Fingers

Fingers

Especialista en Manos | Ced. Prof. 6070741 | Ced. Esp. 8556493

Trigger Finger

Flexor tenosynovitis, better known as trigger finger, is a condition where any of the fingers of the hand gets locked, caused by inflammation of the tendon of the affected finger. Although the cause of this condition is unknown, a higher prevalence has been identified in individuals with diabetes and rheumatoid arthritis. Moreover, frequent use of the hands poses a higher risk of developing this disorder.

Symptoms

The finger gets locked and remains in a flexed position when one of the tendons that flex it becomes inflamed, forming a nodule in the palm of the hand. Characteristic symptoms of this disorder include pain and swelling in the palm of the hand and the formation of a nodule at the base of the affected finger.

When the tendon is inflamed, it may dislocate outside the sheath when flexing the finger. If it is severely inflamed, it may struggle to return to its original position, resulting in the finger remaining flexed.

Diagnosis and Treatment

For diagnosis, I must conduct a physical examination. Normally, the tendon moves easily in and out when stretching the finger. However, when the tendon is inflamed, the person may need to pull the finger to introduce the inflamed area into the sheath, providing a sense of relief. Additionally, the doctor may order X-rays to rule out other pathologies.

To treat this condition, it is essential to manage pain and inflammation. Typically, analgesic and anti-inflammatory medications are used, along with immobilization using a splint and warm moist compresses. In some cases, infiltrations with a local anesthetic and corticosteroid may be necessary. Surgery is required to treat chronic trigger finger.

Dr. Emmanuel Ruiz 

Orthopedist
Ced. Prof. 6070741 
Ced. Esp. 8556493
  • Pediatric and Congenital Hand

  • Peripheral Nerve Injuries.

  • Elbow and Forearm

  • Degenerative hand diseases

  • Wrist Pathologies

Hammer Finger

Hammer finger, also known as baseball or shirt button finger, occurs when the end of the finger remains flexed, and the person is unable to straighten it. Typically, it results from trauma where the tendon responsible for extending the last joint of the finger is ruptured. In some cases, it may tear a fragment of the finger bone (avulsion fracture) or experience joint dislocation. In both cases, the deformation that occurs has the same shape.

Diagnosis and Treatment

For diagnosis, a physical examination is necessary, along with X-rays of the finger from different angles to rule out an avulsion fracture. Regarding treatment, it depends on whether there is a fracture or not. If there is no fracture, a splint is applied to the tip of the finger to keep the joint extended until the tendon heals. This splint is worn day and night for approximately three or four months. If necessary, the hand surgeon will explain to the patient how to change the splint without the finger flexing.

In contrast, if there is an avulsion fracture with joint dislocation, the treatment depends on the patient’s specific needs. In some cases, conservative treatment is not sufficient, and surgery for the hammer finger is required, involving the placement of nails or wires. For both cases, active range of motion is resumed after tendon healing, and rehabilitation may be recommended.

Dupuytren’s Disease

Dupuytren’s disease or contracture involves a progressive contraction of the fascia in the hands, fibrous tissue that causes a gradual and involuntary flexion of the affected fingers, ultimately resulting in a deformity where the hand appears claw-like

Symptoms

As a progressive and slowly evolving disease, it primarily occurs in individuals over 40, especially in men. Moreover, the right hand is affected twice as often as the left. It typically begins with a nodule in the palm, forming cords from the palm to the fingers, leading to their flexion. The ring and little fingers are most commonly affected, but all fingers can be involved. There is a hereditary component, but carrying the anomalous gene does not guarantee the onset of the disease. Around 50% of people with this disorder have both hands affected. Medical attention is often sought when flexion becomes permanent and disabling.

Diagnosis and Treatment

Diagnosing this disease requires a physical examination by a hand specialist. In mild cases, conservative treatment involves using night splints to prevent contractures and permanent flexion, keeping the fingers extended. Stretching exercises are recommended in mild cases.

In severe cases, when contractures become disabling and impede normal hand and finger use, surgery is necessary. The surgical procedure releases the contractures, and skin grafts may be used to cover exposed areas after the release. A splint is used during the post-surgery recovery to maintain finger extension. Despite the procedure, contractures may reoccur.

Injuries of the Volar Plate

The finger joints are equipped with ligaments that facilitate bone movement. One such ligament is the volar plate, which prevents hyperextension of the fingers. If this movement is forcefully executed, it can lead to a volar plate rupture. This condition involves an avulsion of a small bone fragment from the middle phalanx of the ligament due to hyperextension. Often, injuries to collateral ligaments that provide lateral stability in the finger joints accompany volar plate injuries.

Symptoms

This condition can result from trauma or diseases such as rheumatoid arthritis, which weakens the volar plate, increasing the risk of injury. Symptoms include tenderness, pain, swelling, and joint deformity. Pain may intensify during finger movement, limiting the range of motion.

Diagnosis and Treatment

An assessment of the injury is necessary, as it can range from ligament elongation to avulsion fractures. I will order X-rays to rule out an associated fracture. Treatment depends on the severity of the injury.

