Common Causes of Finger Stiffness

by TOI Admin September 22, 2014

By Zakariah S. Mahmood, M.D.

A common complaint of patients who are referred to a hand specialist is loss of mobility and motion of the fingers. Most often these complaints are gradual in onset, rather than starting abruptly. The stiffness and loss of mobility may or may not be associated with pain. Usually, patients complain of the inability to do activities they enjoy because of loss of gripping ability or fine dexterity. Important and common causes of this loss in mobility include Dupuytren's contracture, arthritis, locked trigger finger, and various injuries. Fortunately, there are treatments available for these conditions. The following article describes the common causes and treatment options for finger stiffness.

Dupuytren's Contracture

The palm of the hand contains many important structures that allow the hand to function normally. Very small nerves travel next to tendons and muscles, allowing the hand and fingers to create function. To help bind, cushion, and separate these structures, there is a thick layer of connective tissue called the palmar fascia.  It is similar in appearance and texture to gristle found in meat. Normally, this layer is not visible nor necessarily palpable from the skin surface. It is this layer that develops a scar (fibromatosis) in Dupuytren's contracture.

Dupuytren's causes a contracture or bending of the fingers into the palm. Typically there can be demonstrable cords in the palm and fingers that act as tethers, which keep the fingers from opening up all the way. Occasionally, these cords can be accompanied by small pits or nodules in the skin. Patients typically seek help when the amount of tethering interferes with daily activities such as shaking hands, putting the hands in the pockets, or fine manipulation. It is also possible that the cords can interfere with grip. Typically, the cords do not cause pain. Dupuytren's contracture is a genetic disorder that is most often found in people of northern European ancestry, but can effect anyone. It can occur in one or several areas of the hand and fingers and at nearly any age. The severity and progression vary from person to person and cannot be accurately predicted, but the speed of previous progression and previous responses to treatments can serve as general guides.

Treatment is focused on allowing the fingers to straighten out and restoring function. This can be done surgically by excising (removing) the cords in the palmar fascia, incising (cutting, but not removing the cords), and Xiaflex injections. These are specific injections which work to dissolve the cord, allowing the finger to straighten out without surgery. There are various advantages and disadvantages to each of these treatments, and your orthopaedic hand specialist can help you decide which is best for you based on your pattern and severity of Dupuytren's contracture.

Trigger Finger (Stenosing Tenosynovitis)

Trigger finger, or stenosing tenosynovitis, is a common condition and can cause a stiff finger. In a normal finger, there is a 'tunnel' made up of a system of pulleys throughout the finger, which the tendon glides through. When there is swelling, from any number of causes, the tendon can catch at the opening of the tunnel. For example, this is similar to a thread which can be typically be pulled back and forth easily through the eye of a needle, but when there is a knot on the thread, it gets caught at the eye of the needle. Like in trigger finger, when this knot/swelling is big enough, the tendon can actually get caught in the tunnel. There are other, more rare conditions that can be mistaken for a locked trigger finger, and these must be kept in mind when considering a diagnosis. A trigger finger usually presents pain, locking or catching of the finger when moving it, and occasionally a permanently bent finger.

Trigger fingers can be treated with steroid/cortisone injections as a first line of treatment. There is a success rate of up to 75% after a single injection. Splinting the finger in extension is also a treatment option, but these splints are often poorly tolerated and can be cumbersome and uncomfortable to wear, so are not typically offered. A final option is surgical treatment. With surgery, a small incision is made at the edge of the tunnel and it is 'opened' so that the tendon does not get caught. With the needle and thread analogy, this is similar to widening the eye of the needle, allowing the knot on the thread to easily move back and forth. Surgery is typically a permanent fix for this problem.

Arthritis

It should be apparent that stiffness in the finger or hand is not always arthritis, but arthritis still remains an important cause of finger stiffness. Arthritis is the loss of cartilage that covers the end of the bones, which allows for smooth motion at the joints. It can be caused by a multitude of reasons, including genetics, wear and tear, and injuries, such as fractures. Typically, but not always, arthritis is accompanied by pain in the joints and swelling. Bone spurs can develop and widen the joints, causing misshapen fingers.

Treatment of the arthritis is based on location. NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, aspirin, and naproxen, can be helpful in early stages. As the arthritis progresses, they typically become less effective. Steroid injections are stronger anti-inflammatory medications that can be injected into joints to give relief from the symptoms of the arthritis. Depending on the location of the arthritis, splints or braces can also help. Specifically, thumb base arthritis can be helped with individualized braces. When activity modification, NSAIDs, steroid injections, and splinting fail to help, surgery can be considered as an option to treat arthritis.

