It’s No Fish Tale – These Uncommon Hand & Upper Extremity Fishing Injuries Can Really Happen!

Located on the Gulf of Mexico and home to hundreds of lakes, it’s no wonder that the Texas coast is the playground to fishing enthusiasts far and wide.

Barracuda

unhook stingray2But even the seasoned sportsman can fall victim to some unlikely fishing injuries affecting the hand and upper extremity. In fact, fishermen (and women) put themselves in danger every time they come into contact with marine life – unpredictable behavior/aggressive and often forceful nature of a catch, prevalence of less commonly treated bacteria, unsanitary tools/equipment, poor wound care – all contributing to some common and not so common injuries that hand specialists see in a region like the Texas Gulf Coast.

Some common fishing injuries and conditions with which a Texas hand surgeon is all too familiar include:

fillet_2Many of these common injuries and conditions are treated non surgically and follow the same treatment protocol as any other patient with the same diagnosis – regardless of the cause.

Uncommon Hand & Upper Extremity Fishing Injuries and Conditions

Though there is very little that surprises a hand specialist practicing in “sportsman’s paradise,” an unusual injury associated with fishing will occasionally make its way to a Texas medical clinic.

Some of these uncommon injuries and conditions include:

  • Sting Ray Laceration
  • Fish Bite / Impalement
  • Fish Handler’s Disease / Bacterial Infection
  • Lodged Fish Bones, Fin Spine 

Unlike other injuries that break the skin, these types of fishing injuries are particularly concerning.  Fish and other marine life carry bacterial infections within their bodies, as well as on their skin, which can affect humans if certain precautions are not taken immediately. Some types of bacteria found in marine life are not commonly seen and do not respond to conventional antibiotics frequently used for infections.

Additionally, some marine life such as the Sting Ray utilize defense mechanisms that require special attention when used against a fisherman.

Sting Ray Laceration
While many sting ray injuries involve an inadvertent encounter between a foot or other lower extremity and a sting ray’s barb, some have occurred to the hand or wrist while trying to remove a sting ray from a fishing net or line.

These types of lacerations require more than bandaging.  Not only do sting ray barbs pierce like a weapon, all sting rays are armed with at least one serrated venomous spine at the base of their whip-like tail.  Short-tail sting rays have two tail spines: a slender spike in front of a large, jagged bayonet (1).

In addition to possible damage to muscle, tendons and nerves that can occur from the physical impalement of a sting ray barb, its venom is comprised of many different substances that can cause tissue to break down and die.
Some of the symptoms that Sting Ray venom can cause include:

 

  • Immediate and severe pain radiating up the affected limb
  • Bleeding and swelling in the affected area
  • Sweating
  • Faintness, dizziness and weakness
  • Low blood pressure
  • Salivation, nausea, vomiting, diarrhea
  • Headache
  • Shortness of breath (2)

 

Medical attention is recommended for all sting ray injuries.  Minimally, the wound will be cleaned with warm water to remove the venom and a tetanus booster given if it has been more than five years since the last tetanus booster. Tetanus prevention is required if the patient has never had a tetanus vaccination.  Antibiotics may also be required, and depending on the severity of the injury and amount of damage sustained (often the result of the delay in seeking treatment), surgical intervention to repair soft tissue damage and/or a period of rehabilitation may be required to restore strength to the injured limb (2).

Fish Bite and Impalement
While not every fish injury comes with a venomous double blow, the high risk of bacterial infection and soft tissue damage can be just as serious.  Many fish have sharp teeth, tails and pointed features that can easily break the skin.  Wrestling the unwilling catch onto the boat or beach can leave some sportsmen a bit worse for the wear.

 

Aside from the bacterial concerns that come with marine life, the forceful impact from a sharp feature of the fish can result in soft tissue damage that may require surgical repair and/or months of rehabilitation to restore hand and upper extremity function – as the hand alone is comprised of approximately 34 muscles, 120 known ligaments, and 50 nerves!

 

These types of deep puncture wounds or lacerations in the hand are also at high risk of infection and should be monitored closely.  A delay in the appropriate treatment can lead to complicated tenosynovitis and horseshoe abscess.  Additionally, marine life bacterial infections resulting from Mycobacterium marinum (M. marinum) do not respond to some conventional antibiotic treatment such as amoxicillin (3).

Fish Handler’s Disease
Not every fishing-related Mycobacterium marinum infection is the result of an obvious injury/wound.  A condition known as Fish Handler’s Disease can impact those frequently handling fish and generally affects the hands.  Any inconspicuous cut or small opening on the skin can allow the bacteria to enter the body.  The bacteria’s inability to proliferate in the warm body confines it to the affected area.

