Background & Etiology
A tendon is part of the muscle that attaches muscle to bone. It is a strong, fibrous tissue that is responsible for transferring the forces generated by the muscle to the bone, thus producing movement at the joint. When a tendon becomes irritated or inflamed it becomes painful, especially with movement. Inflammation of the tendon is called tendinitis.
Tendinitis in the fingers occurs when the tendons in the forearm that pass through the wrist joint and into the hand, become inflamed. Tendons in the fingers include the extensor tendons on the top of the hand that straighten the fingers, and the flexor tendons on the palm side of the hand that bend the fingers.
Tendinitis is most often caused by an overuse repetitive strain injury (RSI). Other high risk activities or conditions that can lead to the development of finger tendinitis include:
- Participating in athletic activities that can strain the fingers and hand, like tennis.
- Repetitive strain injuries (RSI) at work occur in people who have jobs that require performing activities of a repetitive nature, like working an assembly line
- Sudden trauma or an accident like a fall where an individual puts their hands down to catch themselves, putting pressure on their fingers.
- Patients with rheumatoid arthritis may be susceptible to tendinitis
- Finger pain or tenderness directly over the tendon that can radiate to the hand or forearm
- Pain or burning sensation during activities
- Difficulty dressing and performing activities of daily living
- Weakness may occur as the inflammation gets worse
- Feeling of tightness or loss of motion due to discomfort
- Swelling of the tendon
If an individual suspects they have tendinitis, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, splinting, ice, hand therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the tendon irritation.
Hand Therapy Interventions
Hand Therapists are occupational therapists or physical therapists who, through advanced study and experience, specialize in treating individuals with conditions affecting the hands and upper extremity. A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT). A qualified hand therapist is educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Finger Tendinitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a hand therapist to regain mobility and range of motion of the finger and tendons.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the fingers.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve movement technique and mechanics in daily use of the involved upper extremity.
- Evaluating splinting needs with possible fabrication of custom splint and instructions in wearing and precautions.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the finger and tendons
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- Splinting as appropriate
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct underlying pathology or the cause of the tendinitis
Most people recover full function following a course of conservative care that includes physical therapy, to strengthen and stabilize the fingers.