Hand Connective Tissue Disorders - OP. DR. SÜLEYMAN KÖKEN

1. Dupuytren’s Contracture

In Dupuytren’s disease, the connective and fatty tissue under the skin of the palm hardens over time, transforming into nodules and acellular connective tissue. These structures cause the fingers to curl inwards towards the palm. This condition, which prevents the fingers from opening, is called Dupuytren’s disease.

Diagnosis and Treatment of Dupuytren’s Disease

Dupuytren’s disease, which causes loss of movement and cosmetic deformity in the fingers, is more common in men over 40 and around that age. Swelling and hardening in the palm, and the inability to open one or more fingers are among the symptoms. The disease does not cause pain; it only negatively affects the person’s mobility.

Diagnosis is made by examination, which reveals hardened palmar nodules and bands that restrict finger opening. Because there is no pain, patients often delay treatment, but this leads to further progression of the disease. Surgical treatment removes the nodules and bands that have formed in the patient’s palm. Physical therapy applications also accelerate the return to activities requiring hand and finger use.

2. Trigger Finger

The fingers of the hand contain flexor tendons and pulleys (tunnel structures through which tendons pass). Pulleys form tunnels in the fingers with a series of rings, allowing tendons to pass through them. These pulleys also help hold the tendons close to the bone.

This condition can occur when the pulleys thicken at the base of the finger and begin to obstruct the passage of tendons through these tunnels. Sometimes this condition can also be seen in the presence of nodules. Although the cause is often unknown, it can occur as a result of rheumatoid arthritis, gout, diabetes, and sometimes finger trauma.

What are the Symptoms of Trigger Finger?

Trigger finger can begin with a feeling of discomfort at the base of the finger when making a fist. This area is very sensitive to pressure; sometimes a nodule may be present in this area, and pain and a “clicking” or locking sensation may be felt during every movement of the tendon, especially when trying to straighten the finger after waking up in the morning.

How is Trigger Finger Treated?

There is no definitive information regarding whether cream use or other medical treatments slow down the process. First and foremost, we recommend quitting smoking as it accelerates healing.

Although the chances of success are very low, using night splints can prevent catching.
Success can be achieved in 80% of patients with steroid injections.

Surgical treatment is recommended in 3 situations:

If you are experiencing serious problems due to catching.
If the finger has become stuck.
If there is severe pain in the finger.

Surgical treatment is a simple, safe, and quick method. Surgery can be performed the same day, with 2 or 3 stitches and a bandage, allowing you to go home.

3. What are Swan Neck and Buttonhole Deformities, and How Do They Occur?

These are specific names for deformities in the finger caused by various reasons. They are curvatures that occur acutely or over time as a result of closed tendon injuries, injuries from sharp objects, certain fractures, or rheumatological diseases.

What are the Symptoms and Signs of Swan Neck and Buttonhole Deformities?

Visible curvatures in the finger are noticeable.
The individual cannot voluntarily raise (swan neck) or bend (buttonhole) the fingertip.
Pain and limited movement in the finger can impair the quality of daily life.
If caused by a sharp object injury, an open wound is visible.
If due to a rheumatological cause, swelling, pain, and limited movement may be noticed in other fingers, the wrist, or another joint in the body.

How is Swan Neck or Buttonhole Deformity Treated?

If it is caused by closed trauma, tendon rupture, or a fracture, the treatment plan is determined according to the degree of the problem, which finger is affected, and the individual characteristics of the patient. While non-surgical treatments with appropriate splints can be performed, there may also be cases requiring surgery. If the problem is due to rheumatological reasons, the most appropriate treatment is applied in collaboration with rheumatologists. Adding physical therapy and rehabilitation to the treatment of these significant deformities, which are prone to permanent problems, is crucial for minimizing or preventing problems.

4. Tendon Adhesions, Shortening, or Dysfunction

What is a Flexor Tendon? What is the Function of a Flexor Tendon?

Flexor tendons are strong, flat structures that connect the forearm muscles to the bones in the fingers and the thumb on the palm side of the hand. These tendons allow us to bend our wrists, hold a teacup, button our shirts, open jars, and perform everyday activities that require bending our fingers and thumbs.

How Do Flexor Tendons Get Injured? What Are the Symptoms of a Flexor Tendon Injury?