 

Common symptoms include swelling, tenderness, and bluish-purple spots. Fish Handler’s Disease is treated with special antibiotics used specifically for this type of bacterial infection.  Recovery can take months.

Lodged Fish Bones, Fin Spine
Occasionally in the handling of fish a fish bone or fin spine can lodge in the hand. Though this may not be painful or immediately worrisome to the injured party, these types of injuries are concerning.  Such injuries often leave residual fragments of foreign organic matter in the soft tissue, which can cause secondary infections such as Staphylococci and Streptococci (4).

 

Typically, x-rays are used first to try and identify a foreign body in the tissue, though are not always successful in doing so.  An MRI may be indicated to identify fine fin spines and tiny bones lodged in the body’s tissue. The surgical removal of the foreign body is important.  Failure to seek and remove the foreign body may lead to persistence of infection (4). Multiple surgical procedures may be required, and the patient is put on antibiotics to prevent infection. Physical therapy may be required after surgery to regain mobility of the hand.

 

If this type of injury goes untreated it can result in permanent disability and hospitalization for infection. Though the area may look as if it has healed, but is still tender, swollen, discolored, or abnormal in any way, individuals are urged to see a hand specialist.

 

Prevention and Precaution
Understanding the unique aspects of the marine life occupying the waters you’re sporting and utilizing protective gloves and garments while fishing can go a long way in injury prevention.  As the largest organ of the human body, our skin serves as a protective barrier.  When any area is compromised, our entire body is compromised. Individuals with other health conditions, such as diabetes or immune deficiency disorders should be particularly cautious and consult a hand specialist for proper wound care.

If not addressed properly, even seemingly minor fishing injuries can result in serious infection, lingering weakness or permanent disability – inhibiting participation in the sport you love.

 

References

 

How Your “Musculoskeletal Mindset” Can Impact Injury Risk at Work

While the study of orthopedics has traditionally placed emphasis on the physical influencers impacting our bones, tendons, ligaments and other surrounding soft tissue comprising the musculoskeletal system, new research now spotlights the increasingly important role of workplace “psychosocial” factors on musculoskeletal disorders (MSD).Tired man being overloaded at work

According to the Canadian Centre for Occupational Health and Safety (CCOHS), a workplace psychosocial factor is defined as “a non-physical aspect of the workplace that is developed by the culture, policies, expectations and social attitude of the organization.” [1]

Basically, psychosocial factors umbrella the different emotional responses to the demands placed on workers while performing their job –  including frustration, dissatisfaction, depression and despair. The resulting stress induces physiological responses that can contribute to the development of musculoskeletal disorders.

New research reported by the CCOHS identifies some physiological responses to psychosocial factors, including:

  • Increased blood pressure, which in small joint spaces can increase pressure on tendons, ligaments and nerves.
  • Increased fluid pressure over a prolonged period of time can also increase pressure in joints and on surrounding soft tissue as well as the carpal tunnel.
  • Reduction of growth functions can reduce production of collagen and consequently the body’s ability to heal or recover after performing work functions.
  • Over time a decreased sensitivity to pain can prompt workers to work beyond their body’s physical capacity, predisposing it to injury.
  • Increased muscle tension can increase pressure on and around the joints and may cause excessive use of force during certain activities and movements.
  • The body’s heightened state of sensitivity may overburden the musculoskeletal system by prompting a person to lift more, work faster, etc.

It is difficult in our current healthcare environment to directly attribute “workplace psychosocial factors” as a cause of workplace MSD, because of the many other factors that contribute to such disorders/injuries (biomechanical, etc.). Increasingly, though, evidence and newly published scientific research studies are helping to spotlight the role that these factors play, and the link between “stress induced physiological changes” and musculoskeletal disorders.

Additionally, a growing number of research studies are reporting a link between emotional disorders (anxiety, depression) and medical and surgical complication rates, lower patient satisfaction scores and readmission risk in joint replacement patients. [2,3]

There will likely be much more research on these topics in the coming years.

This new information underscores the importance of identifying and addressing psychological stressors and our response to them, as they are proving to have a significant impact on not only the cardiovascular but also the musculoskeletal system – two vital contributors to overall health and well-being.