Initially, the finger is immobilized for a short period, and mobility exercises are initiated after a few days to prevent complications like joint stiffness. Rehabilitation is essential for restoring the function of the affected finger or fingers. As part of range of motion exercises, “finger-to-finger” splinting may be employed throughout the day initially and later, only during periods of high activity.

For more severe injuries, especially those involving fractures or joint instability, surgery may be necessary. Often, post-surgical stiffness may occur, which can be addressed with additional surgery to regain the range of motion.

Are you interested in this procedure? Contact me! I’m Dr. Emmanuel and I’m always available to fix your finger injury.

Injuries to the Fingertip

Injuries to the fingertip, specifically in the nail bed, which is the skin beneath the nail, are the most common hand injuries. The structures that can be affected include the nail, the nail bed, the fingertip, joints, bone, and nerve endings. Additionally, when an injury occurs near the nail base, tendons can also be affected. Common causes include cutting injuries, crushing incidents, and other accidents such as amputations or industrial machinery incidents.

Diagnosis and Treatment

To accurately diagnose a fingertip injury, a hand specialist must conduct a physical examination to determine if there is damage to nerves, blood vessels, nail structures, joints, bone, or tendons. X-rays are very useful in determining if a fracture is present.

The treatment of these injuries depends on their severity, extent, and the structures involved.

  • Mild injuries to the nail bed are conservatively treated by immobilizing the area to control pain and inflammation. When there is a significant blood accumulation, drainage may be necessary to reduce pain.
  • If the nail is torn off, it requires repair with absorbable sutures.
  • Severe injuries may require surgical treatment; if there is a fracture, nails may be used for stabilization.
  • Complex lacerations may require tissue repair and even skin grafts.

Injuries without fractures typically heal in approximately two to three weeks, while those involving fractures take five to seven weeks to heal. Regardless of whether there is a fracture or not, it is advisable to refrain from smoking during the recovery period.

Once the injuries have healed, active range of motion exercises are recommended to regain function in the affected finger or fingers. Physical rehabilitation is sometimes recommended. Additionally, during recovery, using the other fingers is advised to prevent stiffness.

Replantation

Replantation is a surgical procedure where a completely amputated part of the body is reattached. The goal of replantation is to restore the maximum possible function of the amputated part and is recommended when it is expected that the replanted tissue will have the same function as a prosthesis.

However, not all amputated parts can always be replanted, for example, when tissue damage is severe or when there are multiple lacerations in the amputated part. When replantation is an option, the decision must be made between the hand surgeon and the well-informed patient, considering aspects such as the patient’s medical condition, recovery time, and rehabilitation duration.

How is a replantation surgery performed?

  1. Inspect the damaged tissue of both the amputated part and the stump.
  2. Identify the bone, arteries, veins, tendons, and nerves involved in the amputation.
  3. Reconnect all mentioned structures sequentially, starting with fixing the bone using nails, plates, or screws.
  4. Subsequently, repair veins and nerves under the microscope.
  5. If necessary, grafts of veins, nerves, or tendons from other parts of the patient’s body may be used.

Postoperative Care

After replantation surgery, anticoagulants are administered to maintain blood flow to the replanted part, requiring the patient’s hospitalization. During the recovery period, keeping the limb elevated is crucial to prevent swelling, and pillows can be used for this purpose.

It’s important to note that the function of the amputated part is not fully restored. Long-term physical therapy and the use of temporary orthoses are often necessary. Additionally, the involved joints frequently experience stiffness.

Certain factors can jeopardize the success of replantation by decreasing blood flow to the replanted part, such as compromised vascularity, pre-existing diseases, coffee, tobacco, and alcohol consumption, and exposure to cold.

After rehabilitation of the replanted limb, some surgeries may be necessary, such as:

  • Tenolysis, the release of tendons from scar tissue.
  • Capsulotomy, the release of stiff joints.
  • Nerve repair and grafting.
  • Late amputation due to poor function or chronic pain.

What to Do in Case of Finger Injuries?

Accidents can happen unexpectedly. If you injure your hand or fingers, follow these steps:

  1. Stay calm and seek clinics that perform finger surgeries in Monterrey.
  2. Identify the type of wound. For minor wounds with bleeding, wash with soap and water and cover with a sterile gauze.
  3. Once bleeding stops, apply an ice pack to reduce pain and swelling.
  4. If swelling or pain persists, seek medical attention.
  5. For deep cuts or excessive bleeding, seek immediate medical attention. I’m Dr. Emmanuel Ruiz, hand specialist, and I can provide the most appropriate treatment for your injury.
  6. If there’s suspicion of a fracture, immobilize and call emergencies. Do not attempt to straighten it.
  7. In case of amputation, stay calm, raise the hand, and apply pressure to stop bleeding. Place the amputated finger in a cool environment without direct ice contact.

8. You can contact me immediately for quality medical care and suitable treatment for your injuries, including the possibility of finger surgery in the hospitals I serve in Monterrey.