Pain in the hands can be difficult, especially if you work with your hands in any way. People often attribute this pain to both trigger finger and carpal tunnel syndrome, but not everyone understands the difference between the two. While both conditions affect the hands, they can manifest in different parts of the hand and up the arms, with different symptoms and severities.
About the Hand and Wrist
The wrist is formed where the two bones of the forearm (the radius and the ulna) meet at the carpus. Rather than a single joint, the wrist is composed of multiple joints where the arm bones and the hand meet, allowing movement in all directions.
Small eight bones form the carpus, collectively called the carpal bones. These bones are grouped, with half of them at the upper end of the wrist and half on the lower side of the hand. Other bones in the hand include the metacarpals, which compose the middle part of the hand. The finger bones are known as the phalanges, including 14 narrow bones in total.
These bones are held in place by a series of tendons and ligaments. Between the wrist and the hand is a passageway known as the carpal tunnel, which allows the median nerve to pass through and provide sensation in the thumb, index finger, middle finger, and thumb, and one side of the ring finger.
Tendons are also found in the fingers. Flexor tendons are long, cord-like structures that attach the muscles of the forearm and the bones of the fingers. When these muscles are contracted, the flexor tendons allow the fingers to bed. Each of these tendons passes through a tunnel in the palm that lets it glide smoothly, called the tendon sheath.
Under the tendon sheath are bands of tissue called “pulleys” that hold the flexor tendons closely to the finger bones. As a finger moves, the tendons pass through the pulleys.
Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the carpal tunnel becomes narrow or the tissue surrounding flexor tendons swells, placing pressure on the median nerve and reducing its blood supply. This abnormal pressure on the median nerve can cause numbness, tingling, pain, and weakness in the hand.
Most carpal tunnel is caused by repetitive hand and wrist use over a prolonged period of time. This can include typing, playing sports, or even driving in certain positions that cause swelling. Activities that involve extreme flexion or extension of the hand and wrist can also increase pressure on the nerve.
Women and older people are the most likely to suffer from carpal tunnel syndrome, though other factors influence this. Some people may have a naturally smaller carpal tunnel or other inherited differences that change their anatomy. Pregnancy and conditions like diabetes, rheumatoid arthritis, and thyroid gland imbalances can also be associated with the condition.
Signs of Carpal Tunnel Syndrome
The most prevalent symptoms of carpal tunnel are numbness, tingling, burning, and pain. This primarily shows up in the thumb, index finger, middle finger, and ring finger and can wake people up in the middle of the night.
Other common symptoms may include:
- Occasional shock-like sensations that radiate down the thumb and index, middle, or ring fingers
- Pain and tingling that may travel up the forearm and toward the shoulder
- Weakness or clumsiness in the hand, which may make it more difficult to perform fine motor motions like buttoning clothing
- Consistently dropping things due to weakness, numbness, or a loss of spatial awareness in the hand
Most of these symptoms begin gradually, without a specific injury, and may come and go at first. As the condition worsens, it can become more persistent and more frequent. Many people report nighttime symptoms because of the position of their wrists during sleep, and that moving or shaking their hand relieves symptoms.
Diagnosing Carpal Tunnel
If you present with signs of carpal tunnel syndrome, a doctor will first talk with you about your general health and medical history, as well as what you are experiencing. Carpal tunnel can usually be diagnosed based on symptoms and a series of small physical tests like:
- Pressing down or tapping along the median nerve on the palm side of your wrist and hand to see if it causes tingling in your fingers. This is known as Tinel’s sign.
- Bending and holding your wrists in a flexed position to test for numbness or tingling in the hands.
- Testing sensitivity in your fingertips and hands by lightly touching them with a special instrument while your eyes are closed.
- Checking for weakness in the muscles around the base of your thumb.
- Looking for atrophy in the muscles around the base of your thumb. Severe cases may mean the muscles become visibly smaller.
The doctor may also order a series of tests, including electrophysiological testing of the nerves to measure how well the median nerve is functioning. This can help determine the severity of your condition, whether the nerve is compressed elsewhere, if other nerves are compressed, and whether you have a medical condition like neuropathy that may be contributing. The most common tests are an electromyogram (EMG) that measures the electrical activity in the muscles to show any nerve or muscle damage. Nerve conduction studies can also be used to measure the signals in the hand and arm to detect where they are not being conducted effectively.
Ultrasounds, x-rays, and MRIs may also be used for diagnostic purposes and to rule out other injuries causing your symptoms.
Treatment for Carpal Tunnel Syndrome
Non-surgical treatment options include:
- Bracing or splinting. A brace or a splint can be used at night to keep you from bending your wrist while you sleep. By keeping the wrist in a straight or neutral position, you can reduce pressure on the nerve in the carpal tunnel. A brace can also be used during the day when doing activities that may worsen symptoms.