Surgery for arthritis in the fingers varies based on the location of the arthritis. One surgical option is when the larger two joints in the finger, between the Proximal Phalanx and the Middle Phalanx, are fused. Another surgical option is to have a small joint replacement. A fusion procedure keeps the problem finger joints from moving so that pain is eliminated. Joint replacements aim to maintain or improve range of motion and eliminate pain. The smallest joints at the tip of the finger, between the Middle Phalanx and Distal Phalanx, are usually fused when the arthritis fails to respond to other treatments. This eliminates pain and restores a more normal appearance at the tip of the finger, however, this is also at the expense of motion.

Finally, thumb base arthritis, located between the Trapezium and the 1st Metacarpal Bone, has many surgical remedies. One surgical treatment for thumb arthritis is similar to a hip arthritis, where the arthritis is eliminated by removing the head of the femur (thigh bone) and then replaced using a metal implant. In thumb arthritis, a portion of the bone at the base of the thumb or the entire bone is removed, eliminating the arthritis. Usually, a suture or a tendon from the wrist area can then be used to replace the missing bone rather than a metal implant.

Other important causes of finger stiffness and loss of motion include old tendon injuries, sprains, and fractures that have healed incorrectly. These should always be considered among other possibilities for a stiff finger. If you are experiencing finger stiffness, ask your orthopaedic hand specialist about your particular diagnosis and treatment options available to you.

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Finger

TOI is a proud sponsor of the 7th Annual Dancing With The Doctors

by TOI Admin July 14, 2014

TOI is a proud sponsor of the 7th Annual Dancing with the Doctors Saturday, July 19th at 6pm, benefiting The Boys and Girls Club of Marion County and the YMCA of Marion County. Over the past year, Dancing with the Doctors raised over $100,000 for local children; the past beneficiaries include Munroe Foundation, Boys and Girls Club, YMCA and Drayton Florence Foundation. This year, Dancing with the Doctors will benefit the Boys and Girl Clubs of Marion County as well as the YMCA of Marion County. The event will be held at the Circle Square Cultural Center, located at 8395 SW 80th St, Ocala, FL 34481. For more information or to purchase tickets, please click the image below.

New Ocala Facility Ribbon Cutting and Open House

by admin August 15, 2011

  



The Orthopaedic Institute hosted an official open house and ribbon cutting ceremony with representatives of the Ocala Chamber of Commerce to celebrate the opening of the new Ocala medical facility on August 11. Over 200 colleagues in the local business and medical communities enjoyed guided tours of the facility, hors d’ oeuvres and opportunities to meet TOI physicians and administrators.

 

TOI has offered its services in Ocala since 2008 when it opened its office in the Deerwood Office Park. Only steps away from the former office, TOI’s new state-of-the-art 17,000 sq ft medical facility is located on 17th Street one mile east of Ocala Regional Medical Center. The significant expansion allows TOI to offer additional services to the community, all under one roof.

 

The physicians practicing at this location include Adil Kabeer, M.D., Joseph R. Locker, M.D., Rodger D. Powell, M.D., Michael K. Riley, M.D., Marc J. Rogers, D.O., and Paul J. Rucinski, M.D.

 

In addition to clinical services, the new facility offers digital X-ray, MRI, DME, EMG/Nerve Conduction Studies, Physical Therapy and Hand Therapy.

 

We would like to thank all involved for your hard work and dedication in continuing to promoting our core value of Improving Lives- Everyday.

 

 

 

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Community Involvement | General Information

New Ocala Medical Facility Now Open

by admin July 11, 2011


The Orthopaedic Institute’s new medical facility in Ocala opened its doors today at 1710 SE 16th Avenue, only steps away from the previous Deerwood Park Location. This new 17,000-square-foot state-of-the-art medical facility is conveniently located on 17th Street one mile east of Ocala Regional Medical Center.

 

Physicians practicing at this location include Joseph R. Locker, M.D., Michael K. Riley, M.D., Marc J. Rogers, D.O., Paul J. Rucinski, M.D., and visiting physician Rodger D. Powell, M.D. In addition to clinical services, the facility will offer digital X-ray, MRI, DME, EMG/Nerve Conduction Studies, Physical Therapy and Hand Therapy.

 

"Completion of our new medical office complex is a major step in our plan to further invest in the community and provide more comprehensive services to patients," said Eric Brill, CEO of TOI.

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TOI's Ocala medical complex construction update

by admin May 2, 2011

The Orthopaedic Institute’s new 16,275-square-foot facility will be located at 1710 SE 16th Avenue. Construction has been underway since November and will be completed in July. See the most recent construction progress here.



For more information and to see the progression from November 2010 to January 2011, click here.

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