 

References

  • Canadian Centre for Occupational Health and Safety (CCOHS), cchos.ca , https://www.ccohs.ca/oshanswers/psychosocial/musculoskeletal.html .
  • Wood TJ, Thornley P, Petruccelli D, et al. Preoperative predictors of pain catastrophizing, anxiety and depression in patients undergoing total joint arthroplasty. J Arthroplasty. 2016 Dec;31(12):2750-2756.
  • Gold HT, Slover JD, Joo L, et al. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplasty. 2016 Nov;31(11):2385-2388.

 

 

What Spring and Summer Mean to Our Musculoskeletal Health

Spring has finally arrived and time isn’t the only thing jumping forward.  Our enthusiasm for the outdoors is renewed and our activity schedule is ramped up.  From the slopes to spring sports, new plantings and training for one of the biggest bike rides in Texas, the potential for overuse injuries is particularly high this time of year – following less active winter months.

Some of the musculoskeletal injuries and conditions most commonly seen in the spring and summer months include:

  • Skier’s Thumb
  • Friction Blisters
  • Allergy-Related Muscle Fatigue / Joint Pain
  • Carpal Tunnel Syndrome
  • Golfer’s Elbow

Skier’s Thumb

Though the skies and poles are packed away, signs of a common injury following an active ski season may linger a bit longer.  Skier’s thumb, also known as Texter’s Thumb skiers-thumb gardening cycling MLB: Oakland Athletics at Chicago White Sox golfing tennisamong millennials, refers to injury of the unlar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MP) joint.  This occurs when the abnormal pulling of the thumb, such as that from a fall or harsh pull while affixed to the ski pole/hoop, causes a forced abduction or hyperextension of the proximal phalanx of the thumb. If unaddressed, this injury is further exacerbated by the repetitive use of the injured thumb in texting.

Friction Blisters

While the most common concerns during baseball season include pitch count and the stress that excessive pitching and throwing has on a player’s elbow and shoulder over the course of a baseball season, these generally occur mid to late season following many practices and games.

A lesser known injury often occurs as the season gets started and impacts pitchers in particular – friction blisters.   The repeated trauma created between the baseball seams and the fingers of the pitching hand, predominately at the tips of the index and long fingers, can result in friction blisters.

Friction blisters, which are the result of repetitive friction and strain forces that develop between the skin and various objects, are also common this time of year among those increasing gardening efforts and tennis players hitting the court.

Friction blisters form in areas where the “stratum corneum” and “stratum granulosum” are sufficiently robust such as the palmar and plantar surfaces of the hands and feet [1].

 

Allergy-Related Muscle Fatigue / Joint Pain

With the vibrant colors of spring come seasonal allergies and a host of symptoms that can sometimes make involvement in many of these long-awaited activities a challenge.  While pollen allergies most commonly cause nasal congestion, a runny nose, a sore/scratchy throat and itchy eyes, they can also cause hives, itchy skin, chronic cough, mood changes and body aches/muscle and joint pain. After exposure to pollen, the body reacts to it as a foreign invader by releasing antibodies and natural chemicals called histamines. Histamine is a substance that causes inflammation in the body. Sometimes allergies can advance to bronchitis and mimic flu-like symptoms, including a low-grade fever, body aches and muscle fatigue which can make everyday activity and exercise more challenging if unaddressed. Continuing to train or play while the body fights to overcome allergy challenges can predispose the musculoskeletal system to injury.

 Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is one of the most common overuse conditions seen in hand and upper extremity orthopedic care.  In the spring and summer, it is often the result of new activity excessively engaging the hand and wrist such as gardening and cycling. It is generally the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes.  This nerve becomes irritated in the compressed tunnel and can cause numbness, pain, tingling and weakness in the thumb, index and middle fingers.  CTS can come on quickly and command attention or linger with varying degrees of pain that becomes gradually more intense over time.

Another hand and wrist condition, Handlebar Palsy, also known medically as ulnar neuropathy, is an overuse or repetitive stress condition that affects cyclists, though generally after completion of a long, competitive ride.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.

 

Golfer’s Elbow

While the greens are rarely bare in Houston, golfing tournaments really ramp up in the spring and so too do one of the most common overuse conditions associated with the sport – Golfer’s Elbow.  Also known as medial epicondylitis, Golfer’s Elbow affects the muscles and tendons on the inside (medial) portion of the elbow. The repeated activity of swinging the golf club places strain on the elbow, irritating and inflaming the tendons and muscles at the elbow joint.  This inflammation can cause pain on the inside of the elbow, as well as in the forearm and wrist.

