Stiffness in Fingers After Wrist Fracture Recovery

Stiffness in the middle finger?

Hello, I had a car accident a year and a half ago, resulting in a fracture of the radius and ulnar bones (near the wrist).
The metal pins were removed a year ago.
Recently, within the past month, I have noticed stiffness in my fingers when I wake up in the morning, with the middle and index fingers being the most affected, making it difficult to perform extension movements.
The symptoms gradually improve after getting out of bed.
There are no abnormal sensations in my fingers (no numbness or pain), and the joints are not red, swollen, or painful.
I am wondering what might be causing this issue.

Pang Ba, 20~29 year old female. Ask Date: 2006/12/03

Dr. Chen Xingyuan reply Orthopedics

Dear Reader,
Based on your description, it seems you may be experiencing trigger finger, which is likely not significantly related to your previous radius and ulnar fracture.
The formal medical term for trigger finger is stenosing tenosynovitis of the flexor tendon.
This condition is typically caused by narrowing of the first annular pulley of the flexor tendon sheath, leading to pain in the finger and difficulty extending the proximal interphalangeal joint.
The finger often gets stuck in a flexed position and cannot straighten on its own; when you attempt to extend it manually, it may suddenly snap back, resembling a trigger mechanism, hence the name "trigger finger."
Normal hand function relies on the smooth and nearly frictionless gliding of tendons, and inflammation of the tendon sheath can lead to narrowing that affects tendon function.
Patients may experience pain and limited joint mobility.
Causes of trigger finger include acute injury, repetitive minor trauma from work or sports, tumors, infections, inflammation, gout, rheumatoid arthritis, or metabolic disorders.
Trigger finger can also be idiopathic, meaning the cause is unknown, and it commonly occurs in middle-aged women, often in conjunction with De Quervain's tenosynovitis or carpal tunnel syndrome.
Surveys indicate that about two-thirds of patients may have concurrent stenosing tenosynovitis in other fingers, and sometimes two or three fingers may be affected simultaneously, with 25% experiencing it in both hands.
Physical examination typically reveals tenderness at the distal palmar crease or the metacarpophalangeal joint, and sometimes a movable nodule can be palpated, which may catch when the patient flexes or extends the affected finger.
This movement can be quite painful, and some individuals may be unable to fully straighten their finger.
Diagnosis primarily relies on clinical examination and medical history, without the need for X-rays or other tests.
Conditions to differentiate include diabetes, rheumatoid arthritis, ganglion cysts, and hand contractures.
In severe cases, the condition may lead to flexion contracture of the proximal interphalangeal joint or permanent stiffness.
Treatment typically involves oral non-steroidal anti-inflammatory drugs (NSAIDs) along with appropriate rest, or injecting a small amount of corticosteroid into the tendon sheath.
If symptoms persist, a second corticosteroid injection may be administered after three to four weeks.
Corticosteroid injections are generally reserved for the acute phase, as repeated injections can lead to tendon rupture, elevated blood sugar levels, nerve injury, or bacterial infections.
Long-term use of medications may also cause gastric ulcers or other side effects.
In general, if symptoms do not improve after more than two injections, surgical intervention is recommended.
Surgery is safe and effective, performed under local anesthesia, and typically takes about ten minutes, allowing for outpatient treatment without hospitalization.
Post-operative pain is usually minimal, and function can be restored after a few days of rest.
I recommend that you visit an orthopedic clinic for a definitive diagnosis to provide appropriate treatment.
Wishing you health and safety!
Sincerely,
Dr.
Chen

Reply Date: 2006/12/03

More Info

After experiencing a wrist fracture and subsequent surgery, it is not uncommon to encounter stiffness in the fingers, particularly in the morning. This phenomenon can be attributed to several factors related to the healing process and the body's response to injury.

Firstly, stiffness in the fingers after a wrist fracture can often be a result of joint immobility. When a fracture occurs, the surrounding muscles, tendons, and ligaments may become less active due to pain, immobilization, or the surgical procedure itself. This disuse can lead to a decrease in flexibility and range of motion in the joints, particularly in the fingers. The stiffness you are experiencing, especially in the morning, is likely due to the accumulation of synovial fluid and the natural tightening of the joint capsule overnight when the hand is at rest.
Additionally, the healing process itself can contribute to stiffness. After a fracture, the body forms scar tissue as part of the healing process. While scar tissue is essential for recovery, it can also limit movement and flexibility in the affected area. This is particularly true if the scar tissue forms around the joints or tendons of the fingers, leading to a sensation of tightness or restriction when trying to extend the fingers.

Another factor to consider is the potential for mild arthritis or joint stiffness that can develop after a fracture. Even if you are not experiencing pain, the joint may still be undergoing changes that can lead to stiffness. This is often referred to as post-traumatic arthritis, which can occur even in the absence of significant injury to the cartilage.

To address the stiffness you are experiencing, there are several strategies you can implement:
1. Gentle Stretching and Range of Motion Exercises: Engaging in gentle stretching exercises for your fingers and wrist can help improve flexibility and reduce stiffness. Focus on slowly extending and flexing your fingers, as well as performing circular motions with your wrist.

2. Warm Compresses: Applying warmth to your fingers and wrist before performing exercises can help relax the muscles and improve blood flow, making it easier to move your fingers.

3. Gradual Strengthening: As your fingers become more flexible, consider incorporating strengthening exercises to improve muscle tone and support around the joints. This can include squeezing a soft ball or using therapy putty.

4. Physical Therapy: If stiffness persists, consulting a physical therapist can be beneficial. They can provide tailored exercises and treatments to address your specific needs and help restore full function to your hand.

5. Hydration and Nutrition: Ensure you are staying well-hydrated and consuming a balanced diet rich in vitamins and minerals that support joint health, such as omega-3 fatty acids, vitamin D, and calcium.

6. Monitor Symptoms: Keep an eye on any changes in your symptoms. If you notice increased pain, swelling, or any other concerning signs, it may be wise to consult with your healthcare provider for further evaluation.

In summary, the stiffness you are experiencing in your fingers after a wrist fracture is likely due to a combination of joint immobility, scar tissue formation, and potential changes in joint health. By implementing a consistent routine of stretching, strengthening, and possibly seeking professional guidance, you can work towards improving your finger mobility and overall hand function. If symptoms persist or worsen, do not hesitate to reach out to your healthcare provider for further assessment and management.

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