Hand and Finger Injuries: Chronic Hand and Wrist Pathologies

Common chronic hand pathologies seen by family physicians include carpal tunnel syndrome, trigger finger, and de Quervain tenosynovitis. Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity and is caused by compression of the median nerve at the wrist. Trigger finger, also known as stenosing tenosynovitis, is caused by a metaplasia of the A1 flexor tendon pulley and the flexor tendon causing increased friction and decreased space for tendon gliding in the flexor tendon sheath. de Quervain tenosynovitis has a similar metaplasia of the tissues of the first dorsal extensor compartment over the radial styloid. For these pathologies, nonsurgical management includes activity modification, immobilization, and corticosteroid injections. Lack of benefit from these nonsurgical options is an indication for surgical referral.