Tackling tendinitis and trigger finger
The human hand is a remarkable and complex structure, but it is also susceptible to various ailments that can significantly impact one's daily life. Two common tendon issues that affect the hand are tendinitis and trigger finger. Both conditions can cause stiffness, discomfort, and pain. Thankfully, there are simple, effective treatment options to help patients regain full functionality and alleviate discomfort.
Tendinitis: Addressing Inflammation and Restoring Function
Tendons are cords or bands of tough fibrous tissue that connect muscle to bone. Sometimes, through injury or overuse, tendons become inflamed. This is called tendinitis, and it commonly occurs in joints throughout the body.
“Tendinitis causes non-distinct pain,” explains Dr. Jhade Woodall, a surgeon practicing at Eastern Idaho Regional Medical Center (EIRMC) who specializes in treating hand and wrist dysfunction. “Maybe the patient fell. Maybe they’ve been retired for a while and all of a sudden decided to build a shed or a deck. They did more work than they’re used to, so they’re sore and stiff, but the pain doesn’t go away. It’s sore with motion, especially resistive motion.”
Occasionally, x-ray or MRI imaging is needed to diagnose tendinitis and rule out other causes of pain, like a fracture. However, as Dr. Woodall says, “a lot of times, I can just maneuver the limb and see if there is soreness along the tendon.”
He further explains that tendinitis treatment is usually simple: “The first step is just rest—avoiding activity. Sometimes a splint can be used to prevent movement of the joint. Cold packs and acetaminophen or ibuprofen can reduce inflammation and get the pain and swelling down.”
But that is the easy part of tendinitis treatment. The hard part is giving the tendon time to heal. Tendinitis patients tend to be impatient.
“After four, six, maybe eight weeks, then they can try physical therapy to regain motion and strength,” says Dr. Woodall. “It’s hard to wait that long because people want to be active. But, unlike muscles, tendons are ‘white tissue’—they don’t have blood—so they take a long time to heal. Resting to allow for healing and then increasing strength over time is the best way to go.”
When rest and pain medications fail to help, Dr. Woodall recommends a steroid injection to reduce inflammation and promote healing. Steroids are also an effective treatment for trigger finger, which is another painful condition in a finger or thumb caused by inflammation.
Trigger Finger: Unlocking the Cause and Solutions
Trigger finger, also known as stenosing tenosynovitis, is a common condition that affects the tendons in the fingers. Anyone, of any age (infants to elderly), can develop the condition, and it is easily diagnosed through examination. The patient is asked to make a fist and then open the hand. If one finger stays bent and “pops” when the doctor manually extends it, then it is trigger finger.
“The tendon runs through a sheath, or ‘tunnel,’ that keeps it connected to the finger bone,” Dr. Woodall explains. “Trigger finger occurs when a nodule or scar tissue develops on the tendon or the sheath, causing the tendon to catch or lock within the tunnel.”
“Unlocking” (straightening) the stuck finger is what causes the popping sensation, and that can be painful.
“Pain is typically the reason that a primary care doctor refers patients to me,” says Dr. Woodall. “They’ve put up with the popping for a while, but now that it hurts, they need help. Treatment is pretty easy.
“We can try splinting and therapy, and that can work. That’s option one. By the time they see me, though, it’s usually past the stage where splinting helps. Almost everyone I see gets an initial steroid injection—that’s option two. Steroids decrease inflammation and knock down the swelling, which helps the healing process and allows the tendon to smoothly move through the tunnel.”
Steroid injections are very effective at curing trigger finger. According to Dr. Woodall, 70–80% of all patients [except for those with diabetes] are cured with just one injection. After six weeks, patients have a follow-up visit. If the symptoms have not resolved, then a second steroid injection can be given, and that normally has an 80–90% cure rate. If that does not work, then there’s option three.
Outpatient Surgery for Trigger Finger
“For the 10-20% where the trigger finger is recalcitrant, I go with a very simple surgery that can be done in my office,” Dr. Woodall explains. “It is very low risk, only takes 5–10 minutes, and the patient sees immediate results.”
In-office trigger finger surgery begins with thoroughly cleansing the hand and administering a local anesthetic. A small incision is made at the base of the affected finger. With the help of ultrasound, the doctor guides a very small scalpel to the tendon sheath and cuts the roof of the tunnel. The patient is asked to make a fist and then extend the fingers. If the affected finger does not straighten immediately, then the doctor tries again. If it does straighten, then the operation is a success.
Recovery, as Dr. Woodall explains, is quick. “The incision is closed with a few stitches, and the patient wears a dressing for about five days. They can go back to light use almost immediately. But I don’t recommend that they go swinging a hammer or doing other intensive labor since the skin needs to heal. Most people do remarkably well. All things considered, it’s an easy win.”