There are several different problems that can occur with the fingers. While an injury or a trauma may cause these, most often they are secondary to several of the degenerative diseases such as rheumatoid arthritis and osteoarthritis. These diseases affect the joints and eventually the tendons of the fingers, resulting in various deformities. For this reason, if you already have one or some of these conditions, it is important to begin to take steps to prevent further complications and additional finger deformities. Your health professional can educate you on ways to protect your hand and fingers.
To understand the deformities, some basic terminology is needed. The tendons of the the fingers are actually quite complicated and sometimes do several things, but for the sake of understanding, the information will be simplified.
The tendons that control and support the fingers are called the extensor tendons and the flexor tendons. The extensor tendons are located on the back of the fingers and work to straighten the fingers. The flexor tendons are located on the palm side of the fingers and work to bend the fingers. There are three joints in the fingers. The joint closest to the palm or hand is the metacarpal phalangeal joint, or MCP. The middle joint is the proximal interphalangeal joint, or PIP. The end joint is the distal interphalangeal joint, or DIP.
Dupuytren's Contracture
Dupuytren's contracture is a condition that generally affects the palm area of the hand. It is sometimes also seen in the foot, but not very often. The cause is unknown at this time. Heredity may be a factor, as well as injury.
The palm of the hand has a thin tissue under the skin called the palmer aponeurosis. This tissue is very dense and tough. It has some movement and sliding ability but generally is very secure. The aponeurosis attaches to the tissues and tendons of the fingers, especially the ring and little finger. It is partly because of this tissue that we are able to have a secure grasp and grip. With Dupuytren's contracture this tissue becomes thicker and begins to shorten a bit. As it contracts and shortens, it pulls on the fingers making them bend and pull toward the palm. The fingers affected most are the ring and little finger, although the middle finger may also be involved. When this condition is seen in the foot, it usually appears on the sole of the foot.
Treatment involves surgery to release the thickened tissue. Whether or not surgery is performed depends on how severe the contracture has become, how much it affects function, and if it is progressing.
After surgery, rehabilitation is primarily focused on improving range of motion for the fingers and regaining strength. Initially, the main emphasis is on returning the full range of the fingers and keeping the fingers stretched out of the bent position. As range of motion improves and healing of the incision sites progresses, the treatment transitions to a strengthening phase. This strength program is usually accompanied by functional activity training as well. Functional training works on grasping objects, writing, dressing activity and finger coordination.
The final outcome after surgery and rehabilitation in Dupuytren's contracture is fairly good in terms of regaining use of the hand and fingers. However, in some cases, the contracture has been known to recur.
Swan Neck Deformity
This condition can be a result of rheumatoid arthritis. In this situation, the flexor tendon of the PIP slips to the side and up to the back of the finger and the extensor tendon of the DIP slips to the side and to the palm surface of the finger. This results in the middle of the fingers bending up and the ends of the fingers bending down.
Boutonniere Deformity
This condition occurs when the extensor tendon at the PIP breaks or becomes detached at that joint. The result is that the finger stays bent at the PIP joint.
Mallet Finger
This usually occurs from an injury. The extensor tendon becomes torn or breaks at the DIP joint. The result is the very tip of the finger stays bent.
Ulnar Deviated Fingers
This condition is quite common with the arthritis conditions. In this situation, usually both the flexor and extensor tendons slide to the sides of the fingers. They usually slide to the little-finger side of the fingers. The result is some or all of the fingers tend to bend a bit, as well as bend toward the direction of the little finger.
|