Hand Pain: Is It a Bone or Muscle Issue? - Family Medicine

Dr. Xiao Yongxun reply Family Medicine

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Dear Mr.
Zeng:
Trigger Finger:
1.
Trigger finger is primarily caused by repetitive or forceful use of the fingers or thumb, leading to an inflammatory response in the tendons.
Normally, the tendons glide smoothly within the synovial sheath of the finger joints.
However, due to inflammation and swelling of the tendons, prolonged irritation can cause scarring and thickening of the corresponding synovial sheath, which affects the tendons' movement.
When the finger or thumb bends, the inflamed tendon may catch as it moves through the narrowed synovial sheath, resulting in a snapping or popping sensation.
2.
Symptoms include a clicking or popping pain when bending or straightening the fingers, especially after prolonged inactivity.
However, the pain may slightly alleviate after movement.
In the morning, the fingers may feel particularly stiff.
Pain or nodules may develop at the base of the fingers or thumb.
There may be a snapping or clicking sensation during finger movement.
A stuck finger may not straighten without assistance from the other hand.
Rheumatoid Arthritis:
1.
Rheumatoid arthritis is a systemic chronic inflammatory disease that most commonly affects the joints.
It is characterized by non-suppurative proliferative synovitis, which can lead to cartilage destruction and progressive destructive arthritis over time.
It most frequently occurs in young adults, but can affect individuals of any age, with a female-to-male incidence ratio of 3 to 5.

2.
It is essentially a symmetrical arthritis that may also present with systemic symptoms such as fatigue, malaise, and low-grade fever.
Initially, symptoms may be subtle, with joint stiffness and pain, particularly in the morning.
As the disease progresses, joints may become swollen, movement may be restricted, and complete joint stiffness (ankylosis) may occur, leading to claw-like hands and ulnar deviation.
Approximately 50% of patients may experience symptom relief or even remission after about 10 years, while only about 10% will have persistent damage after 15 to 20 years.
The small joints of the hands and feet, as well as the ankles, knees, wrists, elbows, shoulders, and temporomandibular joints, are most commonly affected.
Clinically, the interphalangeal joints may appear spindle-shaped, and the inflammatory response around the joints can lead to local myositis, resulting in muscle atrophy around the affected joints.
3.
The pathological mechanism is primarily related to humoral and cellular-mediated immune responses.
Patients typically have elevated levels of immunoglobulins, and all patients possess a type of autoimmune antibody known as rheumatoid factor (RF), which is an antibody against the Fc portion of IgG, primarily IgM, but also IgG and IgA.
IgM rheumatoid factor is present in the blood of 80% of patients but is not found at the sites of joint lesions, so its role remains unclear; however, the level of IgM is positively correlated with disease severity.
In contrast, IgG rheumatoid factor is found at the sites of joint lesions and is believed to be closely related to disease onset.
In summary, based on your description and the information provided, the likelihood of trigger finger or rheumatoid arthritis is low.
It is advisable for you to discuss this matter directly with your primary care physician for further evaluation or to seek consultation at an orthopedic outpatient clinic at a regional hospital.

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Reply Date: 2020/05/17