Palm base of fingers/thumb
Trigger
- Finger or thumb can click with movement or PIPJ can lock as finger/thumb bends towards palm
- Can be associated with pain
- Work up:
- steroid injection (Community Physiotherapy (pending MSK Hub development))
- locked digit: urgent referral to hand surgeons
- consider Low Priority Procedure Policy prior to referral
- If not improving/ reoccurrence/intrusive problem
- referral to hand surgeons
- BSSH Trigger finger/thumb
Dupuytrens
- Benign painless condition affecting palmar and finger fascia, often strong family history
- Refer to hand surgeon if:
- if contracture PIP joint more than 20 degrees and/or MCP joint contracture 30 degrees
- in thumb: any contracture affecting function
- BSSH Dupuytren's disease
- consider Low Priority Procedure Policy prior to referral
Dorsal little/ring finger
Dropped fingers
- Unable to extend little finger (+others) actively
- May be history of rheumatoid or inflammatory disease or trauma
- Consider Vaughan Jackson (rupture of extensor digiti minimi (EDM)) +/- extensor digitorum comnuis (EDC) for fingers
- Work up:
- x-rays of wrist and hand
- urgent referral to hand surgeon
Dorsal thumb
Thumb not moving actively but good passive movement
- Consider tendon problem
- Causes: trauma, rheumatoid, inflammation, infection
- Thumb not bending to palm = possible flexor pollicis longus problem (FPL)
- Thumb not straightening = possible extensor policis longus (EPL) problem (can be associated with distal radius fracture)
- Work up:
- x-rays of wrist and thumb
- requires urgent referral to hand surgeons for review
Dorsal MCP (Metacarpal Phalangeal) joints
Single MCP joint stiffness, swelling and pain
- Consider OA
- Work up:
- analgesia & advice
- x-ray confirmation (AP and lateral of specific joint)
- If not improving:
- hand therapy at Community Physiotherapy (pending MSK Hub development)
- ultrasound guided steroid injection (radiology dept)
- severe symptoms refer to hand surgeons
Bilateral/Multiple MCP joint stiffness, swelling and pain
- Consider inflammatory
- Work up:
- analgesia & advice
- x-ray (both hands +/- wrists AP/lateral and oblique)
- If not improving &/or persistent for more than 6 weeks:
- consider bloods & referral to Rheumatology
- hand therapy at Community Physiotherapy (pending MSK Hub development)
- ultrasound guided steroid injection (radiology dept)
- severe symptoms refer to hand surgeons
Dorsal PIP (Proximal Interphalangeal) joints
Single PIP joint stiffness, pain and swelling
- Consider OA
- Work up:
- analgesia & advice
- x-ray confirmation (AP and lateral of specific joint)
- If not improving:
- hand therapy at Community Physiotherapy (pending MSK Hub development)
- ultrasound guided steroid injection (radiology dept)
- severe symptoms refer to hand surgeons
Bilateral/Multiple PIP joint stiffness, pain and swelling
- Consider inflammatory
- Work up:
- analgesia & advice
- x-ray (both hands: AP/lateral and oblique)
- If not improving &/or persistent for more than 6 weeks:
- consider bloods & referral to Rheumatology
- hand therapy at Community Physiotherapy (pending MSK Hub development)
- ultrasound guided steroid injection (radiology dept)
- severe symptoms refer to hand surgeons
Dorsal DIP (Distal Interphalangeal) joints
Single DIP joint stiffness, pain and swelling
- Consider OA or trauma
- May have associated mucous cyst over dorsal aspect DIPJ
- Work up:
- Trauma: consider mallet injury
- extension splint
- xray
- refer to hand trauma service
- No trauma
- analgesia & advice
- x-ray confirmation (AP and lateral of specific joint)
- Trauma: consider mallet injury
- If not improving:
- refer to Community Physiotherapy (pending MSK Hub development) for hand therapy
- ultrasound guided steroid injection (radiology dept)
- severe symptoms &/or symptomatic nail growth problems or recurrent discharge refer to hand surgeons
- BSSH terminal finger joint arthritis
Bilateral/Multiple DIP joint pain, stiffness and swelling
- Consider inflammatory
- Work up:
- analgesia & advice
- x-ray (both hands +/- wrists AP/lateral and oblique)
- If not improving &/or persistent for more than 6 weeks:
- consider bloods & referral to Rheumatology
- hand therapy at Community Physiotherapy (pending MSK Hub development)
- ultrasound guided steroid injection (radiology dept)
- severe symptoms refer to hand surgeons
(Visited 1,614 times, 159 visits today)
Leave feedback
You must be logged in to post a comment.