Hand Conditions

Sports Injuries

Pronator Syndrome

Definition:

Compressive neuropathy (dysfunction) of the median nerve at the level of the elbow that creates paresthesia (pins-and-needles) in the thumb, index, middle finger, and radial half (thumb side) of the ring finger.

Symptoms:

  • Aching pain over the proximal volar aspect (inside or palm side) of the forearm.
  • Includes sensory symptoms into the palm of the hand.
  • Symptoms increase with repetitive pronosupination (rotation) of the forearm.
  • Unlike carpal tunnel syndrome, symptoms are typically not present at night.

Pathology:

  • Compressive entrapment of the medial nerve at one or more of five potential sites.
  • Commonly associated with medial epicondylitis, a form of tendonitis known as golfer’s elbow.

Treatment:

Non-surgical

  • Rest, activity modifications, removable splint, ice and NSAIDs (ibuprofen).
  • Removable splint should avoid forearm rotation.

Surgical

  • Indicated when non-operative treatment fails.
  • Surgical decompression of the median nerve at all 5 possible sites of compression.

Mallet Finger

Definition:

Extensor tendon disruption/rupture with or without an associated small dorsal (top of finger) fracture of the base the distal phalanx (last bone of each finger).

Symptoms:

  • Pain and swelling at the very distal (top) joint of the finger.
  • Extension lag (drooping) of the finger with the inability to fully straighten.

Pathology:

  • Traumatic in nature (caused by a direct blow to tip of finger or laceration to top of finger).
  • Common in athletic activity when a ball strikes the tip of the finger.
  • Tear/avulsion of the extensor tendon with or without an associated fracture.

Treatment:

Non-surgical

  • Strict immobilization/splinting in full extension for at least 6-8 weeks.
  • An additional 4-6 weeks of nighttime splinting.

Surgical

  • Indicated when non-operative treatment fails.
  • Mallet fingers that involve a phalanx fracture of more than 50% of the joint surface.