Bellapianta Orthopedics Hand

It is made of an incredible network of bones, cartilage, nerves, connective tissues and joint fluid — all working together to perform some of the strongest and most intricate movements on a daily basis. And yet, is surprisingly delicate. When your hand hurts — whether from carpal tunnel, a jammed finger or worse — it often seems like you can’t focus on anything else.

Hand pain can be caused by overuse, traumatic injuries, or arthritis and other diseases. Some issues can be treated at home with anti-inflammatory medications and hot or cold treatments, but you should always be checked out by Dr. Bellapianta first. Depending upon the severity of your condition, orthopaedic care may be needed to avoid long-term complications. Your treatment may range from physical therapy to corticosteroid injections to surgery.

Conditions of the Hand

Hand pain can be caused by disease or injury affecting any of the structures in the hand, including the bones, muscles, joints, tendons, blood vessels, or connective tissues.

Anatomy

The hand and wrist consist of dozens of bones, joints, ligaments, tendons, and muscles that need to work together seamlessly in a variety of positions hundreds of times a day. As such, they often require highly specialized medical care when they become injured.

Arthritis

Hand pain is one feature of joint inflammation (arthritis) that may be felt in the hand. Rheumatoid arthritis and osteoarthritis are the two most common types of arthritis in the hand.

Osteoarthritis

The fingers may become stiff, painful and swollen, and bumps may develop on the finger joints. Over time, the pain may decrease and eventually disappear altogether, although the bumps and swelling can still remain.The fingers may bend sideways slightly at the affected joints. Painful cysts may develop on the backs of the fingers.In some cases, a bump may also develop at the base of the thumb, where it joins the wrist. This can be painful, making it difficult to perform manual tasks such as writing, opening jars or turning keys.

Osteoarthritis also commonly affects the knees and hips, so is probably the cause if you have pain in other joints as well.

Rheumatoid Arthritis

The hands and wrists can also be affected by rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disease. This means that your immune system (which usually fights infection) attacks the cells that line your joints by mistake, making them swollen, stiff and painful. The hand pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a relatively common condition that causes pain, numbness and a tingling sensation in the hand and fingers.

These sensations usually develop gradually and start off being worse during the night. They tend to affect the thumb, index finger, middle finger and half of the ring finger.Carpal tunnel syndrome is caused by compression of the nerve that controls sensation and movement in the hands. It will sometimes get better on its own. Otherwise, wrist splints and corticosteroid injections are often recommended.

Surgery (carpal tunnel release surgery) is usually only recommended for severe cases of carpal tunnel syndrome, when symptoms last for more than six months or other treatments have not been effective.

Ganglion Cyst

A ganglion is a fluid-filled swelling that develops near a joint or a tendon, ranging in size from a pea to a golf ball. It looks and feels like a smooth, soft lump under the skin. It is made up of a thick, jelly-like fluid, called synovial fluid, which surrounds joints and tendons to lubricate and cushion them during movement. Ganglions are most common on the wrists (particularly the back of the wrist), hands and fingers.
They are generally harmless, but can sometimes be painful, especially if they are next to a nerve.

De Quervain's Disease

De Quervain's disease is a painful condition that affects tendons where they run through a tunnel on the thumb side of the wrist.

The sheath surrounding the tendon becomes swollen and thick, and moving your thumb will be very painful. The cause isn't understood. Some sources claim it is a type of tenosynovitis (see below) or tendonitis, but this is not true. De Quervain's disease is not associated with inflammation.
Some mild cases get better on their own after a few weeks of rest and avoiding the activity that triggered it. A wrist splint or a corticosteroid injection may help. Severe cases may need to be treated with surgery, which involves widening the tunnel through which the tendon passes.

Trigger Finger/Thumb

Trigger finger is a condition that affects the tendons in the hand. When the affected finger or thumb is bent towards the palm, the tendon gets stuck and the finger clicks or locks. The exact cause is not known.
The symptoms can include pain, stiffness, clicking and a small lump in the palm at the base of the affected finger or thumb. If you think you may have trigger finger, make an appointment to see your GP, so they can examine your hand and offer advice about treatment. In some people, trigger finger may get better without treatment.

