Trigger finger syndrome: causes, symptoms and treatment. dr

What is trigger finger syndrome

(also known as stenosing tenosynovitis, stenosing ligamentitis, snapping finger, snapping finger, spring finger, spring finger, Knott's disease, nodular tendinitis, Digitus saltans)

This is a common hand disease that results in painful locking of one or more fingers in a flexion position. Women over the age of 50 are predominantly affected. In terms of frequency of lesions, the thumb is in first place, followed by the middle finger, followed by the index and ring fingers. Literally translated, “Tendovaginitis stenosans” means “compressive inflammation of the tendon sheath”; this disease was first described by A. Nott (1850). Tendon sheaths surround the extensor and flexor tendons of the hands, wrists, feet and ankles. Tendons are fibrous cords of tough tissue that attach the forearm muscles in the arm to the bones of the wrist, metacarpus, and fingers. This "muscle-tendon-system" allows flexion and extension of the wrist and fingers.
The tendons slide along the protective sheath, the so-called. tendon sheath, which consists of a strong outer and very delicate inner sheath (Synovialis). The job of the synovium is to prevent friction when the tendons that flex and extend the fingers slide.
In order to fix the flexor tendons in the peripheral parts of the palm and fingers on the bone during active flexion and prevent their extension, in many places there are so-called. annular and cruciate ligaments (Fig. 1).

The cause of trigger finger syndrome is an inflammatory narrowing of the tendon sheath, usually in the area of the A1 annular ligament, proximal to the main joint of the finger. Locking of the fingers in a flexion position can also be caused by thickening of the tendons. With inflammation of the tendon sheaths, the synovial membrane swells so much that it is difficult or completely impossible for the tendons to slide along it. Friction, and in the later stages, braking can even be felt by hand.
When the fingers (except the little finger) are strongly flexed, the thickened part of the flexor tendon is pulled through the narrow part of the tendon sheath (annular ligament) towards the body, passing through the narrow place is accompanied by a painful click. The thickened part of the tendon does not pass through the narrow place (annular ligament A1) and gets stuck in front of it (Fig. 2),

the finger is blocked in a bent position and only with great effort and overcoming pain can it return to an extended position.

Causes of Trigger Finger Syndrome

Anatomically, all people have a narrowing in the area of the A1 annular ligaments, i.e., a predisposition to the development of this disease with frequently repeated overload at work and at home. Activities that require constant grasping movements or prolonged use of tools that put pressure on the A1 annular ligaments and other parts of the tendon sheath during work can contribute to their irritation, leading to thickening of the tendons or tendon sheaths.
Symptoms of trigger finger can also occur with chronic polyarthritis (rheumatoid arthritis), gout and other metabolic diseases (eg, diabetes mellitus).
In children, the cause of the disease (Pollex flexus congenitus = congenital bent thumb) initially lies in a change in the tendon; it is too thick, which prevents it from sliding freely in the tendon sheath.

Signs and symptoms of trigger finger syndrome

Before the painful click characteristic of the diagnosis occurs when trying to straighten the finger, pain is felt in the peripheral part of the palm at the site of narrowing, that is, at the site of the A1 annular ligament. Pressure on the examined finger leads to increased pain.
In the early stages of the disease, difficulty gliding and friction of the flexor tendon, as well as a nodule in the area of the tendon in front of the annular ligament, can be felt. In the later stages of the disease, the sore finger may be blocked in a bent, or less often in an extended position. Patients with trigger finger syndrome often experience a clicking sound at the end joint of the thumb, and indeed, it is this joint that locks the thumb into a flexed or extended position. Despite this, the cause is still located in the area of the annular ligament A1 at the height of the main joint.

Trigger Finger Syndrome Diagnosis

As a rule, a typical medical history (anamnesis) and clinical examination identifying the described symptoms leads to a reliable diagnosis. Before surgery, an X-ray examination should be carried out to exclude causes of diseases related to bones or, for example, calcification of soft tissues.
In children, parents or a doctor notice if the end joint of the thumb is fixed in a bent or straightened position. The child screams when passively trying to straighten the thumb, which remains in a bent position.

