Finger / Thumb Tendons

The issues described below are the most common, although, in theory, a tendon injury could occur anywhere in the fingers or thumb. There is much that can be done to help the hand and our specialist knowledge is the best place to start. There 29 major and minor bones in the hand, 29 major joints, over 123 named ligaments, and 34 muscles which move the fingers and thumb. Lots to look at!

 

  • Thumb Extensor (EPL) Tendon Rupture

    This is the long tendon that runs over the bony prominence over the back of the wrist and its job is to straighten the end joint of the thumb or help bring the thumb towards the index finger. Due to where it sits in the hand/wrist it is vulnerable to rupture if you fracture your wrist or have Rheumatoid Arthritis and have a lot of inflammation around the tendon area.

    You will sometimes, but not always, feel pain and you will have an inability to straighten the end joint of the thumb easily or lift the thumb up when the hand is placed flat on a table.

    You may be required to have X-rays or scans to confirm the rupture.

    Sometimes this does not require treatment at all and patients are able to use their hand relatively normally but sometimes a surgical repair will be required.

  • Mallet Finger

    This is an injury where the tendon that extends the tip of the finger is torn. This can often be caused by catching the end of the finger during sport, but occasionally household tasks such as catching the finger tucking in bed sheets can cause it.

    When the tendon tears, in some cases it can pull off a small fragment of bone too (which we call a mallet avulsion fracture).

    The symptoms are pain and swelling over the end of the finger and the inability to straighten the end joint of the finger under your own power so it always lies in a bent position.

    The treatment is splinting the finger in a straight position for 6 to 8 weeks (continuously- do not let that finger bend at all during this time) to allow the tendon to heal. Some of the severe cases of this may result in surgery.

  • Boutonniere Injuries

    This is when the middle (or PIP) joint is bent down while the end (or DIP) joint is bent back. This is most common in the index finger.
    The most common cause of this is stubbing the finger causing an injury to the back of the PIP joint (called the central slip) or arthritis. It can also happen if a cut occurs to the central slip.
    With these injuries, you often feel pain and swelling in the PIP joint and have an inability to actively straighten the middle joint or bend the end joint.
    An X-Ray is suggested to check for fractures and that the joint is in the correct alignment, sometimes an ultrasound may be needed too to see exactly what soft tissues are damaged.
    It is worth bearing in mind that this deformity may not show for several days, or even weeks after the injury, so can often be confused with the more common sprains to the ligaments of the middle finger.
    Splinting is usually the suggested treatment for stubbing-type injuries to hold the middle finger straight whilst it heals for between 4 and 8 weeks. If the injury is caused by a cut or does not respond well to the splinting, it can require a surgical repair. You will also require hand or physiotherapy after either treatment as it can take months to restore full function.

  • Flexor Tendons

    These are a series of strong chord-like structures that run between the forearm and the fingers and thumb on the palm side. Their job is to flex the wrist and fingers/thumbs.
    These usually become damaged by a cut(or a bite!) across the palm side of the fingers/hand/wrist. Occasionally they can be damaged by a violent pulling to a finger.
    They will usually present with a cut/wound on the palm side of the hand/fingers with an inability to bend the finger/fingers either partially or totally with pain, and the injured finger/fingers will usually lie a lot straighter than the uninjured fingers.
    These can be treated with a surgical repair but will require involved splinting and therapy after the surgery to protect the repair, usually for 6 weeks, and regain the strength and movement afterwards.

  • Extensor Tendons

    These are the strong flattish chords that run from the forearm to the bones in the fingers and thumb on the back of the hand and their job is to straighten the wrist/thumb/fingers. These usually become damaged by a cut (or a bite!) across the back side of the fingers/hand/wrist. Some of these can also be caused by stubbing type injuries the finger, most often at the end or middle finger joints.

    Some of the more common extensor tendon injuries to the fingers and thumb do not have an open wound but are closed, and are described as Mallet/Boutonniere/EPL)

    They will usually present with a cut/wound on the back of the hand/fingers with an inability to straighten the finger/fingers with pain, and the injured finger/fingers will usually lie dropped compared to the uninjured fingers.

    These open injuries can be treated with a surgical repair but will require involved splinting and therapy after the surgery to protect the repair, usually for 6 weeks, and regain the strength and movement afterwards which can sometimes take up to 6 months.

    If these are only partially cut or torn, or closed injuries they can often be managed with therapy and splinting.

  • Trigger Fingers

    This is a relatively common issue which can affect one or more of the tendons in the thumb or fingers. It is where the tendon becomes inflamed and swollen so it catches in the sheath (a tunnel that holds it flat to the palm). This can, therefore, make it difficult to move the affected finger resulting in a clicking sensation. If the condition gets worse sometimes the finger may get stuck in a bent position then suddenly “pop” straight again. Occasionally it may stop bending or straightening if the swollen area becomes too big to fit through the tunnel. You will often have pain at the base of the affected finger when you press on it or move it.

    In some people, this problem resolves on its own with rest (and anti-inflammatories if safe to do so). Sometimes, to allow it to rest, a splint can be made to help. It can also be helped with a corticosteroid injection or in cases where all this has failed; surgery.

  • De Quervains

    This is a condition where the tendon and/or tendon sheath becomes inflamed on the thumb side of the wrist. It causes pain which is made worse by lifting the thumb or picking up an object or even using scissors. Gardening, working or sport can aggravate it too. You will also experience pain on pressing the irritated site and sometimes swelling. Occasionally you may get clicking at the tendons.

    There are often no specific causes to this problem, it is often common in mothers to young babies (this is not known whether to have a hormonal element or to a change in activities after birth), but often, it just starts on its own.

    In some people, this problem resolves on its own with rest (and anti-inflammatories if safe to do so). Splinting can also be effective to help immobilise the thumb and wrist, these can either be custom make or bought in a chemist or sports shop. We have some in stock here. It can also be helped with a corticosteroid injection or in cases where all this has failed – surgery.