Carpal Tunnel Syndrome 

Hand/Wrist Tendonitis and Trigger Finger

Hand/wrist tendonitis is a condition caused by using the hands in ways that are forceful or repetitive, or by putting the hands in awkward postures (postures in extreme joint positions). In general terms, tendonitis is an inflammation of the tendons, which are the fibers that attach muscles to bones. Since many muscles and tendons are used to control the hand and wrist, there are several types of tendonitis that are grouped together and labeled as 'hand/wrist tendonitis.' All of these conditions are characterized by pain, swelling, warmth, redness, or discomfort of the fingers, hand or distal forearm. These disorders include deQuervain's syndrome (thumb tendonitis), and tendonitis of the extensors and flexors of the forearm, wrist, and fingers.Trigger finger is another condition in the hand that involves the tendons.

Work-Related Risk Factors

• forceful hand use
• repetitive hand use
• awkward postures during hand use (postures in extreme joint positions)
• sharp tool handle edges

Double jointedness (hyperlaxity) of the wrist, thumb, or fingers is a risk factor for tendonitis near the double joint.

Specific areas of tendonitis may be traced back to specific activities that use the affected muscle or tendon.For example:

• Work involving repetitive hand motion with frequent thumb extension, or extreme lateral wrist movements is risk factor for deQuervain's syndrome (thumb tendonitis).
• Repetitive wrist flexion against resistance is a risk factor for tendonitis of the wrist flexor tendons.

Wrist flexor or extensor tendonitis is more likely to occur when workers are not accustomed to doing a task that involves force, repetition, or awkward postures.

Development and Progression

Tendonitis is an inflammatory condition. This inflammation can then lead to small tears in the tendon. The group of disorders referred to commonly as hand or wrist tendonitis may actually be one of four different types of tendonitis: paratendonitis (tenosynovitis), tendonosis, tendonitis, or peritendonitis crepitans.Paratendonitis is inflammation of the paratenon layer that is between the tendon and its sheath.Tendonosis is a degeneration of the tendon fibers that may also be characterized by an increase in blood supply, some cell death, or hardening of tissues due to calcium deposits.Tendonitis can range from a tendon strain due to inflammation, to degeneration or even tears in the tendon.Lastly, peritendonitis crepitans is when the musculotendinous junctions become inflamed.

The muscles that bend the fingers are connected to the bone with tendons.These tendons slide through a narrow tunnel.When the tunnel opening becomes irritated and narrows, or the tendon itself becomes inflamed, the tendons can become stuck in the tendon.When this happens, people may not be able to straighten the finger, appropriately called "trigger finger."

In some people these conditions may become chronic and limit life and work activities.

Common Symptoms

Individuals with hand/wrist tendonitis have pain, swelling, warmth, redness, or discomfort of the hand or forearm.Individuals with de Quervain's syndrome have pain during thumb movement due to tendon irritation at the thumb.

Trigger finger is a condition in which the finger makes a snapping sound when the person tries to straighten it.The finger may become locked in a flexed position and the clicking sound can be alarming, but the condition is not usually very painful.

Common Treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs, e.g. ibuprofen or naproxen) are often helpful.Other treatments include rest, occupational or physical therapy, ice or heat applications.Injections of corticosteroids ("cortisone injections") may be beneficial in the short term.Stretching and strengthening exercises for the hand and wrist are recommended after the pain improves.Work should be modified to limit intense hand and wrist activity.Recovery can be a slow process taking from six months up to two years.

In extreme cases of trigger finger, surgery may be required to release the tendon that became stuck in a flexed position.Trigger finger is not very common.

Carpal Tunnel Syndrome

Work-Related Risk Factors

• Forceful exertions of the wrist and hand
• Highly repetitive activities of the wrist and hand
• Prolonged use of vibrating tools
• Awkward postures of the wrist

Age, body mass index (BMI; a measurement of the relation between body weight and height), and gender are also risk factors for carpal tunnel syndrome.Individuals who are older, obese, or female may be at greater risk of developing the condition.

Development and Progression

The carpal tunnel is in the wrist, bordered by the carpal bones on the back of the wrist and the transverse carpal ligament on the palm side of the wrist.Tendons that flex (bend) the fingers go through the carpal tunnel, along with the median nerve.The median nerve provides nerve supply to the skin over the palm side of the thumb, index finger, middle finger, and part of the ring finger.The median nerve also connects toseveral muscles that move the thumb and part of the fingers.Anything that increases pressure in the carpal tunnel can reduce the function of the median nerve as it passes through the carpal tunnel.Increased pressure in the carpal tunnel can occur from the previously mentioned risk factors.Additionally, trauma, such as a wrist fracture, can increase pressure in the carpal tunnel.Nerve conduction studies are often used to determine if the median nerve function is reduced.

Common Symptoms

Individuals with carpal tunnel syndrome have numbness and tingling (and occasionally pain) over the palm side of the thumb, index finger, middle finger, and occasionally the ring finger. Symptoms are often worse at night and may wake the person at night. Symptoms may be worse if the wrist is held in extreme flexion or extension.

Common Treatment

Conservative treatment for carpal tunnel syndrome includes resting splints and nonsteroidal anti-inflammatory drugs (NSAIDs, e.g. ibuprofen or naproxen).  Injections of corticosteroids ("cortisone injections") may be beneficial in the short term.  Stretching and strengthening exercises for the elbow and wrist are recommended after initial symptoms improve. Work activities should be modified to minimize extreme positions of the wrist.

When median nerve function is reduced and symptoms are severe, surgery is often needed to release the pressure in the carpal tunnel.  In severe cases of carpal tunnel syndrome, loss of hand function may be permanent. 

Carpal tunnel syndrome is compression of the median nerve within the carpal tunnel of the wrist.The condition is characterized by numbness and tingling in the palm side of the thumb, index finger, and middle finger.