Trigger Finger Syndrome Treatment

Conservative (if the finger is not blocked):
- Avoidance of disease-causing activities
- Immobilization
- Anti-inflammatory drugs for tumor relief:
  - tablets, syringes or suppositories (systemic administration)
  - local injection into the tendon sheath (controversial method)
- Local ice application
Operational:
If conservative treatment does not help, the patient suffers from pain and the finger is fixed in a bent or straightened position.

Anesthesia (narcosis)

There are various options to guarantee a pain-free operation for the patient. Your anesthesiologist will explain these options to you.

Operation methods

Surgeries for trigger finger syndrome are usually performed on an outpatient basis, which means that the patient can be sent home after surgery.

1. Preparation for surgery:

Bleeding:
The operation is performed on a bloodless arm in order to guarantee optimal visibility conditions and limit the risk of damage to important structures (nerves, blood vessels, tendons). The operated arm is wrapped in a rubber bandage and clamped in the shoulder with a pressure cuff for the duration of the operation.
Skin disinfection and covering with sterile cloth:
To avoid infection, the skin is disinfected and the surgical site is covered with a sterile cloth.
Magnifying glasses:
The operation is carried out with the use of magnifying glasses, which help to distinguish well and thereby protect the important functional structures of the hand.

2. Sequence of the operation:

Postoperative treatment

After the operation, the patient returns home, his fingers and, above all, the operated finger must remain in motion, but not overworked, in order to avoid adhesion and fusion of the flexor tendons, as well as contracture of the finger joints.
Constantly holding the hand in a raised position helps to avoid bleeding, swelling, pain, and guarantees healing of the wound without complications.
5th-7th day after surgery: first dressing change (may be performed by a family doctor).
14th day after surgery: change of bandage and removal of stitches (can be performed by a family doctor).
One day after the stitches are removed, the dressing is no longer needed. Start regular (3-4 times a day) exercises in cold water (add ice if necessary). Cold relieves swelling and pain. Patients who cannot tolerate cold take warm water.
Five days after the sutures are removed, treatment of the postoperative scar begins. Calendula ointment (or other fatty ointments) is rubbed into the scar 4-5 times a day, it softens, becomes elastic, less painful and sensitive. Patting the scar, for example with a soft brush, also helps.
Therapeutic exercises and/or occupational therapy are rarely required, but are prescribed immediately if movement difficulties arise.
The duration of the patient's disability is usually 3 weeks.

Healing process after surgery

Pain after surgery is usually minimal and most patients do not require painkillers.
Trigger finger symptoms and associated pain stop immediately after surgery, and in rare cases, friction in the tendons is felt, which completely disappear within a few weeks.
Negative sensations in the postoperative scar largely disappear after the first 6-8 weeks, after 3-6 months, patients no longer complain of pain in the scar. However, only after 12 months can we say that the scar has completely healed.

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Thanks to the device of the brush, each person can perform the most complex functions, such as capturing small details.

As a result of negative factors, this ability may be lost. One of the reasons that can induce them is the development of stenosing ligamentitis.

General clinical picture

"Trigger finger" - that's what the common people usually call a similar disease. It is usually given little importance, despite its danger.

Stenosing ligamentitis is an inflammatory process in which the annular muscle of the finger is affected. Thanks to her, he is set in motion. When this tendon is normal, the finger moves freely. In the presence of inflammation, the annular muscle increases in volume, often grows together with the tissues that surround it.

If the disease is too advanced, the finger will soon stop moving altogether.

Causes of the pathological condition

The most common causes of Knott's disease in adults include following:

Inflammation of ligaments and joints, including chronic diseases (polyarthritis, rheumatism, etc.);
Predisposition due to heredity;
The occurrence of overload due to prolonged manual labor;
Congenital structural features of the muscles, ligaments and tendons of the hand.

Stenosing ligamentitis in children is caused by the rapid growth of structures and tissues of individual parts of the hand.

There is a category of people whose risk of developing a similar disease is several times higher. IN risk group includes diseases such as gout, rheumatism, diabetes, arthritis. In this case, it is recommended to be more attentive to your own health, and to begin treatment when the first signs appear.

Symptoms of the disease

Stenotic ligamentitis has very pronounced symptoms. It includes the following list of signs:

At the moment of pressing on the base of the finger that is bothering you, the pain becomes brighter;
Decreased functioning;
The pain in the finger itself is not concentrated and may radiate to the forearm or hand;
A well-felt click that occurs when you try to straighten and bend your finger;
A dense, painful lump appears at the base of the finger.

