly or insidiously and initially appears at the base of the thumb, in the area that corresponds to the first extensor compartment. Often the pain radiates towards the thumb or forearm, and it is sometimes difficult for the patient to locate a specific point of pain.

De Quervain's tendonitis is curable with appropriate treatment, which consists of eliminating inflammation of the affected tendons, thus providing pain relief and recovery of mobility and function.

Objectives of a rehabilitation program:

  • Improving mobility and joint movement

  • Relief from pain and inflammation

  • Teaching and counselling of support products (orthotics, splints, etc.)

  • Return to work activities , daily life and sports activities  

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