WHAT YOU SHOULD KNOW
Some tendons in the hand and wrist are held in place to make them run in the right direction especially where they pass over joints. Patients can tear the fibers that direct the tendons causing the tendons to slip out of place back and forth over the edge of a nearby joint. This produces snapping. The two most common places for this are by the small bone of the wrist on the little finger side and over the knuckles on the back of the hand.
MEDICAL HISTORY
Patients report an annoying ache and pain and are disturbed by the snapping phenomenon that is an obvious sign that something is not right. The snapping or “giving way” of the tendon creates a sense of weakness or poor function of the body part. At the knuckles the finger may not lift all the way up.
EXAMINATION
Placing the finger or wrist in certain positions will demonstrate the tendon instability and recreate the snapping.
ADDITIONAL TESTS
None are needed.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL STABILAZATION | |
| CONSISTS OF | Protective splinting | Rebuilding the fibers that control the tendon’s position and route |
| FEATURES | Worn for 4-6 weeks | Uses local tissues, no need to borrow from elsewhere in the body, outpatient surgery |
| ADVANTAGES | Only good immediately after injury | Restores stability of the tendon |
| DISADVANTAGES | Cannot correct established problem | Restricted use of the hand during 6 weeks of healing followed by rehabilitation program |
RECOVERY
The hand or wrist will be placed in a splint to protect the surgical work. Sutures are removed in the office at 2 weeks. Once the tissues are healed between 4-6 weeks, the splints are removed and motion rehabilitation is started to overcome the stiffness that has set in. Daily exercises must be done to regain first movement and then strength in a process that takes up to 3 months after surgery.