Diagnostic techniques

The process of diagnosing trigger finger syndrome occurs directly from a doctor. A survey and examination of the finger is usually sufficient. As a rule, tests are not prescribed.

Stages of disease manifestation

The manifestations of this disease can be divided into three stages.

Pain and clicking first stage are still irregular, sometimes pass and do not bother you too often.

As soon as serious efforts are made to straighten the finger, we can say that the disease has developed to second stage.

As a rule, already at this stage the tendon thickens, and a lump forms under the sore finger.

Third stage characterized by the fact that the finger completely loses the ability to move. In any case, you should not wait for the last stage, since only timely treatment helps to get rid of the disease faster.

Healing procedures

The purpose of the appropriate procedures, of course, depends only on what stage the stenosing ligamentitis is at and what the age of the patient is. When treating stenosing ligamentitis in children, conservative therapy is more often used, while surgery is usually recommended for adults.

Conservative treatment

Most often, conservative treatment is applicable for stenosing ligamentitis. It is usually expressed in the use physiotherapy. Gradually, if the stage of the disease is too advanced or the procedures do not produce results, additional prescriptions are added in the form of special medications.

Mandatory immobilization for a period of at least two weeks. During this period, the hand, as a rule, is completely restored. This happens, of course, not independently, but through the use of different methods. For example, physiotherapy.

Most often, with stenosing ligamentitis, the following are prescribed: physiotherapy measures:

Electro- and phonophoresis with the use of special preparations;
Applications using paraffin or mud;
Ozokerite.

One of the procedures included in physical therapy - massage - should be excluded altogether. This is necessary so as not to worsen the condition of the inflamed tissues, since absolute rest is important for the hand.

Anti-inflammatory drugs may also be assigned additionally. For example, hydrocortisone, novocaine. All hormonal or nonsteroidal drugs Only a doctor can prescribe trigger finger treatment, who, based on research and the characteristics of the body, will select the most suitable ones.

Self-treatment in this case is not only not an option, but also a danger.

During the prescribed treatment period, it is important to completely forget about all stress. No work that involves prolonged strain on the wrist should be performed.

This applies not only to house cleaning, but also to activities that require fine motor skills of the fingers (embroidery, fiddling with small parts, knitting). The speed of treatment will depend on the observance of the principle of complete rest.

Surgical intervention

In many cases, conservative treatment may not produce results at all, or it will simply be short-lived.

In case of relapses, deterioration of the muscle condition, or if the stage of stenosing ligamentitis is very advanced, it is prescribed surgical intervention.

Closed ligamentotomy

The procedure is performed under local anesthesia. No incision is made, only a small puncture. Surgery for stenosing ligamentitis is performed using an eye scalpel.

The annular ligament on the hand is cut, and the depth of the cut will depend on how quickly the finger snapping disappears. It is characteristic that after such a simple operation only an aseptic dressing is applied, since the cut is very small.

In total, the duration of the surgical intervention does not exceed 20 minutes.

This method also has several disadvantages:

There is no visual control, which means that there are high chances of damaging something;
Possibility of damage to the flexor tendon;
The likelihood of a hematoma;
Relapses are possible.

Open ligamentotomy

The cut of the palm does not exceed 3 centimeters. The exposure of the annular ligament, inflamed and fused with other tissues, occurs in layers. Next, the ligament is dissected along the lateral surface.

After this, it is important for the surgeon to ensure that the flexor tendon glides freely. Sutures are placed on the wound and the hand is fixed with a plaster cast for several days. All stitches are removed after 2 weeks.

Forecast

After successful treatment, surgical or non-surgical, the functions of the hand are completely restored. This applies to all cases, except those in which complications may have arisen during treatment.

The percentage of relapse after surgical treatment is an order of magnitude lower compared to conservative treatment. Therefore, in some cases, the latter method of exposure is not used at all, and doctors immediately resort to surgery.

Video: Doctor explains why trigger finger syndrome occurs

The most complete answers to questions on the topic: “the joint of the thumb hurts and clicks.”

Inflammation of the flexor tendon of one of the fingers and the adjacent ligaments is called Knott's disease, or trigger finger; non-surgical treatment of this pathology is possible in the early stages, when the damaged finger is still able to straighten, albeit with great difficulty.