 Preventing Injury

Easing into new activity gradually and preparing appropriately can reduce risk of overuse injuries and conditions.  Strengthening muscle groups equally and stretching sufficiently both before and after activity are key, particularly after less active winter months.

Ensuring proper equipment (cycling and other ergonomic gloves and tools) and products (moisturizing to reduce calluses and blister risk) can protect the parts of the body most vulnerable to some of these spring activities and sports. Behavior/activity modification can also help to distribute stress to different parts of the body, reducing repetitive impact on one particular area.

While allergies are often unavoidable, antihistamines and corticosteroids can reduce symptoms and improve performance.  Understanding the associated muscle fatigue and joint pain will help you modify activity accordingly to avoid injury.

Periodically resting and refraining from the activity causing pain can help restore limb strength and prevent more serious injury or damage to the affected area.

 References

[1] McNamara AR, Ensell S, Farley TD. Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management. Am J Orthop. 2016 March;45(3):134-36.

Handlebar Hazards

Repetitive Stress Hand & Wrist Conditions Affecting Cyclists

As training begins for the upcoming MS150, we thought we’d talk about some of the common overuse, or repetitive stress, hand and wrist conditions affecting cyclists.  By discussing some of these conditions and ways to reduce your risk, hopefully we can ensure pain free cycling and play a hand in many successful rides.

How Repetitive Stress Occurs
Avid cyclists competing year round in weekend rides and races tend to experience various types of overuse strains and stress associated with such a sport – nearly one-third of these

Hyperextended Wrist

affect the hand and upper extremity.  Despite the best equipment and preventive measures, the jarring vibration of a rough terrain, handlebar hand positioning for hours at a time or tense ride into the wind can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy (also known as ulnar neuropathy).  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

Carpal Tunnel Syndrome

Hyper Flexion of Wrist

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  CTS is the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. CTS is one of the most common overuse hand and wrist conditions affecting cyclists. When the median nerve becomes irritated in this inflamed and compressed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers – causing discomfort and affecting a cyclist’s ability to even shift gears with the affected hand.  Resting periodically and stretching the hands, changing grip to reduce hyperextension and hyper flexion may help during the ride, but ongoing pain may require treatment – which is generally nonsurgical and may entail night bracing and/or injection therapy.  CTS pain remaining unresolved following nonsurgical treatment may require a minimally invasive Endoscopic Carpal Tunnel Release.

Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.  The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of it may result in numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications can generally resolve this condition.

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists – as the continuous vibration of the motorcycle causes the same type of conditions long rides and regular bicycling can cause.

Reducing Your Risks
Decades of cycling enthusiasts have contributed to an array of preventive cycling gear and recommendations for reducing a fellow cyclist’s risk for such conditions.  These include everything from basic and specialized gel cycling gloves to additional handlebar padding and adjustments in handlebar height and overall bike fit specific to each rider.

Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion, along with frequent adjustments to grip and position on the handlebars, should reduce risk for carpal tunnel syndrome and handlebar palsy.

Figures source:  http://www.hughston.com/hha/a_15_3_2.htm

 

 

 

FIREARM INJURIES -When Things Get Out of Hand

While firearm injuries to the hand and upper extremity represent a small percentage of all firearm traumas, when they happen the injury is often severe.

Frequently the result of mishandling a gun, the damage that both a bullet, the chamber and even the recoil can pose to the small bones and joints of the hand and wrist can be devastating and have a longterm impact.

Scope of Hand & Upper Extremity Problems in Firearm Users Range from Trauma to Repetitive Stress Conditions

From partial limb loss to stress fractures and repetitive stress conditions historically diagnosed in those working in a daily repetitive task, firearm users should recognize the dangers that exist behind the barrel as well.

Trauma – Open Wound

A broadly distributed article on an unfortunate handgun user losing the top half of his ill placed thumb – a result of the powerful vapors escaping from the chamber upon firing – cast a spotlight on the dangers of using certain firearms and the magnitude of damage that can occur to the small bones and intricate network of nerves, tendons and ligaments of the hand.

While this type of injury is uncommon, it is important to know what to do should it happen. Collecting any remains separated from the impacted area could aide a hand surgeon with replantation.  Rinsing the wound with sterile, normal saline and wrapping it if possible is advised just before heading to an emergency center for immediate assistance.

