Left Hand Pain: Trigger Finger or Carpal Tunnel Syndrome?

Left hand issues?

Hello Doctor, last month I slipped while handling a pot and injured my left thumb, which hasn't healed yet.
It hurts whenever I apply pressure to the tip of my thumb.
Additionally, around September 20th, I noticed that when I woke up, my left hand was bent downwards, and it would hurt when I tried to make a fist.
After testing each finger, I found that my middle finger was stiff and could not bend.
It started to become increasingly stiff around noon, and by 9 PM, the stiffness was very noticeable.
When moving the finger joints, I could hear a clicking sound.
The stiffness is most severe at night, making it difficult to bend my hand downwards (this happens every night, with the daytime being more manageable).
Some people have suggested that it might be "trigger finger," while others think it could be "carpal tunnel syndrome." I have seen specialists in orthopedics, rheumatology, rehabilitation, and neurology.
Blood tests confirmed there are no rheumatic issues, and nerve conduction studies showed compression issues in both hands, but there is no numbness in either hand.
I would like to ask whether this is likely "trigger finger" or "carpal tunnel syndrome." Thank you.

nancy, 40~49 year old female. Ask Date: 2017/10/30

Dr. Yin Xinbei reply Rehabilitation

It is possible that both conditions are present, and it is recommended to treat them together.

Reply Date: 2017/10/30

More Info

Based on the symptoms you've described, it seems that you may be experiencing a combination of conditions, specifically trigger finger (stenosing tenosynovitis) and possibly carpal tunnel syndrome. Both conditions can cause pain and discomfort in the fingers and hand, but they have different underlying mechanisms and treatment approaches.

Trigger Finger: This condition occurs when the tendons that control finger movement become inflamed or irritated, leading to a narrowing of the sheath that surrounds the tendon. This can cause the finger to catch or lock in a bent position, which aligns with your description of your middle finger being stiff and unable to bend. The pain you experience when exerting force with your fingers, especially in the morning or after periods of inactivity, is also characteristic of trigger finger. The "catching" sensation you mentioned is a classic symptom, and it often worsens with repetitive use or after periods of rest.

Carpal Tunnel Syndrome: This condition arises from compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms typically include numbness, tingling, and pain in the thumb, index, middle, and part of the ring finger. While you mentioned that you do not experience numbness, the nerve conduction studies indicating some level of compression suggest that there may be mild involvement of the carpal tunnel. The pain and stiffness you feel, especially at night, could be exacerbated by wrist positioning during sleep, which is common in carpal tunnel syndrome.

Given that you have seen multiple specialists and have undergone various tests, it is essential to consider the possibility of both conditions coexisting. The absence of rheumatoid factors in your blood tests helps rule out inflammatory arthritis, which is a positive sign. However, the nerve conduction studies indicating compression suggest that there may still be some underlying nerve involvement.

Treatment Options:
1. Conservative Management: Initially, treatment for both conditions often includes rest, splinting, and anti-inflammatory medications. A splint can help immobilize the affected fingers and wrist, reducing strain on the tendons and nerves.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A therapist can provide exercises to improve flexibility and strength in your fingers and wrist, which may alleviate some of the stiffness and pain.

3. Corticosteroid Injections: If conservative measures do not provide relief, corticosteroid injections into the tendon sheath (for trigger finger) or the carpal tunnel may help reduce inflammation and pain.

4. Surgery: If symptoms persist despite conservative treatment, surgical options may be considered. For trigger finger, a procedure to release the tendon sheath can be performed. For carpal tunnel syndrome, a carpal tunnel release surgery can relieve pressure on the median nerve.

In conclusion, it is crucial to follow up with your healthcare provider to discuss your symptoms in detail and consider a comprehensive treatment plan that addresses both potential trigger finger and carpal tunnel syndrome. Early intervention can often lead to better outcomes and prevent further complications. If you have any additional questions or concerns, do not hesitate to reach out to your healthcare team for further guidance.

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