TRIGGER FINGER
Trigger finger is a condition that involves one of the fingers or thumb becoming stuck in a bent position and then rapidly straightened like the trigger of a gun. This condition is caused by a narrowing of the sheath that surrounds the tendons in the finger, and is common in people who perform repetitive gripping actions but can occur in anyone. Trigger finger causes stiffness, pain and may eventually lead to an inability to completely straighten the finger. When you try to straighten your finger, it will lock or catch before popping out straight.
Causes
Trigger fingers are more common with certain medical conditions such as rheumatoid arthritis, gout and diabetes. Repeated and strong gripping may lead to the condition. In most cases, the cause of the trigger finger is not known. Trigger fingers are more common in women than men. They occur most frequently in people who are between the ages of 40 and 60 years of age.
Symptoms

Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use.  Signs and symptoms of trigger finger may progress from mild to severe and include:

  • Tenderness or a bump (nodule) in the palm at the base of the affected finger
  • Swelling
  • Catching or popping sensation in your finger or thumb joints
  • Pain when bending or straightening your finger
  • Finger catching or locking in a bent position, which suddenly pops straight
  • Finger locked in a bent position, which you are unable to straighten
Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning. Your fingers will often loosen up as you move them.

Sometimes, when the tendon breaks free, it may feel like your finger joint is dislocating. In severe cases of trigger finger, the finger cannot be straightened, even with help. Sometimes, one or more fingers are affected.

Treatment
Mild cases of trigger finger can often be treated through conservative home methods such as rest, finger exercises and avoiding repetitive movements. More severe cases may need an injection of a corticosteroid — a powerful anti-inflammatory medication — into the tendon sheath. In some cases, this improves the problem only temporarily, and another injection is needed. If two injections fail to resolve the problem, surgery should be considered.

If the condition does not respond to conservative treatments, surgery may be recommended to release the sheath that restricts the movement of the tendon. This outpatient procedure can be done with numbing the arm and is done with a very small incision. The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. The clicking or popping goes away first. Finger motion can return quickly, or there can be some stiffness after surgery. Hand therapy is recommended after surgery to regain better use of your hand. Light activities with the hand are permitted right away and the use can be advanced as tolerated.

Ganglions

Ganglions are fluid-filled cysts commonly found on the tendons and joints of the wrists, hands and feet. Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands.   These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment but some cysts may put pressure on nearby nerves, potentially causing pain, weakness or numbness.   If the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available.

Treatment is based on the degree of the symptoms. Ganglions can be treated by aspiration or surgical removal, depending on the size and severity of the cyst.

Causes
The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They grow out of a joint or the lining of a tendon, looking like a tiny water balloon on a stalk, and occur when the tissue that surrounds a joint or a tendon bulges out of place. Inside the cyst is a thick lubricating fluid similar to that found in joints or around tendons. These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts can occur in all ages and are not cancerous and will not spread to other areas.
Symptoms
Ganglion cysts most commonly develop along the tendons or joints of your wrists or hands. The next most common locations are the ankles and feet. These cysts can occur near other joints as well. The diagnosis is usually based on the location of the lump and its appearance. They are usually oval or round and may be soft or very firm. Cysts at the base of the finger on the palm side are typically very firm, pea sized nodules that are tender to applied pressure, such as when gripping. Ganglion cysts are round or oval and usually measure less than an inch (2.5 centimeters) in diameter. Some are so small that they can’t be felt. The size of a cyst can fluctuate, often getting larger when you use that joint for repetitive motions.
Aspiration

This minimally invasive procedure involves draining the fluid from the cyst with a syringe, and may be combined with a steroid injection to help fully heal the area. This treatment is not always permanent and many ganglions return after aspiration.  Aspiration frequently fails to eliminate the ganglion because the “root” or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not removed. In many cases, the ganglion cyst returns after an aspiration procedure.

Surgery

Surgery may be recommended for cysts that are painful or interfere with joint movement. Ganglion surgery is performed under a regional anesthetic and involves complete removal of the cyst and any attached tissue to ensure permanent treatment.  By removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion, the likelihood of it returning is decreased. Even after successful surgery, there is a small chance the ganglion will return.

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