- NSAIDs. Non-steroidal anti-inflammatory drugs include over-the-counter medications like ibuprofen and naproxen. In addition to addressing pain, these medications also reduce inflammation, which can lessen pressure on the nerve.
- Activity changes. If you notice certain movements and activities aggravate your symptoms, changing or modifying them can help. This may include making your workstation more ergonomic or avoiding certain sports altogether.
- Nerve gliding exercises. Exercises can help the median nerve move more freely within the carpal tunnel.
- Steroid injections. When steroids are injected into the carpal tunnel, they can relieve symptoms or calm flare-ups of the syndrome.
When these treatments fail to work, it is common for surgery to be considered as a treatment option. This is typically the best route in cases of long-standing numbness and wasting of the thumb muscle. The surgical procedure is called a carpal tunnel release, which aims to relieve pressure on the median nerve by cutting the ligament that forms the roof of the tunnel. The release of this ligament can increase the size of the tunnel and decrease pressure, returning blood flow and function to the nerve.
Carpal tunnel releases are typically done on an outpatient basis and may use an open incision or an endoscopic approach depending on your case.
After any treatment, you will likely work with a physical therapist to regain strength and motion in the hand and develop a strategy to avoid similar issues in the future.
Trigger Finger
When a patient has trigger finger, the A1 pulley at the base of the finger is inflamed or thickened, which makes it harder for the flexor tendon to glide through it when the finger is bent. Over time, the flexor tendon can also become inflamed and develop a small nodule on its surface. When the finger is moved and the nodule passes through the pulley, it may create a sensation of catching or popping, which can be painful. More severe cases can cause the finger to lock and become stuck in a bent position.
The exact causes of trigger finger are not well known, but it can be related to forceful movements of the fingers and thumb. The condition is also more common in people with certain medical conditions like diabetes and rheumatoid arthritis.
Symptoms of trigger finger usually begin without a specific injury but may follow a period of heavy or extensive hand use, especially pinching and grasping. These symptoms include:
- A catching, popping, or locking sensation during finger movement
- A tender lump at the base of the finger on the palm side of the hand
- Pain when straightening or bending fingers
Stiffness and locking usually worsen after inactivity, like upon waking up in the morning. Severe cases can end with the finger stuck in a bent position, requiring another person or your other hand to return to normal.
Diagnosing Trigger Finger
A trigger finger can usually be diagnosed when your doctor talks to you about your symptoms and examines your hand. Imaging scans are not usually needed. Instead, your doctor will look for:
- Tenderness over the flexor tendon sheath in the palm of your hand Thickening or swelling of the tendon sheath
- Triggering when you bend or straighten the finger
Treatment for Trigger Finger
Initial treatment for trigger finger does not usually require surgery. Instead, you may be advised to:
- Rest. Avoid activities that worsen your symptoms, and rest your hand as much as possible.
- Splint. Wearing a splint at night can keep the impacted thumb or finger in a straight position and prevent it from locking up.
- Do exercises. Gentle stretching exercises can decrease stiffness and improve the range of motion in the finger.
- Take medications. Over-the-counter medications and NSAIDs are useful for relieving pain and inflammation.
- Use steroid injections. Anti-inflammatory medication can be injected into the tendon sheath at the base of the trigger finger in order to resolve the triggering.
If the finger does not improve with non-surgical treatment, elective surgery may be presented by your doctor as an option. The decision will usually be based on how much pain or loss of function you are experiencing, but if your finger or thumb is stuck in a flexed or bent position, it may be recommended more highly.
The surgical procedure to address trigger finger is called tenolysis or a trigger finger release. The procedure’s goal is to release the A1 pulley that is blocking tendon movement to allow the flexor tendon to glide more easily through the tendon sheath. This is typically an outpatient procedure done using a local anesthetic, and it can be done through an open incision or a small needle. The A1 pulley is then divided so that the flexor tendon can glide freely.
You should be able to move your finger immediately after surgery and may be given simple exercises to perform at home to increase your range of motion.
Addressing Carpal Tunnel and Trigger Finger
When it comes to hand pain, many people struggle to overcome symptoms due to how often our hands are used daily. It is important to find a provider who works with you on future strategies to avoid issues alongside resolving current symptoms and addressing their root cause. At AICA Orthopedics, our team works to understand your goals and needs, then develop a comprehensive treatment plan designed especially for you. Our staff includes orthopedic doctors, chiropractors, physical therapists, pain management specialists, and neurologists who will work together to address your concerns holistically. We even have on-site diagnostic imaging to cut down on your time going between facilities and waiting for results. If you are ready to find solutions for your hand pain and work towards pain-free movement, contact AICA Orthopedics today.