Flexor Tendon Injuries

A deep cut on the palm side of your fingers, hand, wrist, or forearm can damage your flexor tendons, which are the tissues that help control movement in your hand. A flexor tendon injury can make it impossible to bend your fingers or thumb.

Anatomy

Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This causes parts of the body (such as a finger) to move.

The muscles that move the fingers and thumb are located in the forearm. Long tendons extend from these muscles through the wrist and attach to the small bones of the fingers and thumb.

The tendons on the top of the hand straighten the fingers. These are known as extensor tendons. The tendons on the palm side bend the fingers. These are known as the flexor tendons.

When you bend or straighten your finger, the flexor tendons slide through snug tunnels, called tendon sheaths, that keep the tendons in place next to the bones.

Description

A torn or cut tendon in the forearm, at the wrist, in the palm, or along the finger will make it impossible to bend one or more joints in a finger.

Because flexor tendons are very close to the surface of the skin, a deep cut will most likely hit a flexor tendon. In these cases, the tendon is often cut into two pieces.

Like a rubber band, tendons are under tension as they connect the muscle to the bone. If a tendon is torn or cut, the ends of the tendon will pull far apart, making it impossible for the tendon to heal on its own.

Because the nerves to the fingers are also very close to the tendons, a cut may damage them, as well. This will result in numbness on one or both sides of the finger. If blood vessels are also cut, the finger may have no blood supply. This requires immediate surgery.

Occasionally, flexor tendons may be partially cut or torn. With a partial tendon tear, it may still be possible to bend your finger, but not completely. These types of tears can be difficult to diagnose.

Causes

In addition to cuts on the arm, hand, or fingers, certain sports activities can cause flexor tendon injuries. These injuries often occur in football, wrestling, and rugby. "Jersey finger" is one of the most common of these sports injuries. It can happen when one player grabs another's jersey and a finger (usually the ring finger) gets caught and pulled. The tendon is pulled off the bone. In sports that require a lot of arm and hand strength, such as rock climbing, tendons and/or their sheaths can also be stretched or torn.

Certain health conditions (rheumatoid arthritis, for example) weaken the flexor tendons and make them more likely to tear. This can happen without warning or injury — a person may simply notice that his or her finger no longer bends, but cannot recall how it could have happened.

Symptoms

The most common signs of a flexor tendon injury include:
An open injury, such as a cut, on the palm side of your hand, often where the skin folds as the finger bends
An inability to bend one or more joints of your finger
Pain when your finger is bent
Tenderness along your finger on the palm side of your hand
Numbness in your fingertip

Hand Fractures

A hand fracture is a break in one of the bones in the hand. This includes the small bones of the fingers (phalanges) and the long bones within the palm (metacarpals). A broken hand can be caused by a fall, crush injury, twisting injury, or through direct contact in sports.

In most cases, a hand fracture will heal well with nonsurgical treatment. Depending on the type and location of the fracture, this may include wearing a cast, splint or buddy straps for a period of time. For more serious fractures or for fractures that do not line up properly, however, surgery may be required to realign the broken pieces of bone.

Anatomy

The bones in your hand include:

Phalanges. These are the small bones that form the thumb and fingers. There are two phalanges in the thumb and three in each of the fingers.
Metacarpals. These are the five bones that are located in the palm of the hand.

The most common hand fracture is a fracture of the fifth metacarpal—the bone in the hand that supports the little finger. This is commonly called a “boxer’s fracture” and involves the "neck” of the bone, next to the knuckle joint. A boxer’s fracture is caused most often by punching or striking a hard object when your hand is closed in a fist.

Symptoms

Signs and symptoms of a hand fracture may include:

Swelling
Bruising
Tenderness or pain
Deformity
Inability to move the finger
Shortened finger
The injured finger crosses or “scissors” over its neighbor when making a partial fist

In the case of a boxer’s fracture, the patient’s knuckle may look sunken in or depressed. This is caused by the displacement or angulation of the end or “head” of the metacarpal bone.