The surgical approach depends on the severity of damage to the tissue and bone. Open wounds like this are always treated with antibiotics, as “skin” is the body’s largest organ and when its protective barrier is compromised in this way and vulnerable to bacteria, antibiotics are used to reduce risk of infection.   If there is damage to the bone, surgery would entail stabilizing the bone.  Then, the tendons are repaired and the blood flow is re-established – with repair of the artery and veins. Potential problems can result from the magnitude of the blast, confounded by the risk of infection.  The expected outcome and long term function of such an injury is often highly variable as it depends on the amount of tissue damage from the accident.  Often times patients are able to regain adequate function despite not having full mobility of the injured extremity during their recovery.

Forceful Impact – Stress Fractures

Sportsmen frequently using what are known as “big-bore” handguns (models with rifle-type cartridges) have increasingly reported problems with their shooting hand – pain, swelling, weakness when shooting – following periods of preparation/practice for an upcoming hunt. This type of pain can stem from damage to the carpal bones of the wrist, as well as the forearm and elbow as a result of the repetitious and harsh recoil impact (much like a worker regularly using a Jackhammer or other such high powered equipment).  In some cases, this can result in a stress fracture.  Stress fractures are most commonly seen in the lower extremity of frequent runners or athletes, but can occasionally occur in the hand and upper extremity when subjected repeatedly to unusual force.

Treatment of stress fractures generally entails rest from the activity and possibly bracing.  Rehabilitative exercises are also effective in strengthening the shooting arm for both overcoming fatigue and reducing risk for more serious damage.

Repetitive Stress Conditions

Conditions like carpal tunnel syndrome and tennis elbow are considered repetitive stress conditions, most often associated with repetitive tasks in work or sports.  They are occasionally seen in the avid sportsman – practicing to perfect their shooting prior to a hunting season or holding the firearm only certain times of the year in a way to which the hand/arm is not accustomed.

These conditions are most often treated nonsurgically with rest and anti inflammatory medication.  Rehabilitation therapy is also frequently used to address these conditions – to restrengthen, stimulate healing and in some cases retrain hand and arm position during tasks identified as triggers. A new procedure known as the Graston Technique® is also an effective therapeutic way to address these types of repetitive stress conditions.  It entails uniquely designed stainless steel instruments and specially trained hand therapists to detect and treat the affected areas of soft tissue irritation.

Long-term Impact

Persistent pain and chronic inflammation can alter the natural mechanics of the affected limb, negatively impacting joints and accelerating joint degeneration – which could eventually result in osteoarthritis if unaddressed.

Reducing Risks

The best way to reduce the risk of firearm or other activity-related hand and upper extremity conditions is to space practices so that adequate time is allowed to rest the “master” hand and arm.  Strengthening exercises will also allow muscles to protect the soft tissue and bones.  Most sports also have protective gear, developed to address some of the most common conditions associated with frequent involvement.  Hunting is no exception, with brakes, grips and shooting gloves designed to reduce the impact of frequent shooting on the hand, wrist and elbow.

When pain is persistent, seeking medical attention will often reduce risk of more serious injury and permit conservative treatment to effectively address the problem and promote a healthier approach to the activities you enjoy.

 

 

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 3 (Trigger Finger)

This is the last part of a three-part series on unexpected hand and wrist conditions experienced during pregnancy.  We have focused in this series on three of the most common conditions expectant moms may experience, Carpal Tunnel Syndrome, de Quervain’s Tendonitis and Trigger Finger.

Last month we discussed deQuervain’s Tendonitis and the non invasive ways in which we address the condition – and prior to that Carpal Tunnel Syndrome.  In this last part of the series, we focus on Trigger Finger.

Any one of these conditions may be prompted in expectant moms as a result of the hormonal changes, increased blood flow and water retention and swelling in the body during pregnancy.

Trigger Finger is a disorder characterized by snapping and locking of the flexor tendon of the affected finger or thumb. The term Trigger Finger comes from the unlocking of the finger, in which case it pops back suddenly as if releasing a trigger.

Trigger Finger is the result of inflammation of tendons connecting muscles of the forearm to the finger and thumb bones.  This connection permits movement and bending. While in most cases the inflammation is the result of a repetitive or forceful use of the finger or thumb, medical conditions causing a change in tissues – such as pregnancy – may also prompt Trigger Finger.

One of the early symptoms of Trigger Finger is soreness at the base of the finger or thumb, followed by painful clicking or snapping when flexing or extending the affected finger.  Occasionally there may be swelling.  Periods of inactivity may make this worse, though eases with movement.  In more severe cases, the affected finger or thumb may lock in a flexed or extended position – and forced to straighten.  Joint stiffening may eventually occur.

