Ask Dr. Zhao: Understanding tendon disease
By Pei-Shan Zhao
Q: Reader Mrs. Lee has a friend who suffered a swollen wrist, a bent middle finger and hand swelling. An orthopedic specialist diagnosed her with:
1. Trigger finger (recommended surgery)
2. Ganglion cysts
3. DeQuervain’s tendonitis or tenosynovitis
Mrs. Lee has never heard of these conditions and wonders if she can get a second opinion for her friend. What happens if she does not get surgery? Are there specialists in Chinatown who can treat her?
A: After consulting with hand surgery expert Jennifer Hoffman, MD, your friend’s diagnoses are probably right.
Although you have never heard of these conditions, they occur often. People of all ages get them, but they are more common in women than men. The diagnosis is often made by complaints from the patient and exams by the doctor. Occasionally, the doctor asks for X-rays to look for problems in adjacent joints, such as arthritis (joint inflammation). Doctors are not sure what causes these diseases, but the good thing is they are not cancerous and will not spread to other areas.
Ganglion cysts are lumps in the hand and wrist, occurring close to joints or tendons. The most common locations are front (palm) side and back side of the wrist. It is like a water balloon filled with clear fluid or gel.
Ganglion cysts differ in size, and they may or may not be painful. If the patient does not feel pain, one can see how it goes. Sometimes, the cyst goes away itself.
If the cyst is painful, splints can limit movement of the joint and ease the pain. Patients can also take over the counter medicines like Tylenol, aspirin or ibuprofen. Aspiration of the fluid from the cyst can be done in a doctor’s office. Release of pressure within the cyst may ease the pain, but the cyst often comes back. If nonsurgical treatment does not provide pain relief or if the cyst occurs again, surgery can be done.
Trigger finger or trigger thumb, also known as Stenosing tenosynovitis and De Quervain’s tendonitis, are tendon diseases. Tendons are the ropes that connect the muscle to the bone. Pulleys are a series of rings that form a tunnel through which the tendons slide. In the finger, these pulleys hold the tendons close against the bone. The tendons and the tunnel have a slick lining that allows easy movement of the tendon through the pulleys. When the tunnel becomes narrow, the tendon feels “sticky” and the finger begins to trigger or lock when it bends. So, the “trigger finger” involves the pulleys and tendons that bend the fingers. The area of trigger finger is often tender to local pressure. A small lump sometimes also exists in this area.
Patients with De Quervain’s tendonitis have painful tendons on the thumb side of the wrist because the tunnel where the tendons run becomes narrower than normal. Movement of the hand and thumb causes pain, especially when one grasps something.
Because movement of the hand, finger or thumb results in pain, doctors often use a splint to stop you from moving your finger, thumb and wrist to ease the pain. In the meantime, patients can take nonsteroid anti-inflammation drugs also. Cortisone (a type of steroid) injections into the tendon compartment are helpful for relieving pain and triggering. Whether the patient’s symptoms get better varies. Sometimes repeat injections are necessary to fully improve the symptoms. If rest, medication and steroid injections do not work, surgery is needed to open the tunnel and make more room for the tendons.
These surgeries often are done in a day surgery center under local anesthesia and patients can go home shortly after the surgery. Whether your friend needs surgery depends on her symptoms and what treatment she had before. We have excellent hand surgeons and anesthesia teams at Tufts Medical Center in Chinatown. Your friend can see Dr. Hoffman by calling her office at (617) 636-5155.
Pei-Shan Zhao is an attending anesthesiologist and director of the Asian Community Outreach Program in the department of anesthesiology, Tufts Medical Center. He is a graduate of Peking University’s School of Medicine, and trained at Peking University and Caritas St. Elizabeth’s Medical Center in Boston.
This post is also available in: Chinese