Mallet Finger (Baseball Finger)

Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Although it is also known as "baseball finger," this injury can happen to anyone when an unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go. As a result, you are not able to straighten the tip of your finger or thumb on your own.

With a mallet finger injury, the fingertip droops and cannot be actively straightened.

Anatomy

Tendons are tissues that connect muscles to bone. The muscles that move the fingers and thumb are located in the forearm. Long tendons extend from these muscles through the wrist and attach to the small bones of the fingers and thumb.

The extensor tendons on the top of the hand straighten the fingers. The flexor tendons on the palm side of the hand bend the fingers.

Description

In a mallet injury, when an object hits the tip of the finger or thumb, the force of the blow tears the extensor tendon. Occasionally, a minor force such as tucking in a bed sheet will cause a mallet finger.

The injury may rupture the tendon or pull the tendon away from the place where it attaches to the finger bone (distal phalanx). In some cases, a small piece of bone is pulled away along with the tendon. This is called an avulsion injury.

The long, ring, and small fingers of the dominant hand are most likely to be injured.

Symptoms

The finger is usually painful, swollen, and bruised. The fingertip will droop noticeably and will straighten only if you push it up with your other hand.

Risk for Infection

It is very important to seek immediate attention if there is blood beneath the nail or if the nail is detached. This may be a sign of a cut in the nail bed, or that the finger bone is broken and the wound penetrates down to the bone (open fracture). These types of injuries put you at risk for infection.

First Aid

To relieve pain and reduce swelling, apply ice to your finger immediately and keep your hand elevated above your heart.

Sprained Thumb

A sprained thumb occurs when the ligaments that support the thumb stretch beyond their limits or tear. This usually happens when a strong force bends the thumb backwards, away from the palm of the hand. The most common way for this to occur is by falling onto an outstretched hand.

Most thumb sprains involve the ulnar collateral ligament, which is located on the inside of the knuckle joint. A tear to this ligament can be painful and may make your thumb feel unstable. It may also weaken your ability to grasp objects between your thumb and index finger.

Treatment for a sprained thumb usually involves wearing a splint or cast to keep the thumb from moving while the ligament heals. For more severe sprains, surgery may be needed to restore stability to the joint.

Description

Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the thumb help keep the bones in proper position and stabilize the joint.

Sprains can range from a stretch or tiny tear in the fibers that make up the ligament to a complete tear through the ligament or through its attachment to the bone.

Grades of Thumb Sprains

Sprains are graded, depending on the degree of injury to the ligaments

Grade 1 sprain (mild). The ligaments are stretched, but not torn.
Grade 2 sprain (moderate). The ligaments are partially torn. This type of injury may involve some loss of function.
Grade 3 sprain (severe). The ligament is completely torn or is pulled off its attachment to the bone. These are significant injuries that require medical or surgical care. If the ligament tears away from the bone, it may take a small chip of the bone with it. This is called an avulsion fracture.

Injury to the Ulnar Collateral Ligament of the Thumb

The most common ligament to be injured in the thumb is the ulnar collateral ligament. This strong band of tissue, which is attached to the middle joint of the thumb (the metacarpophalangeal or MCP joint), keeps your thumb stable so that you can pinch and grasp things.

A sprained thumb is often called a “skier’s thumb” because falling on the ski slopes with your hand strapped to a ski pole is a common cause of injury to the ulnar collateral ligament.

The ligament can also be injured more gradually, over time, from repetitive grasping or twisting activities. This type of chronic injury is known as a “gamekeeper’s thumb.”

The ulnar collateral ligament can tear in different ways. For example, it may be pulled off its attachment at the base of the first bone (the proximal phalanx) in the thumb or from its origin on the metacarpal bone. It can also be torn through its middle, although this is less common.

Cause

Any strong force that bends the thumb backwards, away from the palm of the hand, can stretch or tear the ulnar collateral ligament. This most often occurs by falling onto an outstretched hand.

