Overview
Tendonitis and ganglions can come from repetitive activities.
Tendons normally move smoothly within a tendon sheath with motion of the wrist and fingers. When tendons swell in patients with tendonitis, there is friction between the tendon and the overlying sheath which could lead to swelling and a painful catching sensation and even locking.
Ganglions or cysts above the wrist can occur without any trauma. They can occur in young healthy patients when there is a proliferation of the joint fluid called synovial fluid. They can occur in older patients when there is arthritis that stimulates increased fluid formation that produces cysts.
Symptoms
Trigger Finger
This problem results in a painful locking and catching. There is often tenderness in the fingers and the patient often has to use their opposite hand to straighten out the flexed finger. There can be tenderness in the nodule in the palm or at the base of the thumb and it can occur in all of the fingers and the thumb.
DeQuervain’s Tenosynovitis
This condition occurs when the tendons that provide motion to the thumb become inflamed. This causes painful swelling on the thumb side of the wrist and pain when gripping or lifting particularly by lifting between the thumb and index finger.
Ganglion Cyst
Ganglion cysts can occur from a sack or bubble like swelling on the palm side of the wrist or opposite side of the wrist. They can be painful, but frequently are not. However, ganglion cysts can limit wrist motion.
Causes
Trigger Finger
Trigger finger can be caused by repetitive activities or can develop without any prior warning. There is an increased incidence of trigger fingers among patients who are diabetic although most patients with trigger fingers are not diabetic. It is thought that the change in glucose metabolism causes the ligaments to thicken, the thickening of ligaments or sheath around the tendons causes increased friction, which produces the inflammation.
DeQuervain’s Tenosynovitis
Dequervain’s Tenosynovitis occurs for similar reasons of that of trigger fingers i.e. either with a sudden increase in activities or a gradual constriction of the ligament over time can causing friction between the tendon and the tendon sheath that produces the symptoms. Patients who are diabetic also have an increased incidence of DeQuervain’s Tenosynovitis.
Ganglion Cyst
Ganglion cysts occur in either young healthy patients with no history of trauma or arthritis or they can occur in older patients when there is an area of arthritis. They are caused by joint fluid that expands the joint lining (synovium) beyond the normal confines to produce a sack that is connected to the joint. It is more common in women possibly because the wrist ligaments are thinner and allow for this sack to escape much more easily. In older patients, the presence of arthritis can lead to increased synovial fluids. This increase in pressure produces distention and sac formation.
Risk Factors
Diabetes can be a risk factor for Trigger Finger and DeQuervain’s Tenosynivitis.
New mothers are also at risk because of the sudden change in their lifting activity that can cause DeQuervain’s Tenosynovitis.
Women have an increased risk in developing Ganglion Cysts compared to men. There may often be a history of minor trauma or a wrist sprain. Older patients with arthritic joints are also at increased risk in forming ganglion cysts because of the increase in synovial fluid production.
Diagnosis
Trigger Finger
Trigger Finger is often easy to diagnose clinically because of the locking and catching sensation that is produced as the patient tries to flex and extend their finger. The patient can also experience tenderness in the palm and in more subtle cases, there can be a stiffness or stickiness as the patient tries to move.
DeQuervain’s Tenosynovitis
A test called the Finkelstein Test can be performed by grasping the thumb with the fingers and by moving the wrist away from the thumb to stress the tendons. If this produces significant pain at the wrist it can confirm the diagnosis. There is often the characteristic presence of swelling and tenderness over the thumb side of the thumb.
Ganglion Cyst
In most cases, ganglion cysts are easy to diagnose. Large cysts will transilluminate against a pen light. Sometimes they can be quite small and may not be identified without using a magnetic imaging resonance test. Most of the cysts that ultimately need to be removed are easy to diagnose clinically.
Complications
Trigger Finger
Permanent stiffness can develop in the finger if the trigger finger is not treated. This problem becomes a particular concern when the patient cannot fully straighten their finger despite using the other hand.
DeQuervain’s Tenosynovitis
The tendons are not at risk for rupture with DeQuervain’s Tenosynovitis, but there is risk of longstanding inflammation that can be very difficult to treat and eradicate if the condition is not treated early on.
Ganglion Cyst
The ganglions can continue to enlarge with worsening symptoms in some cases.
Recovery
Trigger Finger
Very little post-operative therapy is needed after trigger finger surgery. Patients can begin moving their finger immediately after surgery. They can drive and perform daily activities the day after surgery and can generally resume all activities once they have their stitches removed 10 days after surgery.
DeQuervain’s Tenosynovitis
Immobilization of the affected joints is recommended to allow the inflammation around these very important thumb and wrist tendons to subside with splinting for 10 days in a plastic splint that immobilizes both the thumb and wrist. A gentle physical therapy program is recommended to regain flexion and thumb motion. Patients can generally return to all daily activities in three weeks.
Ganglion Cyst
After surgery, a plastic splint is worn for five days, Then patients will begin a gentle physical therapy program that begins with wrist motion once the splint has been removed. Generally, the patients can return to most light activities once the sutures have been removed and all activities after three to four weeks.