Qui sotto puoi leggere una traduzione del traduttore umano in inglese. Hai anche accesso all’originale spagnolo cliccando sulla bandiera nell’angolo in alto a destra. Questo link ti consente di accedere a una versione di traduzione automatica di Google in italiano: http://bit.ly/2J8yKgH

Tendons are bands of tissue whose main function is to connect muscle and bone, transmitting the impulse of muscular contraction that facilitates movement. Therefore, any damage or condition that they suffer has important disabling effects on the patient. This is the case of tendon inflammations, known as tendonitis, with two manifestations of special impact such as trigger fingers and De Quervain syndrome.

Tendonitis is a very frequent pathology, usual origin of pain and functional limitations. It is, in essence, an inflammation of the tendon, which -in most cases- causes pain due to friction with its passage area.

The main risk factor for suffering from tendonitis are the degenerative processes of loss of elasticity associated with age (the incidence already increasing after 40). However, there are multiple variables of influence such as excessive work or sports activity, certain injuries or diseases such as diabetes.

Two of its more common manifestations are the so-called trigger fingers and De Quervain syndrome. We addressed both with Dr Francisco del Piñal.

Dr, as an initial perspective against tendonitis, in a generic way, what clinical approach is the most appropriate?

As a starting point, and speaking in general as you ask, we must adopt a conservative position. That is to say, rest and immobilization, through splint for example, especially when the tendonitis is due to intense activity or to a specific trauma.

However, if this approach and the use of anti-inflammatories do not solve the problem permanently, surgical solutions must come into play. The patient’s response to surgery in these cases is very positive.

What is the source of pain in these situations?

The tendons, when exercising their function, must go through a kind of ‘tunnels’ with limited space (formed by rings known as pulleys). We could compare them with the clamps or guides of the fishing rods.

Thus, if there is inflammation, if the sheath that protects and forms part of the tendon ‘widens’, it generates an increase in volume and loss of flexibility (stenosing), which hinders  the transit we alluded to.

As a result, patients ‘force’ the affected area until the movement occurs. It is here, broadly speaking, where pain arises.

Let’s talk about specific pathologies, why ‘trigger fingers’? (…)

This disease causes inflammation of the flexor tendons of the fingers, that is, those that allow them to bend; thereby causes pain and difficulty in the movement of flexion. It receives the name of trigger fingers because -depending on the phase in which it is- the patient has a hard time stretching his finger until, suddenly, it is “shot”, generating additional pain.

Any risk factor?

Fundamentally the age, with the tendon degeneration associated with aging. Except in athletes, especially those who ‘crush’ the area like the climbers, it doesn’t usually occur in young people.

Solutions?

We are facing a pathology of difficult non-surgical solution. In certain cases, it is treated with the injection of corticosteroids, which can lead to tendinous ruptures; since this treatment of trigger fingers not only eliminates inflammation, but also reduces the ability of the tendon to recover.

We must bear in mind that resolving a flexor tendon rupture is complex, while fixing a trigger finger through surgery is relatively easy. With surgery, what we do is open, widen the ‘tunnel’ or pulley so that the tendon has more room to enter. It is a 100% healing action.

Let’s move now, Dr, to another of the pathologies with higher incidence, what is the De Quervain syndrome?

Unlike the trigger which can appear on any of the fingers, the De Quervain syndrome affects the extensor tendons of the thumb. There is an inflammation, similar to the one we have previously described, which implies pain in the passage of the tendon through its ‘tunnel’.

However, it has a particularity, especially from the point of view of the patient: because of its location, those who suffer from this pathology usually associate it with wrist problems when, as I said, it is a tendonitis of the thumb.

Taking into account the role of the thumb, Dr, the daily activity of patients should be quite affected, shouldn’t it?

Indeed, it is a very disabling condition, since the thumb is fundamental in all the daily actions that we perform with our hands; to which it’s necessary to add the pain that’s also generated when moving the wrist, due to that position which we spoke before about.

Video: Intervention in case of De Quervain syndrome. Dr Del Piñal

Any group or profile with a greater predisposition to suffer De Quervain?

Like the the trigger fingers, the determining factor is age and its degenerative processes in the tendons. Its appearance is more frequent in diabetic people also.

On the other hand, another element to take into account are situations of overactivity. This is the case of mothers with small children. In the first months of post-pregnancy, because of the enormous work done, they are more vulnerable to this type of tendonitis.

How is the answer given from surgery?

The basis of the treatment of De Quervain syndrome is identical to that of tendonitis that causes trigger fingers. The objective is to make the pulley larger, facilitating the passage of the extensor tendon, and thus end the circle of inflammation and pain. In this way, we eradicate the disease.

It is a simple procedure, with local anesthesia, immediate results and quick recovery.