Sprained thumbs are also common in skiers and in athletes who participate in sports that involve catching and throwing a ball, like football, baseball, and basketball.

Symptoms

Depending on the severity of the sprain, pain may or may not occur at the time of the injury. You may have bruising, tenderness, and swelling around the base of your thumb, near the palm.

If the ulnar collateral ligament is completely torn, the end of the ruptured ligament may cause a lump or swelling on the inside of the thumb. Your thumb joint may also feel loose or unstable. You may have difficulty grasping items between your thumb and index finger.

It is important for your doctor to evaluate even a mild thumb sprain if it does not improve quickly. Proper diagnosis and treatment of a thumb injury is necessary to avoid long-term complications, including chronic pain, instability, and arthritis.

Arthritis of the Hand

The hand and wrist have multiple small joints that work together to produce motion, including the fine motion needed to thread a needle or tie a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult. Arthritis can occur in many areas of the hand and wrist and can have more than one cause.

Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.

Description

Simply defined, arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.

Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.

Disease

When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is much more common and generally affects older people. Also known as "wear and tear" arthritis, osteoarthritis causes cartilage to wear away. It appears in a predictable pattern in certain joints.

Rheumatoid arthritis is a chronic disease that can affect many parts of your body. It causes the joint lining (synovium) to swell, which causes pain and stiffness in the joint. Rheumatoid arthritis most often starts in the small joints of the hands and feet. It usually affects the same joints on both sides of the body.

Trauma

Fractures, particularly those that damage the joint surface, and dislocations are among the most common injuries that lead to arthritis. Even when properly treated, an injured joint is more likely to become arthritic over time.

This x-ray shows fractures within the finger joints.

Symptoms

Pain

Early symptoms of arthritis of the hand include joint pain that may feel "dull," or a "burning" sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping. The pain may not be present immediately, but may show up hours later or even the following day. Morning pain and stiffness are typical.

As the cartilage wears away and there is less material to provide shock absorption, the symptoms occur more frequently. In advanced disease, the joint pain may wake you up at night.

Pain might be made worse with use and relieved by rest. Many people with arthritis complain of increased joint pain with rainy weather. Activities that once were easy, such as opening a jar or starting the car, become difficult due to pain. To prevent pain at the arthritic joint, you might change the way you use your hand.

Swelling

When the affected joint is subject to greater stress than it can bear, it may swell in an attempt to prevent further joint use.

Changes in Surrounding Joints

In patients with advanced thumb base arthritis, the neighboring joints may become more mobile than normal.

Warmth

The arthritic joint may feel warm to touch. This is due to the body's inflammatory response.

Crepitation and Looseness

There may be a sensation of grating or grinding in the affected joint (crepitation). This is caused by damaged cartilage surfaces rubbing against one another. If arthritis is due to damaged ligaments, the support structures of the joint may be unstable or "loose." In advanced cases, the joint may appear larger than normal (hypertrophic). This is usually due to a combination of bone changes, loss of cartilage, and joint swelling.

Cysts

When arthritis affects the end joints of the fingers (DIP joints), small cysts (mucous cysts) may develop. The cysts may then cause ridging or dents in the nail plate of the affected finger.

De Quervain's Tendinosis

De Quervain's tendinosis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinosis" refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist.

Anatomy

Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a sheath.

Any swelling of the tendons and/or thickening of the sheath, results in increased friction and pain with certain thumb and wrist movements.

Causes

De Quervain's tendinosis may be caused by overuse. It also is associated with pregnancy and rheumatoid disease. It is most common in middle-aged women.

Symptoms

Signs of De Quervain's tendinosis:

Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.
A "catching" or "snapping" sensation may be felt when moving the thumb.
Pain and swelling may make it difficult to move the thumb and wrist.

Ganglion Cyst of the Wrist and Hand

Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in various locations, but most frequently develop on the back of the wrist.

These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment. However, if the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available.

