The tendon that bends the finger passes through a tube-like tendon sheath. If the tendon and sheath become irritated and enlarged from repetitive gripping action, inflammation may occur making it difficult for the tendon to pass through the sheath. The condition is called trigger finger because the tendon catches and then suddenly releases, as if clicking a “trigger.” In the thumb its called trigger thumb.
Signs and symptoms of trigger finger may progress from mild to severe and include:
- Finger stiffness, particularly in the morning
- A popping or clicking sensation as you move your finger
- Tenderness or a bump (nodule) in the palm at the base of the affected finger
- Finger catching or locking in a bent position, which suddenly pops straight
- Finger locked in a bent position, which you are unable to straighten.
Trigger finger more commonly affects your thumb or your middle or ring finger. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.
Trigger finger can be caused by a repeated movement or forceful use of the finger or thumb. Rheumatoid arthritis, gout, and diabetes are also risk factors for trigger finger. Forceful grasping, or vibration such as with repeated use of power tools can also contribute to the development of a trigger digit.
Basilar Joint Arthritis
Although there are several types of arthritis, the one that most often affects the joint at the base of the thumb (the basal joint) is osteoarthritis (degenerative or “wear-and-tear” arthritis).
Smooth cartilage covers the ends of the bones, enabling the bones to glide easily in the joint. Without it, bones rub against each other, causing friction and damage to the bones and the joint. Osteoarthritis occurs when the cartilage begins to wear away. The joint at the base of the thumb, near the wrist and at the fleshy part of the thumb, enables the thumb to swivel, pivot, and pinch so that you can grip things in your hand.
Arthritis of the base of the thumb is more common in women than in men, and usually occurs after 40 years of age.
- Pain with activities that involve gripping or pinching, such as turning a key, opening a door, or snapping your fingers
- Swelling and tenderness at the base of the thumb
- An aching discomfort after prolonged use
- Loss of strength in gripping or pinching activities
- An enlarged, “out-of-joint” appearance
- Development of a bony prominence or bump over the joint
- Limited motion
Prior fractures or other injuries to the joint may increase the likelihood of developing this condition.
Arthritis of the Fingers
Different forms of arthritis affect the hands in different ways. For example, psoriatic arthritis, a type of arthritis related to the skin condition psoriasis, is most likely to cause pain in the joints closest to the fingernails (called the distal joints), while in osteoarthritis, the most common form of arthritis, cartilage can wear down in all the joints in the fingers and thumb.
Symptoms of arthritis in the hands may include:
- Pain in some or all of the joints, including joints of the fingers, wrists, and thumbs
- The growth of bony knobs on finger joints
- Swollen, red, or warm joints
- Stiffness in the fingers, especially in the morning in patients who have rheumatoid arthritis
- Growth of lumps, or nodules, under the skin of the hands in patients with rheumatoid arthritis
- Fingers that look like “swollen sausages” in patients with psoriatic arthritis
- Difficulty with motions that require gripping and twisting, such as opening jars
Also known as “wear and tear” arthritis, osteoarthritis causes cartilage to wear away and it’s exact cause is uncertain. Those patients whose parents had severe arthritis in their hands appear to be at increased risk to develop similar symptoms.
Mallet finger is an injury to the thin extensor 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.
The finger is usually painful, swollen, and bruised. However, sometimes (and hard to explain), there will be minimal bruising or pain. The fingertip will droop noticeably and will straighten only if you push it up with your other hand.
A mallet injury usually occurs when an object hits the tip of the finger or thumb. The force of the blow can tear the extensor tendon. Occasionally, a minor force such as tucking in a bed sheet will cause a mallet finger. The long, ring, and small fingers of the dominant hand are most likely to be injured.
The injury may pull the tendon away from the place where it attaches to the finger bone (distal phalanx) or in some cases, a small piece of bone is pulled away along with the tendon. This is called a “Bony Mallet Digit.”
COURTESY OF AAOS.ORG(Top) A rupture of the extensor tendon. (Bottom) A fragment of the distal phalanx has pulled away with the tendon.
A jersey finger, also known as a football finger, is a type of flexor tendon injury in which the tendon is pulled off the bone at it’s insertion point. The flexor tendons of the hand play a very important role in functioning of the hand and allow independent flexion of each finger and thumb.
- Inability to flex the finger completely.
- Pain is often (but not always) felt in the tip of the finger.
- Tenderness over the palmar side of the finger.
- Swelling and Bruising at the tip of the finger.
- Tendon is often (but not always) felt as a soft mass on the palmar side of the hand.
- Jersey finger very frequently occurs in contact sports like football and rugby.
- Catching of finger in a jersey and tearing a tendon while tackling opponents in contact sports is the common cause of jersey finger.
- A jersey finger injury most frequently affects the ring finger of the hand.
Dupuytren’s Disease and Contracture
Dupuytren’s contracture is a thickening of the fibrous tissue layer underneath the skin (fascia) of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).
Dupuytren’s contracture is more common in men than in women.
Dupuytren’s contracture symptoms usually occur very gradually and starts with nodules and pitting of the palmar skin.
Nodules. One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away without treatment.
Bands of tissue/”Cords”: Tough bands of scar tissue can form a linear looking and feeling tissue along each finger.
Contracture: One or more fingers bend (flex) toward the palm as the cords contract. The ring and little fingers are most commonly affected, but any or all fingers can be involved. Grasping large objects and putting your hand in a pocket becomes difficult.
COURTESY OF AAOS.ORG
The cause of Dupuytren’s contracture is not known. It is not caused by an injury or heavy hand use.
There are factors that put people at greater risk for developing Dupuytren’s contracture.
- It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry.
- It often runs in families (hereditary).
- It may be associated with drinking alcohol.
- It is associated with certain medical conditions, such as diabetes and seizure disorders.
- It increases in frequency with age.