There are many causes for pain in the fingers. This article discusses some of the more common ones.
Because the hand is involved in so many day-to-day activities, when something goes wrong, the hand problem becomes noticeable quickly.
Fractures and dislocations of the fingers occur as a result of trauma. The diagnosis is pretty easy to make and both the clinical impression as well as x-rays can confirm the diagnosis and prepare the road for treatment.
Fingers move as a result of an intricate system consisting of tendons that attach at the near end to muscles in the forearm and hand and at the far end to the tips of the fingers. The tendons run through sheaths that are lined with synovial tissue. The inside of the sheath has a small amount of lubricant that allows smooth movement. In addition, a system of pulleys help stabilize the tendons. Contraction of the muscles pulls the tendons and allows a person to move their fingers.
A trigger finger is one that locks when the finger is bent. The finger can be straightened only with difficulty. This occurs because the tendon sheath becomes inflamed and narrowed; this inhibits the ability of the tendon to move normally. Injection of an anti-inflammatory medicine (cortisone) usually helps this situation. Patients who do not respond to injection require surgery.
Another type of painful tendonitis occurs at the outside part of the thumb near the wrist. Activities such as wringing out a rag, and removing lids from jars are very painful. This is called Dequervain’s tenosynovitis. Local heat and splinting may help relieve the discomfort. Cortisone injection is often required.
A peculiar form of thickening of the tendon in the palm can lead to a “drawing up”of the third and fourth fingers. This condition- called Depuytren’s contracture- occurs most commonly in middle-aged men. It tends to occur in both hands. Surgery is often required.
Arthritis can affect the fingers. Specifically, osteoarthritis (OA) can cause painful nodular swelling involving the last row of finger joints- the distal interphalangeal joints. These swellings are called Heberden’s nodes. A similar problem in the joints one row in – the proximal interphalangeal joints, is called Bouchard’s nodes. These swellings are painful at first. Over time the nodules harden and do not hurt.
Rheumatoid arthritis (RA) is another type of arthritis that affects the hands. The row of finger joints closest to the wrist- the metacarpophalangeal joints is often affected. The proximal interphalangeal joints also are involved in RA.
Gout, pseudogout, and psoriatic arthritis can affect the fingers. Psoriatic arthritis, the arthritis associated with psoriasis, causes a finger to swell up like a sausage. This can be very painful.
Each of these forms of arthritis is treated differently from the other.
Some forms of arthritis such as rheumatoid arthritis and psoriatic arthritis require aggressive therapy.
Finger problems need to be diagnosed properly. In addition to the history and physical exam, x-rays, ultrasound, and magnetic resonance imaging may be required. Once the diagnosis is established, a more precise treatment program can be initiated.
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