Description

A ganglion rises out of a joint, like a balloon on a stalk. It grows out of the tissues surrounding a joint, such as ligaments, tendon sheaths, and joint linings. Inside the balloon is a thick, slippery fluid, similar to the fluid that lubricates your joints.

Ganglion cysts can develop in several of the joints in the hand and wrist, including both the top and underside of the wrist, as well as the end joint of a finger, and at the base of a finger. They vary in size, and in many cases, grow larger with increased wrist activity. With rest, the lump typically becomes smaller.

Cause

It is not known what triggers the formation of a ganglion. They are most common in younger people between the ages of 15 and 40 years, and women are more likely to be affected than men. These cysts are also common among gymnasts, who repeatedly apply stress to the wrist.

Ganglion cysts that develop at the end joint of a finger — also known as mucous cysts — are typically associated with arthritis in the finger joint, and are more common in women between the ages of 40 and 70 years.

Symptoms

Most ganglions form a visible lump, however, smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms, if a cyst puts pressure on the nerves that pass through the joint, it can cause pain, tingling, and muscle weakness.

Large cysts, even if they are not painful, can cause concerns about appearance.

Trigger finger

Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. The condition is also known as “stenosing tenosynovitis.” The ring finger and thumb are most often affected by trigger finger, but it can occur in the other fingers, as well. When the thumb is involved, the condition is called “trigger thumb.”

Anatomy

The flexor tendons are long cord-like structures that attach the muscles of the forearm to the bones of the fingers. When the muscles contract, the flexor tendons allow the fingers to bend.

Each of the flexor tendons passes through a tunnel in the palm and fingers that allows it to glide smoothly as the finger bends and straightens. This tunnel is called the “tendon sheath.”

Along the tendon sheath, bands of tissue called “pulleys” hold the flexor tendons closely to the finger bones. The tendons pass through the pulleys as the finger moves. The pulley at the base of the finger is called the “A1 pulley.” This is the pulley that is most often involved in trigger finger.

Description

In a patient with trigger finger, the A1 pulley becomes inflamed or thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may also become inflamed and develop a small nodule on its surface. When the finger flexes and the nodule passes through the pulley, there is a sensation of catching or popping. This is often painful.

In a severe case of trigger finger, the finger locks and becomes stuck in a bent position. Sometimes the patient must use his or her other hand to straighten the finger.

Cause

While the causes of trigger finger are not well known, several factors may increase your risk for developing the condition. These include:

Medical conditions. Trigger finger is more common in people with certain medical conditions, such as diabetes and rheumatoid arthritis.
Forceful hand activities. The condition is known to occur after forceful use of the fingers and thumb.

Symptoms

Symptoms of trigger finger often start without a single injury. They may follow a period of heavy or extensive hand use, particularly pinching and grasping activities.

Symptoms may include:

A tender lump at the base of the finger on the palm side of the hand
A catching, popping, or locking sensation with finger movement
Pain when you bend or straighten the finger
Stiffness and locking tend to be worse after periods of inactivity, such as when you wake up in the morning.
In a severe case, the involved finger may become locked in a bent position.

Finger Fractures

Nonsurgical Treatment

Your doctor will put your broken bone back into place, usually without surgery. You will get a splint or cast to hold your finger straight and protect it from further injury while it heals. Sometimes your doctor may splint the fingers next to the fractured one to provide additional support. Your doctor will tell you how long to wear the splint. Usually a splint on a fractured finger is worn for about 3 weeks. You may need more x-rays over this time so that your doctor can monitor the progress of your finger as it heals.

Surgical Treatment

Depending on the type and severity of the fracture, you may need surgery to put the bones into alignment. Small devices, such as pins, screws, or wire, will be used to hold your fractured bones together.

Rehabilitation

You may begin using your hand again as soon as your doctor determines it is okay to move your finger. Doing simple rehabilitation exercises each day will help reduce the finger's stiffness and swelling. You may be required to see a physical therapist to assist you in these exercises.

Flexor Tendon Treatment

After examining your hand, your doctor may place your hand in a splint for protection.

