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Tuesday, August 19, 2025

Finger pain


Introduction

Finger pain is a common complaint encountered in clinical practice, ranging from minor injuries to chronic systemic diseases. Given the functional importance of the fingers in everyday activities, even mild pain can significantly impair quality of life. Finger pain may originate from bones, joints, ligaments, tendons, nerves, blood vessels, or soft tissue structures. The underlying causes vary from acute trauma to degenerative arthritis and systemic inflammatory disorders. A structured evaluation and appropriate management plan are essential to prevent long-term disability.

Anatomy of the Finger

Each finger (except the thumb, which has two) consists of three bones (phalanges): proximal, middle, and distal. They are connected by interphalangeal (IP) joints and metacarpophalangeal (MCP) joints. Key anatomical structures include:

  • Bones and joints: Provide support and motion.

  • Ligaments: Stabilize the finger joints.

  • Tendons: Flexor and extensor tendons allow movement.

  • Nerves: Digital nerves provide sensation.

  • Blood supply: Supplied by digital arteries.

Pain in the finger can arise from injury or disease involving any of these structures.

Causes of Finger Pain

1. Traumatic and Mechanical Causes

  • Fractures and dislocations: Usually from falls, sports, or occupational injuries.

  • Sprains and ligament injuries: Excessive stretching or tearing.

  • Tendon injuries (e.g., mallet finger, jersey finger): Common in sports.

  • Repetitive strain injuries: Typing, gaming, or manual labor.

2. Joint Disorders

  • Osteoarthritis: Degenerative changes, particularly in distal interphalangeal joints (Heberden’s nodes).

  • Rheumatoid arthritis: Chronic autoimmune inflammation leading to pain, swelling, and deformity.

  • Psoriatic arthritis: Associated with psoriasis, causing dactylitis (“sausage fingers”).

  • Gout: Uric acid deposition in joints leading to acute painful flares.

3. Tendon and Soft Tissue Disorders

  • Trigger finger (stenosing tenosynovitis): Tendon thickening causing painful clicking or locking.

  • Tenosynovitis: Inflammation of tendon sheaths, often infective or overuse-related.

  • Dupuytren’s contracture: Fibrous thickening of palmar fascia leading to bent fingers.

4. Neurological Causes

  • Carpal tunnel syndrome: Compression of the median nerve causing pain, numbness, tingling in fingers.

  • Peripheral neuropathy: Diabetes or other systemic causes.

  • Nerve injury: Trauma or entrapment of digital nerves.

5. Vascular and Infectious Causes

  • Raynaud’s phenomenon: Finger pain with color changes triggered by cold or stress.

  • Infections (paronychia, felon, septic arthritis): Painful swelling with redness and tenderness.

Clinical Features

  • Pain characteristics: Sharp, throbbing, burning, or dull ache.

  • Associated symptoms: Swelling, redness, deformity, stiffness, numbness, reduced mobility.

  • Pattern: Constant vs intermittent, worse in morning (arthritis) vs with activity (tendon strain).

Diagnostic Approach

  • History: Onset, duration, aggravating factors, occupational history, systemic illnesses.

  • Examination: Inspection (deformity, swelling, erythema), palpation (tenderness, warmth), range of motion, neurovascular assessment.

  • Investigations:

    • X-ray: Fractures, osteoarthritis, gouty erosions.

    • Ultrasound/MRI: Soft tissue, tendon, and ligament pathology.

    • Blood tests: ESR, CRP, rheumatoid factor, uric acid.

    • Nerve conduction studies: Neuropathy and entrapment syndromes.

Treatment of Finger Pain

1. Non-Pharmacological Measures

  • Rest and splinting: Immobilization for fractures, sprains, or tendon injuries.

  • Cold compress: For acute injuries to reduce swelling.

  • Heat therapy: For chronic stiffness and arthritis.

  • Physiotherapy and occupational therapy: Stretching, strengthening, ergonomic training.

  • Lifestyle modifications: Weight control, joint protection techniques.

2. Pharmacological Management

a) Analgesics

  • Paracetamol (Acetaminophen): 500–1000 mg orally every 4–6 hours; max 4 g/day. Effective for mild to moderate pain.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

  • Ibuprofen: 400–600 mg orally every 6–8 hours; max 2400 mg/day.

  • Naproxen: 250–500 mg orally twice daily.

  • Diclofenac: 50 mg orally 2–3 times daily or as topical gel.

  • Celecoxib: 100 mg twice daily or 200 mg once daily (preferred in patients at high GI risk).

c) Corticosteroids

  • Prednisone: 10–20 mg/day orally for severe inflammatory arthritis.

  • Triamcinolone or Methylprednisolone injections: Directly into affected joint or tendon sheath (dose depends on joint size).

d) Disease-Specific Therapy

  • Rheumatoid arthritis:

    • Methotrexate: 7.5–25 mg orally once weekly.

    • Leflunomide: 10–20 mg once daily.

    • Biologics (Adalimumab, Etanercept, Infliximab): Administered subcutaneously or IV according to protocol.

  • Gout:

    • Colchicine: 0.6 mg orally once or twice daily.

    • Allopurinol: 100–300 mg daily for urate-lowering.

  • Infective causes:

    • Amoxicillin–clavulanate: 625 mg orally three times daily for soft tissue infections.

    • Clindamycin: 300 mg orally every 6–8 hours for penicillin allergy.

e) Neuropathic Pain Agents

  • Gabapentin: Start 300 mg daily, titrate up to 1800–3600 mg/day.

  • Pregabalin: 75 mg twice daily, increase if required.

  • Amitriptyline: 10–25 mg at night, titrated according to response.

3. Surgical Management

  • Fracture fixation: Open or closed reduction with internal fixation.

  • Trigger finger release: Surgical release of A1 pulley.

  • Synovectomy or arthroplasty: For advanced arthritis.

  • Drainage and debridement: For abscesses or septic arthritis.

  • Carpal tunnel release: For severe median nerve compression.

Prevention

  • Use protective gear in sports and manual work.

  • Practice ergonomic positioning in typing and repetitive tasks.

  • Maintain hand flexibility with regular exercises.

  • Control systemic risk factors like diabetes and hyperuricemia.

Prognosis

  • Minor injuries and strains generally recover with conservative treatment.

  • Chronic inflammatory disorders such as rheumatoid arthritis require long-term management but can achieve remission with disease-modifying therapy.

  • Untreated infections or fractures can lead to permanent deformity or loss of function.




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