Diagnosing and Treating Trigger Finger

Diagnosing Trigger Finger is done with a physical examination of the hand and assessment of the symptoms.

Treatment for Trigger Finger is generally conservative and may include:

  • Avoiding activity that aggravates the affected finger or thumb
  • Anti-inflammatory medication
  • A steroid injection into the tendon sheath

If conservative treatment is unable to resolve the condition, a minimally invasive surgical procedure to release the tendon sheath may be indicated.  Expectant women are advised to wait before considering surgical treatment as often times the condition is resolved following pregnancy – when the body resumes normal function.

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 2

Last month we discussed several unexpected hand and wrist conditions associated with pregnancy – the first in a series of blogs on this subject.

We focused first on one of the most common pregnancy related hand and wrist conditions, Carpal Tunnel Syndrome – discussing the symptoms and common treatment options available to expectant moms.Pregnancy related hand conditions

This month we’re discussing another common hand and wrist condition women may experience during pregnancy and following childbirth, deQuervain’s Tendonitis.  Like Carpal Tunnel Syndrome, deQuervain’s can develop as a result of the musculoskeletal changes, hormonal fluctuations, pregnancy related fluid retention and nursing – all of which can place stresses on the tendons.

DeQuervain’s Tendonitis affects the tendons around the base of the thumb and results when these tendons become irritated – causing the lining around the tendon, known as synovium, to become inflamed.  Tendonitis actually means “swelling of the tendons.”  Tendons are responsible for attaching muscle to bone.

The main symptom of deQuervain’s Tendonitis is pain and tenderness along the thumb side of the wrist, which may radiate down the thumb or up the forearm when rotating the wrist, grasping things or gripping.  The swelling may also place pressure on nearby nerves, causing numbness in the thumb and index finger.  The pain may be gradual or arise suddenly.

DeQuervain’s Tendonitis is generally easily diagnosed in the physicians office after a physical examination and discussion of patient history.  Patients are then asked to perform a series of hand movements and discuss the level of discomfort and area of pain and tenderness.Parts of the hand and wrist affected by deQuervain's Tendonitis

Treating deQuervain’s Tendonitis
Treatment for deQuervain’s Tendonitis is generally nonsurgical and may include:

  • Resting the thumb and wrist with the support of a splint
  • Anti-inflammatory medication 
  • A steroid injection into the tendon compartment
Look for the final part of this series on Unexpected Pregnancy Related Hand & Wrist problems next month when we talk about Trigger Finger.

Unexpected… Pregnancy Related Hand & Wrist Problems

Pregnancy, while one of the most exciting times of a woman’s life, can also present a few physical challenges – affecting parts of the body new moms-to-be may not expect.

During pregnancy women are not only adjusting to changes in the body necessary to create new life, but also other less expected changes resulting from the musculoskeletal challenges and overall physical demands pregnancy places on body function.  These demands come from added weight of carrying the baby as well as the reallocation of nutrients from mom to baby, hormonal changes and pregnancy-related fluid retention.  

It is this type of physical impact to seemingly unrelated areas of the body like the hands, wrist and elbow that takes most expectant women by surprise.

While problems in these areas might be expected after the baby is born – as extended holding in unusual positions, feeding positions, pushing of strollers and other unusual hand and upper extremity movements place stress on the hands, wrist and elbow – there are actually a number of hand and upper extremity pregnancy-related conditions women may experience.

Such conditions include carpal tunnel syndrome, deQuervain’s tendonitis, trigger finger and general swelling and tingling in the hands and upper extremity.

This article is one in a series focusing on pregnancy related conditions, beginning with carpal tunnel syndrome, as it is one of the most common hand and wrist conditions affecting pregnant women.  While often categorized as a “repetitive stress” condition – which affects those performing a repetitive tasks resulting in irritation and inflammation – it is often also commonly associated with pregnancy.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the compression of the median nerve passing through the narrow carpal tunnel of the wrist.  Increased fluid generated during pregnancy can cause the same inflammatory/compressive effect of repetitive stress generally associated with carpal tunnel syndrome. 

Carpal tunnel syndrome is most often experienced in the third trimester when fluid retention is at its highest.

Symptoms of carpal tunnel syndrome may include pain, tingling and numbness in one or both hands. It is traditionally addressed nonsurgically with behavior modification, rehabilitation exercises and bracing.  If bracing and activity modification do not alleviate the problem, a steroid injection may be given and usually resolves the problem within a day or two.  Patients infrequently will need surgery if the carpal tunnel syndrome is related to pregnancy.