In the initial stage of development of the pathology, the only symptom is difficulty in straightening the finger, which is accompanied by a characteristic click.

After some time, pain appears when moving the affected finger and when palpating it. As the disease progresses, the pain spreads to the entire hand, wrist, and forearm.

In the third stage of the disease, a dense, painful swelling forms at the base of the finger, which makes a clicking sound. Fingers may go numb, the skin becomes pale with a bluish tint. Over time, movement becomes more and more difficult. This is due to the fact that as a result of inflammation, the tendon thickens and mechanically prevents the joint from bending. Gradually, ligaments are involved in the process, providing fixation of the phalanges. Eventually, the finger loses mobility and remains bent.

Trigger finger syndrome most often develops in children under 1 year of age and in women over 40 years of age. The reason for its manifestation may be:

heredity;
injuries;
functional overload;
joint disease;
bones and tendons (arthritis, including rheumatoid, arthrosis, gout, complications of diabetes);
disturbances in the structure of tendons;
difference in the growth rate of bone tissue and muscle tendons.

The most commonly reported injury is the annular ligament of the thumb.

Correction of trigger finger syndrome

Conservative and surgical treatment of Nott's disease is possible. If the finger has completely lost mobility, surgery cannot be avoided. But if flexion and extension are still possible, it is worth trying conservative methods of correcting the pathological condition. It is quite possible to cure trigger finger syndrome at an early stage and fully restore limb function.

In order to decide how to treat stenosing ligamentitis with the best result, it is very important to make a correct diagnosis at an early stage of the disease. X-rays are used to differentiate from arthritis and other diseases with similar symptoms.

First of all, the sore hand needs complete rest to allow the tissues to restore their physiological integrity. At the first stage of development of the pathology, if there is no pain, it is necessary to direct all efforts to strengthen the affected tendon, ligaments and muscles. For this purpose, apply:

fixation in a physiological position;
massotherapy;
special gymnastics and reflexology.

Treatment at home may include self-massage and gymnastics.

How to do self-massage

Before the massage session, you need to take a warm, relaxing bath for the injured hand with sea salt and essential oils. To do this, dissolve 3 tsp in 1 liter of water. sea salt and add 2-3 drops of essential oils of sage and yarrow. The massage is carried out as follows:

Using the thumb of your healthy hand, make circular stroking movements on the inside of the sore palm, then stretch the affected hand, spreading your fingers to the sides.
Using circular movements of the thumb of the healthy hand, stretch the back surface of the injured hand, placing it on the fingers of the healthy hand, straighten the fingers, stretch the wrist area. Movements should be careful, but noticeable.
Deflect the sore hand back as much as possible, straightening the wrist joint; it is important that the process does not cause pain.
Stretch the inner side of the palm with circular movements of the thumb of the healthy hand, starting from the wrist and moving through the pad of the thumb to the base of the little finger. Repeat the procedure on the back of your hand.
Work on all metacarpal bones, ligaments, tendons and phalanges of the fingers.
With the thumb and forefinger of your healthy hand, grasp each finger of the affected hand from the sides and press with pressure from the top to the base, then repeat the movement on the front and back surfaces of the fingers.
Spread the fingers of the sore hand and work the spaces between them, alternating stroking and pressing.
Finish the massage by rubbing each finger and hand completely.

The human hand is a unique and quite complex phenomenon; thanks to its structure, it can perform complex functions, such as grasping small objects. But this ability can be lost due to some negative factors, one of the reasons is that the person requires treatment for trigger finger syndrome. This is what people call the pathology, which in medicine is usually referred to as “stenosing ligamentitis.” Usually, few people begin treatment of stenosing ligamentitis in a timely manner, without attaching special importance to it.

Meanwhile, the pathology poses a certain threat, since it is an inflammation affecting the ring-shaped muscle of the finger. The finger is set in motion precisely thanks to it; in the case when the tendon is in order, it can move freely and carry out certain tasks. As soon as the inflammatory process manifests itself, the volume of the annular muscle increases, in some cases it fuses with the surrounding tissues. Treatment of trigger finger syndrome must be carried out without fail, since there is a danger that with its development the finger will completely lose the ability to move.

