Diagnostics
De Quervain's Tenosynovitis
This condition affects the tendons at the base of the thumb that allow you to lift the thumb up and move it away from the index finger. It is characterized by inflammation of the tendons and/or their synovial sheath. This tissue swelling is not always visible. It often occurs following repetitive movements or overuse of the wrist and thumb, particularly during twisting motions or repetitive gripping with the thumb.
Symptoms
Trigger Finger (Stenosing Tenosynovitis)
Trigger finger occurs when a finger’s flexor tendon has difficulty sliding through its pulley. This pulley acts as a guide for the tendon, but when inflammation is present, the passage becomes too narrow. The tendon becomes irritated, forming a small mass called a nodule, which further hinders movement. As a result, the finger may catch or, in advanced cases, become locked in a bent position and prove difficult to straighten.
Trigger finger is often caused by repetitive use of the fingers, such as repetitive bending motions, prolonged gripping of objects in the palm, or an impact to the palm. It can also appear after sustained or unusual hand exertion, such as manual labour. Sometimes, the cause is difficult to identify.
Symptoms
Trigger finger generally manifests as pain at the base of the finger, accompanied by difficulty straightening the finger after bending it. You may feel a locking or catching sensation during movement, as if the finger is "stuck." In some cases, a small bump may be felt over the affected tendon.
Finger movements become less fluid, and the locking may worsen over time if the condition is left untreated.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by compression of the median nerve within a narrow passage at the wrist called the carpal tunnel. This nerve controls sensation in the thumb, index, middle, and ring fingers.
This problem often occurs in individuals who perform repetitive tasks with their hands, such as typing, using a computer mouse, or handling tools. It can also be encouraged by conditions such as arthritis, hormonal changes (e.g., pregnancy, menopause), wrist trauma, or external factors like exposure to vibration, as these lead to a reduction in the size of the carpal tunnel, compressing the median nerve.
Symptoms
Finger or Wrist Sprains
A sprain occurs when a ligament is stretched or torn following a trauma, such as a fall, a twisting motion, or an impact. Ligaments are bands of tissue that connect bones to one another and ensure joint stability.
Symptoms
Epicondylitis (Tennis Elbow)
Epicondylitis is an inflammation of the tendons that attach to the lateral epicondyle, a bone located on the outer side of the elbow. It generally occurs after repetitive or intense movements of the hand, wrist, or forearm that require extension of the wrist or fingers, such as gripping a tool, screwdriving, or lifting objects. It is nicknamed "tennis elbow" because it frequently appears during racquet sports (e.g., tennis, pickleball). This is the most common diagnosis for elbow pain.
Symptoms
Epitrochleitis (Golf Elbow)
Epitrochleitis is an inflammation of the tendons that attach to the medial epicondyle, a bone located on the inner side of the elbow. It generally occurs after repetitive or intense movements of the hand, wrist, or forearm that require flexion of the wrist or fingers. It is nicknamed "golf elbow" because it frequently occurs during sports involving a club or stick (e.g., golf, hockey).
Symptoms
Complex Regional Pain Syndrome (CRPS)
CRPS is a chronic pain condition that can appear after an injury of any severity level, such as a cut, sprain, fracture, or surgery. It is a frequent complication following a distal radius fracture. However, the pain experienced is disproportionate to the initial injury. This condition is linked to a dysfunction of the nervous system that enters a "state of shock." Note that this condition goes by several names, including reflex sympathetic dystrophy and shoulder-hand syndrome.
Symptoms
Dupuytren's Disease
Dupuytren's disease is a disorder that limits the extension movement of one or more fingers. The fibrous layer covering the palm of the hand, called the palmar aponeurosis (or fascia), contracts due to the disease, leading to an irreversible bending of the fingers. There is no effective intervention to straighten the fingers other than surgery, which involves removing the "diseased" portion of the fascia. Post-operative occupational therapy follow-up consists of scar treatment and ensuring the maintenance of mobility.
Symptoms
Focal Dystonia / Writer’s or Musician’s Cramp
Focal dystonia of the hand is a neurological movement disorder, often related to a specific activity, resulting in involuntary, painless, and repetitive muscle contractions.
It leads to abnormal postures or a loss of fine motor control during specific actions like writing or playing an instrument, while the hand relaxes at rest.
Boutonnière Deformity
A boutonnière deformity occurs when the middle joint of the finger remains bent (flexed) while the end joint of the finger bends backward (extended). This deformity appears when an extensor tendon called the central slip is damaged, or due to excessive contracture of the volar plate, a ligament that limits finger extension.
This deformity can occur after:
- Trauma (a blow or finger sprain)
- A tendon laceration (cut)
- Certain inflammatory diseases such as arthritis
If left untreated, a boutonnière deformity generally progresses rapidly, with the flexion of the middle joint becoming increasingly pronounced and potentially impossible to correct. Occupational therapy treatment involves straightening the finger and allowing the affected structures to heal properly to restore the best possible extension. Early intervention ensures better results.
Swan Neck Deformity
A swan neck deformity results in an over-extension of the middle finger joint accompanied by the flexion of the finger tip. It can appear during an imbalance of the finger tendons, following an injury, or due to inflammatory diseases like rheumatoid arthritis or osteoarthritis. It is one of the most common finger deformities. When very pronounced, it can make it difficult to "initiate" finger flexion.
To facilitate finger use and limit the progression of the deformity, the use of a "silver ring" splint may be recommended by the occupational therapist.
Mallet Finger
Mallet finger occurs when the tendon that allows you to straighten the tip of the finger is injured or torn. It then becomes impossible to actively lift the end of the finger, which remains drooping.
This injury often occurs:
- When an object strikes the tip of the finger (e.g., a ball)
- During a task requiring significant flexion of the finger tip (e.g., scratching a spot, pulling up socks)
Treatment consists of immobilizing the finger tip for several weeks to allow the tendon to heal, followed by a gradual return to finger movements. A custom-made orthotic is preferred, as the proper healing of the tendon depends heavily on the position of the finger within the orthotic. Early management is also crucial for the tendon to heal correctly.