Flexor tendon injuries usually result from penetrating or cutting injuries to the palm of the hand. Injuries can also occur due to sports or arthritic conditions. Arthritic bone spurs or inflamed joint fluid can wear down and sometimes tear the flexor tendons. Symptoms of a flexor tendon injury include pain, swelling, tenderness, and inability to bend the finger.

What is Jersey Finger?

A “Jersey finger” usually occurs when a finger gets caught in another player’s jersey or clothing. It happens when the tendon is pulled from the end of the bone. The tendon doesn’t rupture; it breaks the bone to which it is attached.

What is the Treatment for Flexor Tendon Injury?

Hand and wrist cuts on the palm side should be taken seriously. Flexor tendon injuries are serious. Cut or torn tendons do not heal on their own and require surgery. Your doctor will test the tendons individually to determine which tendons are affected. X-rays may be taken if the injury is caused by glass or other debris.

Tendons are made up of living cells. If the cut ends of the tendon can be brought back together, healing will begin from the cells inside as well as the tissues outside the tendon. Since the cut ends of a tendon usually separate after an injury, it is unlikely that a cut tendon will heal without surgery.

Having surgery as soon as possible after a flexor tendon cut increases the success of the treatment. There are many ways to repair a cut tendon, and certain types of cuts require a specific type of repair. In the finger, it is important to preserve certain pulleys, and there is very little space between the tendon and the pulley for a repair to be made. Nearby nerves and blood vessels may also need to be repaired. After surgery, and depending on the type of incision, the injured area may be protected from movement or a very specific limited movement program may be initiated for several weeks.

Special rehabilitation is often required after flexor tendon surgeries. If unprotected finger movement begins too early, the tendon repair will likely fail. Slow, resistance-free movement of the fingers is permitted after 4-6 weeks. Healing occurs within the first three months after repair.

In most cases, full and normal movement of the injured area does not return after surgery. If it is difficult to bend the finger using its own muscle strength, it may mean that the repaired tendon has detached or there are adhesions in the scar tissue. Scarring from tendon repair is a normal part of the healing process. However, in some cases, scarring (scar tissue) can make bending and straightening the finger very difficult. Depending on the injury, additional treatments may be needed to loosen the scar tissue and prevent it from interfering with finger movement. If hand rehabilitation fails to improve, surgery may be required to release the scar tissue around the tendon.

5. Wrist or Finger Pain

Hand and Wrist

Since a large portion of complaints arising from computer use are related to the hand and wrist, we will focus on this area in more detail. The main causes of complaints in this area can be listed as follows:

Pain and swelling in the wrist
Pain and early fatigue during finger movements
Finger catching
Numbness and tingling in the fingers

Causes

Using the wrist in an excessively bent position
Using the wrist at an angle to the right or left
The mouse being in a hard-to-reach place
Hitting the keys with excessive force
Not resting the hands enough

The diseases that cause these complaints can be listed as follows:

Tension sheath inflammation: The tendons that move the fingers and wrist are surrounded by a sheath to allow for easy movement and pass through tunnels in certain places. As a result of improper positioning and prolonged use of the tendons, the sheaths swell and thicken. Consequently, finger and wrist movements become painful. When the hand is touched, a sensation similar to walking on snow may be felt. The symptoms radiate to the arm.

Trigger finger: The tendon inside the thickened and swollen sheath gets caught during certain movements and, if forced, opens with a painful slipping sensation.

Carpal tunnel syndrome: This occurs especially as a result of working for long periods with the wrist in an excessively bent position. The pressure in the canal through which the nerve passes increases, compressing the nerve. There is pain, numbness, and tingling sensation radiating to the thumb, index finger, and middle finger. The pain can spread to the arm and shoulder. In cases where the hand is used extensively during the day, the symptoms may wake you from sleep at night. The fingers feel swollen. In advanced cases, surgery may be required.

Ulnar tunnel syndrome: Due to overstretching of the 5th finger, the above symptoms may occur in the ring and little fingers.

Precautions

The wrist should be supported.
The hand and wrist should be kept on the same axis.
Documents and the mouse should be within easy reach.
The hands should be rested at regular intervals, and stretching exercises should be performed on the fingers.