These days, our fingers seem to be constantly typing on cell phones, tablets, laptops, desktops, video games and a host of other electronic devices. Many patients complain that they are “working the fingers to the bone.” They’re learning, the hard way, about tendinitis and carpal tunnel syndrome.
The joints are set in motion by muscles; muscles are fastened to the bones by tough, white, rope-like tendons. The tendons of my hands had to glide smoothly along the palms and fingers several hundred times as I typed this short article. Demands for speed and increasing workload can overtax the system, leading to painful inflammation.
The pain of tendinitis can feel like arthritis. It is achy and widespread. Patients find it hard to describe exactly where it hurts. The tendons of the hands passed through a tight canal in the wrist known as the carpal tunnel. Sharing this tunnel is the median nerve. When the inflamed tendon swell, pressure on the nerve can cause numbness in the thumb, index, middle and part of the ring finger.
Treatment starts with understanding the cause of the problem. I ask about needlepoint, gardening, musicianship, video games and other activities requiring repetitive hand and finger movements. Diagnostic ultrasound is often very helpful, as the tendons can be directly visualized while stationary and during painful movements. No x-ray is required for this painless technique.
Rest and anti-inflammatory medication are often helpful. Avoiding overuse is essential. Occupational therapy is often very helpful, providing splinting, ultrasound treatment, moist heat and other modalities, as well as helpful advice on protecting the hands from further trauma. In severe cases, tendon sheaths or the carpal tunnel may be injected with cortisone under ultrasound guidance. This allows for precise placement of the injection and improves her results. In severe cases of carpal tunnel syndrome, surgery may be needed to release pressure on the trap nerve.
The best treatment, of course, is prevention. Rest and moderation of the best medical advice in the fast-paced 21st century.
Here are some suggested references for more information on this topic:
Alan R. Schenk, M.D. FACP