Tendons cannot heal unless the ends are touching, which does not occur with a complete tear. In most cases, a cut or torn tendon must be repaired by a doctor. This requires surgery.

Surgery is usually performed within 7 to 10 days after an injury. In general, the sooner surgery is performed, the better recovery will be.

If your injury is restricting blood flow to your hand or finger, your doctor will schedule an immediate surgery.

Surgical Procedure

Because tendons tear in different ways — such as straight across, at an angle, or pulled right off of the bone — there are many different methods for your surgeon to repair them. All the methods for repair, however, involve special sutures, which are stitches.

Surgery is usually performed on an outpatient basis (you may go home the day of surgery). Your doctor will apply a dressing and splint after the surgery. Many doctors use a plastic type of splint to protect the repair. Your fingers and wrist will be placed in a bent position to keep tension off the repair.

Recovery from Surgery

It can take up to 2 months before the repair heals and your hand is strong enough to use without protection. It may take another month or so before your hand can be used with any force.

Soon after surgery, you will begin physical therapy. Specific exercises will help you gradually regain motion and function. Stiffness after surgery is common, but it usually responds to therapy.

Splint wear and proper exercise, exactly as prescribed by your therapist, are as important to recovery as the surgery itself.

Treatment for Partial Tears

Recent evidence suggests that partially torn tendons do not require surgery for good results. The same splinting and exercise programs that are used for surgery patients can be very effective for patients with partial tears, but with no surgery necessary.

This nonsurgical treatment option is appropriate only after the doctor has explored the wound to accurately assess the extent of the injury.

Long-Term Outcomess

Over the last several decades, advanced research and experience in the treatment of flexor tendon injuries have resulted in improved patient outcomes. Flexor tendon injuries, however, can be very challenging to treat.

Despite extensive therapy, some patients have long-term stiffness after flexor tendon injuries. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion.

Overall, flexor tendon surgery results in good return of function and high patient satisfaction.

Trigger Digit Release

Nonsurgical Treatment

Initial treatment for a trigger finger is usually nonsurgical.

Rest. Resting your hand and avoiding activities that make it worse may be enough to resolve the problem.
Splinting. Wearing a splint at night to keep the affected finger or thumb in a straight position while you sleep may be helpful.
Exercises. Gentle stretching exercises can help decrease stiffness and improve range of motion in the involved digit.
Medications. Over-the-counter medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), can help relieve pain and inflammation.
Steroid injections. Corticosteroid, or cortisone, is an anti-inflammatory agent that can be injected into the tendon sheath at the base of the trigger finger. A steroid injection may resolve the triggering over a period of one day to several weeks. If symptoms do not improve with time, a second injection may be given. If two injections do not help the problem, surgery may be considered.

Steroid injections are less likely to be effective in patients with diabetes, but may still help avoid surgery. They can cause a short-term rise in blood sugar, so glucose levels in diabetic patients should be monitored after injection.

Surgical Treatment

If your finger does not get better with nonsurgical treatment, you may wish to consider surgery. Surgery is elective. The decision for surgery is based on how much pain or loss of function you have in your finger. If, however, your finger or thumb is stuck in a flexed or bent position, your doctor may recommend surgery to prevent permanent stiffness.

Surgical procedure. The surgical procedure for trigger finger is called “tenolysis” or “trigger finger release.”

The goal of the procedure is to release the A1 pulley that is blocking tendon movement so the flexor tendon can glide more easily through the tendon sheath. Typically, the procedure is done in an outpatient setting with an injection of local anesthesia to numb the area for surgery.

Surgery is performed through either a small open incision in the palm or with the tip of a needle. The A1 pulley is divided (released) so that the flexor tendon can glide freely. Although pulleys have an important function in the hand, releasing the A1 pulley should not cause problems in the future.

Complications. Complications can occur with any type of surgery. Your doctor will discuss the risks with you before surgery and will take specific measures to help prevent complications.

