With a second specialty in hand surgery, Dr. Sellers is the perfect choice when you are looking for help with any hand problem, including but not limited to arthritis, carpal tunnel syndrome, trigger fingers and fractures.

Carpal Tunnel Syndrome, Trigger Finger (Stenosing Tenosynovitis), DeQuervain’s Tendonitis, Ganglion Cysts, and Synovium

In order to understand common CARPAL TUNNEL SYNDROME (CTS) and its “first cousins” STENOSING TENOSYNOVITIS (STS) of the finger (TRIGGER FINGER) and DeQUERVAIN’S TENDONITIS of the wrist, as well as GANGLION CYSTS, one must understand SYNOVIUM.

Synovium is a special slippery tissue that is found in the body as a very thin film surrounding tendons, lining the tunnels that tendons pass through, and lining joint surfaces. Synovium produces a tiny amount of fluid (synovial fluid) that makes tendons and joints slide smoothly. If one was to look at a normal, healthy tendon or joint in the body the surface would appear to be glistening from this synovial fluid, but one would not see the Synovium per se.

However, in conditions where the body requires additional lubrication of these structures, certain individuals who are genetically predisposed will develop synovial overgrowth or thickening instead of simply a higher synovial fluid output.

This synovial thickening is the root cause of the conditions listed above. In areas with little room to spare, this thickened Synovium may become an impediment to free movement of the tendon, and occupies so much additional room in the tunnel that other structures in the tunnel may be compromised.

In CARPAL TUNNEL SYNDROME, this latter situation is the problem. In the carpal tunnel at the wrist, there are 9 tendons and one nerve (MEDIAN NERVE) passing through the tunnel. Since there is no provision for expansion of the tunnel, the pressure within the tunnel rises as the synovium thickens. This elevated pressure interferes with the normal function of the MEDIAN NERVE, causing numbness in the fingers, aching in the wrists, and even up into the neck. Treatment, then, requires shrinking the synovium (by anti-inflammatories), mechanically preventing external pressure forces on the nerve (wearing wrist splints at night), or surgically enlarging the tunnel (carpal tunnel release).

TRIGGER FINGER is that condition where a build-up of thickened synovium occurs in the palm as the tendons glide through a fibrous tunnel or sheath that begins about an inch down from the web edge and extends to the last joint of the finger (stenosing tenosynovitis). At the leading edge of this tunnel, the tendons have to take a sharp angle to enter the tunnel, and the friction forces are highest. The localized thickened synovium may cause tenderness in the palm, and may get so thick that the tendon “catches” and the finger may not straighten easily. Many people misinterpret this condition as a problem with the middle joint of the finger. Treatment usually involves cortisone injections to shrink the synovium, or minor surgery to directly release the leading edge of the tendon sheath.

DeQUERVAIN’S TENDONITIS is essentially stenosing tenosynovitis of the first dorsal extensor compartment or tunnel of the wrist. This tunnel is located at the base of the thumb long the edge of the wrist. The thickened synovium along this group of tendons causes pain when moving the thumb, or bending the wrist in certain directions. Treatment is similar to stenosing tenosynovitis of the finger.

Finally, a word about GANGLION CYSTS. In the normal function of synovium, the tiny amount of fluid it produces flows out onto the surfaces of the intended structures and is eventually absorbed. In abnormal conditions, this fluid accumulates within the synovium, gradually building up as a ball of thickened, mucin-like fluid. These are called “synovial cysts”, or, more commonly, GANGLION CYSTS. These cysts can show up anywhere one finds synovium. Typically, they are found on the back of the wrist, on the front of the wrist, over the palm surface of the tendon sheath of the fingers, and over arthritic finger joints.

ARTHRITIS pain in THUMB JOINT can be helped

Many individuals, especially women in their late 40s, 50s, 60s, and beyond will suffer or are now suffering from arthritis at the base of the thumb. This common arthritic ailment, as well as arthritis generally in the hand is unfortunately thought by many to be incurable, and therefore hopeless to be helped. Such is not at all the case!

The thumb, like fingers, has three bones comprising its length. The bone closest to the wrist is called the first metacarpal. This bone rests on and articulates with the trapezium bone of the wrist. It is the first metacarpal trapezium joint, commonly called the basal joint of the thumb- which accounts for the majority of cases of painful thumb bases in the age group noted above.

Why women are affected by basal joint arthritis five times more commonly than men is not completely understood, but probably has to do with hormonal influences on the supporting ligaments of this joint. As the ligaments stretch, the two bone surfaces rub on each other abnormally, thus leading to early mechanical degeneration of the joint and subsequent pain.

The early signs of the disorder are aches in the base area of the thumb which may be made worse by certain stresses. Opening doors, pinching, opening jar lids, turning keys in a lock-these maneuvers can elicit a great deal of pain near the wrist at the thumb base.

With progression of the disease, the movement of the thumb becomes restricted, and in later stages, the metacarpal ‘phalangeal’ joint of the thumb, i.e. the middle joint, begins to actually bend backwards to allow grasping objects. This secondary deformity may require surgical correction at the same time as correction of the base joint if it is deemed necessary by the surgeon.

In early stages of arthritis of the basal joint, resting the hand and taking anti-inflammatory medications may provide relief. As the symptoms become more intense, patients should then seek competent medical care for the next levels of help.

The most efficacious next step is the injection of corticosteroids into the joint. This treatment may control the pain in the joint for many months in some individuals but is not a curative treatment. The use of splints, especially those made by a competent therapist to more precisely fit the patient, can also markedly lessen the pain from the joint by immobilizing it.

The final step in the treatment of basal joint arthritis is a surgical one. During my hand surgery fellowship training, which I completed at the Raymond Curtis Hand Center in Baltimore, I was introduced to the modern surgical techniques for treatment of this common disorder by those who developed the techniques. These surgical approaches are designed to essentially remove the bone-on-bone condition, yet maintain full motion.

These procedures have been used for patients from all walks of life, and have a high success rate.

Suffering from basal joint arthritis is not necessary; help is available to improve one’s quality of life!