Musculo-Tendinous Overuse Syndromes
Under normal circumstances, the friction produced by a healthy tendon gliding through normal tissues is minimal, as synovial fluid lubricates the tendon and pulley surfaces. However, injury to the tendon or abnormal repetitive stress can damage the smooth gliding surface. When the tendon becomes swollen a cycle of inflammation occurs resulting in pain and restricted movement. The symptoms can resolve with rest but recur when the activity is resumed. With time the resisted motion can become severe due to scaring resulting in triggering and locking of the digit. Treatment of the many types of tendonitis is essentially the same. Initial treatment involves rest of the injured part with the use of oral anti-inflammatory agents or local cortisone injections to allow natural healing. Hand surgery can then be necessary to release constrictions or inflamed muscular insertions.
Trigger Finger/Thumb (stenosing tenovaginitis of flexor tendons)
Trigger Finger (or Trigger Thumb) is the most common tendonitis involving the flexor tendon as it passes through the fibrous flexor tendon sheath to enter the finger or thumb. Inflammatory swelling due to overuse causes restriction of the digit movement resulting in triggering or even locking. Treatment initially involves rest and possibly a steroid injection into the region of the tendon sheath. In most cases this will lead to an improvement of symptoms but recurrence is usually best treated by surgical release as a quick local or general anaesthetic day case.
DeQuervain’s Disease (stenosing tenovaginitis of extensor tendons)
DeQuervain’s Disease is stenosing tenosynovitis of the extensor tendons of the first dorsal compartment to the thumb. The stenosis usually occurs at the wrist and is often due to repetitive movement of the thumb. Often differential gliding of the two extensor tendons causes stress between the tendons resulting in tenosynovitis that restricts motion and causes pain. Diagnosis is confirmed by tenderness over the first dorsal compartment and a positive Finkelstein’s test. The mainstay of this overuse syndrome is rest and immobilization of the thumb and wrist in a splint is very important. Again a steroid injection can also be beneficial, but avoidance of the precipitating factors (ie repetitive hand use) is most important. Hand surgery may also be beneficial releasing the constriction on the tendon, but will require postoperative splinting to avoid recurrence. This can also be performed as a small local or general anaesthetic day case procedure.
Tennis Elbow (Lateral Epicondylitis)
Tennis Elbow (Lateral Epicondylitis) involves a degenerative tendonitis of the extensor muscle origin on the lateral epicondyle of the elbow. It can be confused with radial tunnel syndrome due to compression of the radial nerve nearby passing through the two heads of supinator. The condition is caused by repetitive elbow and wrist movement producing stress around structures in the proximal forearm. Treatment is usually nonsurgical involving rest, splinting and steroid injections. A tennis elbow strap and neoprene elbow support will be helpful to alleviate symptoms. Avoidance of precipitating factors is very important to make a complete recovery. Hand surgery is usually reserved for the more recalcitrant situation and involves postoperative therapy including stretching and strengthening exercises before normal use can be resumed.