The most common complications following surgery for trigger finger or trigger thumb include:

Stiffness in the involved finger.
Inability to straighten the involved finger. If you were not able to straighten your finger completely before surgery, you might not be able to do so afterward.
Temporary soreness or swelling at the site of surgery

Less common complications include:

Persistent locking or clicking. This may indicate that more of the pulley needs to be released or may be caused by another problem in your finger.
“Bowstringing.” In a small number of cases, the tendon may “bow” away from the bone, resulting in reduced range of motion. Bowstringing occurs when one of the more important pulleys is released.
Infection (rare)
Digital nerve injury. This may cause numbness or tingling along part of the finger.

Recovery. Most patients are encouraged to move their finger immediately after surgery.

It is common to have some soreness in your palm. Elevating your hand above your heart can help reduce pain and swelling.

Although your incision will heal within a few weeks, it may take from 4 to 6 months for swelling and stiffness in your hand and fingers or thumb to go away completely.

If stiffness, swelling, or pain persist after surgery, your doctor may recommend seeing a hand therapist.

Outcome. Patients who have surgery experience significant improvement in function as well as relief from the pain of a trigger finger. Still, if a contracture or loss of motion was present before surgery, complete range of motion may not be restored.

Ganglion Cyst Treatment

Nonsurgical Treatment

Initial treatment of a ganglion cyst is not surgical.

Observation. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms, your doctor may recommend just waiting and watching to make sure that no unusual changes occur.
Immobilization. Activity often causes the ganglion to increase in size and also increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms and cause the ganglion to decrease in size. As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.
Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it. This procedure is called an aspiration.

The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid can be withdrawn.

Aspiration frequently fails to eliminate the ganglion because the "root" or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not removed. In many cases, the ganglion cyst returns after an aspiration procedure.

Aspiration procedures are most frequently recommended for ganglions located on the top of the wrist.

Surgical Treatment

Your doctor may recommend surgery if your symptoms are not relieved by nonsurgical methods, or if the ganglion returns after aspiration. The procedure to remove a ganglion cyst is called an excision.

Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion. Even after excision, there is a small chance the ganglion will return.

A ganglion cyst at the wrist is removed during a surgical procedure called "excision."

Excision is typically an outpatient procedure and patients are able to go home after a period of observation in the recovery area. There may be some tenderness, discomfort, and swelling after surgery. Normal activities usually may be resumed 2 to 6 weeks after surgery.

Baseball Finger Treatment

Mallet finger injuries that are not treated typically result in stiffness and deformity of the injured fingertip. The majority of mallet finger injuries can be treated without surgery.

In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children, so that the finger does not become stunted or deformed.

Nonsurgical Treatment

Most mallet finger injuries are treated with splinting. A splint holds the fingertip straight (in extension) until it heals.

To restore function to the finger, the splint must be worn full time for 8 weeks. This means that it must be worn while bathing, then carefully changed after bathing. As the splint dries, you must keep your injured finger straight. If the fingertip droops at all, healing is disrupted and you will need to wear the splint for a longer period of time.

Because wearing a splint for a long period of time can irritate the skin, your doctor may talk with you about how to carefully check your skin for problems. Your doctor may also schedule additional visits over the course of the 8 weeks to monitor your progress.

For 3 to 4 weeks after the initial splinting period, you will gradually wear the splint less frequently — perhaps only at night. Splinting treatment usually results in both acceptable function and appearance, however, many patients may not regain full fingertip extension.

For some patients, the splinting regimen is very difficult. In these cases, the doctor may decide to insert a temporary pin across the fingertip joint to hold it straight for 8 weeks.

Surgical Treatment

Your doctor may consider surgical repair if there is a large fracture fragment or the joint is out of line (subluxed). In these cases, surgery is done to repair the fracture using pins to hold the pieces of bone together while the injury heals.

It is not common to treat a mallet finger surgically if bone fragments or fractures are not present. Surgical treatment of the damaged tendon usually requires a tendon graft — tendon tissue that is taken (harvested) from another part of your body — or even fusing the joint straight.

An orthopedic surgeon should be consulted in making the decision to treat this condition surgically.