Hand Surgery IV
Trigger finger is a common and painful disorder of a finger's flexor tendon that causes the finger to "catch" or "lock" when bent or released (if the thumb is affected, the condition is called "trigger thumb"). Trigger finger can be caused by repetitive motion of the finger, rheumatoid arthritis, diabetes and gout. Grasping something for an extended period of time can also result in trigger finger.
The fingers and thumb are able to bend and straighten because of tendons and muscles in the hands and arms. A tendon usually moves smoothly through the sheath (tissue) that covers it.
However, when a finger's flexor tendon becomes inflamed, it may not be able to move smoothly through the sheath so that, when an attempt is made to bend or release the finger, the pulling of the enlarged tendon through the sheath results in the tendon's catching or locking. The medical term for trigger finger is "stenosing flexor tenosynovitis."
Treatment of Trigger Finger
Applying ice, stretching and taking nonsteroidal anti-inflammatory medications are recommended treatments for trigger finger. However, the quickest and most effective treatment is a cortisone injection into the affected tendon's sheath.
If the trigger finger does not go away after two injections, and is not helped by ice, stretching or anti-inflammatories, surgery may be recommended.
During surgery for trigger finger, the tendon sheath is released, and/or inflamed or scarred tissue is removed. Surgery usually permanently cures trigger finger.
Congenital Hand Malformations
Congenital deformities of the hand are physical deformities present at birth that can significantly affect a child's hand function and appearance.
Deformities may occur as a result of abnormal development, birth injuries or genetic factors, and can involve fingers that are fused together (syndactyly), an underdeveloped hand (clubhand), extra fingers (polydactyly) and other abnormalities.
Surgical treatment for congenital deformities varies depending on the type and severity of the deformity, but may include tendon transfers, skin grafts, limb manipulation, external appliances or prosthetic devices to restore normal function and appearance to the hand. Physical therapy is often needed as well to ensure proper development of hand function in young children.
Syndactyly is the most common congenital malformation of the limbs, characterized by the webbing or fusing together of two or more fingers or toes. Syndactyly exhibits a large degree of variation; digits can be partially fused or can be fused along their entire length. The fusion can be simple, with the digits connected only by skin, or it can be complex, with shared bones, nerves, blood vessels, or nails.
Syndactyly results from an error in fetal development, usually caused by a genetic defect. It can occur by itself as an isolated condition, or as one of several symptoms of a multi-symptom disease.
Diseases associated with syndactyly include, but are not limited to, Apert syndrome, Poland syndrome, Jarcho-Levin syndrome, Pfeiffer syndrome, Holt-Oram syndrome, and Edwards syndrome. Syndactyly can be corrected surgically, usually with the addition of a skin graft.
Dupuytren's Contracture Treatment
Dupuytren's contracture is a hand deformity caused by the gradual shortening and thickening of the tissues within the palm of the hand and subsequent hyperplasticity of a node within the palmar aponeurosis. This causes the tendons of one or more fingers (usually the ring finger) to become increasingly difficult to extend, resulting in a perpetually "curled up" finger.
The biological changes within the affected tissue are akin to disorders such as plantar fasciitis in the foot and Peyronie's disease in the penis. The fibrosis within the palmar aponeurosis continues to worsen the condition despite the initial pain fading away, and ultimately condenses itself into the iconic "cord" adjacent to or surrounding the actual tendon. The contracture develops much more slowly in women than in men and occurs frequently after age 40.
Although the underlying biological cause of Dupuytren's contracture is currently unknown, it has been observed to be more prevalent in persons with diabetes mellitus, epilepsy, and alcoholism. However, scientific data has yet to verify these claims. Genetic predisposition to Dupuytren's contracture has been supported by statistical analysis and it is currently believed that individuals with a close family member suffering the disease have between a 60-70% chance of developing it themselves.
Treatment for Dupuytren's is not always advised, due to the relative benevolence of the symptoms. In some cases, the condition may improve on its own. Non-invasive manipulation is usually the first prescribed treatment, such as stretching and heating. Ultrasound treatments can also be very helpful for sore palms.
If these remedies are ineffective, more invasive maneuvers such as needle aponeurotomy or microsurgery (fasciectomy), which weaken or remove the rigid tissue that has built up over time, may be performed. These solutions do run several risks which should be discussed with your doctor first, such as redevelopment of the disease, thickening of unaffected fascia post operation, or damage to nerves in close proximity to the affected area.
Call 512.450.1077 to speak with Dr. Robison and Dr. Trussler if you have any questions or comments or to learn more about how we can help you.