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F e a t u r e
T
Breakthrough
HAND SURGERY
The hand is one of the most complex and intricate structures of the human body.
The combination of bones, cartilage, tendons, muscles, ligaments, nerves, arter-
ies and veins that form the hand are also the building blocks for the functionality
of the hand. It is intuitive, and when these structures are damaged, the hand
cannot function the way it was designed to.
One of the most common problems facing the modern world is repetitive motion injuries
of the hand. Technology has brought in a new era of the information age. Computers,
smartphones, tablets and other hand-held devices have become commonplace
at work, home and recreational environments. These devices, along with
the modern activities of daily living, have caused your hands to work
extremely hard. This can lead to the bones, cartilage, muscles, tendons
and nerves of the hand being compressed and damaged. This damage
will ultimately cause pain and a loss of motion.
WHAT CAUSES TRIGGER FINGER
Tendons tend to be the most
affected structures with repetitive motion of the hand. Tendi-
nitis is an inflammation of the tendons and is the most com-
mon repetitive motion injury of the hand. When a tendon is in
motion for long periods of time, the covering on the tendons
may thicken and cause friction or abrasions on the tendon. This
can lead to inflammation, swelling and pain,” says GAMC hand
surgeon Murtaza Rizvi, MD. Swelling can lead to a tendon not
moving through tissue with the ease and grace that it was designed
to. Sometimes, this pathology can lead to the tendon even becoming
entrapped, such as with a trigger finger.
Trigger finger occurs when inflammation (due to friction) narrows the
space within the sheath that surrounds the tendon in the affected finger,
which gets the finger stuck in a bent position. This occurs at the proximal
interphalangeal joint of the main fingers or the interphalgeal joint of the thumb.
The joint becomes locked and the finger must be popped or stretched to straighten
it. The pain travels into the palm where, during a physical exam, the physician may
find a hard lump over the tendon near the distal half of the palm. If trigger finger is very
severe, the involved finger may be trapped in a locked and bent position. The middle finger and
thumb tend to be the most commonly affected. For patients with trigger finger, symptoms tend to
be the most severe in the morning or when they grasp objects firmly.
TREATING TRIGGER FINGER
This involves a multimodality approach, including conservative and
surgical measures. “Initially, the main treatment plan is resting the involved finger and decreasing
the inflammation with medications,” says Dr. Rizvi. “Common medications include nonsteroidal
anti-inflammatory agents, such as Motrin. Ice, heat, splinting
and stretching exercises can also help with the motion and pain
of a trigger finger,” explains Dr. Rizvi.
More invasive treatments include steroidal injections, percu-
taneous release and surgery. Some patients will need physical
therapy with a hand therapist to enable them to move their finger
better even after surgery, but the majority are able to follow a
home regimen and recover well.
Murtaza Rizvi, MD
Rely on the experts! It is best that these disorders be
treated by a board-certified hand surgeon. Contact the
Glendale Adventist Orthopedic Institute at (818) 863-4446.
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