When extending or bending, many people's fingers click; most people consider this their physiological feature, which does not go beyond the norm. This assumption is erroneous; trigger finger syndrome is a pathology of the tendon-ligamentous apparatus of the hand - also called Knott's disease. Treatment of the developing syndrome is strongly recommended to begin as early as possible, since therapy is most successful at an early stage. Otherwise, the development of irreversible immobility of the joints is possible.

Knott's disease in adults most often develops for the following reasons:

Congenital anomalies in the structure of the tendons and ligaments of the hands;

Genetic predisposition;

Chronic diseases, inflammatory processes in the joints and ligaments;

Prolonged stress on the hands.

In children, this disease also occurs and is a consequence of rapid growth of tissues or individual structures of the hand. There are people who are in a special group at increased risk of developing this disease - these are patients diagnosed with diabetes, gout, and arthritis. If you have these diseases, you need to be especially careful about the first manifestations of trigger finger syndrome in order to begin treatment in a timely manner.

Symptoms of Nott's disease:

Dense, painful, small bump at the base of the finger;

Pain when pressing on the base of the finger intensifies;

The functional ability of the finger is lost;

The pain may radiate to the forearm;

When you bend or straighten your finger, a clearly felt click occurs.

Diagnosis of the disease is carried out by a doctor based on a survey and examination of the patient. Typically, the development of the disease is divided into 3 stages:

1 stage - clicking and pain do not occur often, they are irregular.

2 stage - significant effort has to be applied to straighten the finger, a lump forms, the tendon thickens.

3 stage - the finger stops moving at all.

Depending on the stage of development of the disease, treatment is prescribed. Another significant factor is the patient’s age; children are almost always prescribed conservative therapy; adults are often prescribed surgical intervention.

Conservative treatment is expressed in the use of physiotherapeutic procedures. If the disease is advanced, special medications are also prescribed. The hand is immobilized (immobilized) for at least 2 weeks while it recovers. Physiotherapeutic measures used in the treatment of the disease primarily include mud and paraffin applications, ozokerite, electrophoresis, and phonophoresis. To prevent aggravation of the condition of inflamed tissues, it is not recommended to carry out massage procedures; on the contrary, maximum rest is ensured for the affected limb. Additionally, medications are prescribed - novocaine, hydrocortisone.

Surgical intervention is indicated for advanced stages of stenosing ligamentitis, as well as for deterioration of the muscle condition or for relapses of the disease. The operation is performed under local anesthesia, its duration is no more than 20 minutes, and there is no need to make a large incision, all manipulations are carried out through a puncture. The disadvantages of this method include the likelihood of tendon damage, the appearance of a hematoma, and the possibility of relapse.

Overloading the fingers causes the tendons and tissues to become inflamed and subsequently become larger and damaged. This condition of the structures prevents the fingers or one finger from moving freely. Many people think that if treatment without surgery is impossible, but this is not so. There are some remedies that will help eliminate this disease.

Techniques that can be used at home primarily include taking medications that are purchased without a prescription. Medicines should be classified as non-steroidal with anti-inflammatory properties. These medications include:

Important: when purchasing medications, it is strictly forbidden to take them in combination with each other. Only one drug should be used to avoid mixing in the body of various components of substances that may be incompatible and cause harm to the body. It is also very important to know what stage of the disease is present, a qualified doctor will help with this. In order for medications to give the desired result, you must make sure that the disease is in the initial phase of development, otherwise the medications will not help.

Traditional medicine methods

The next treatment option for trigger finger is traditional medicine. Among the practice-tested methods, the following are distinguished:

Means	application
Medicinal mixture	In order to prepare the mixture, you will need: honey, mustard, oil and Caucasian hellebore. Grind the plant material (30g), mix it with liquid honey, add the remaining ingredients in an amount of 10 ml. Afterwards, pour the composition into a saucepan and place on a small fire, on which the composition should simmer until a mass of homogeneous structure is formed. It is recommended to store this mixture in a glass container, in a place where there is no light. The finger is treated twice a day until the click in the finger disappears. The pain syndrome should disappear in the first days of use.
Propolis	Propolis raw materials and vegetable oil are mixed in equal proportions. This remedy is used three times a day until cure.
Unripe potatoes	The poisonous unripe potato plant will relieve pain. To prepare the product, grind the unripe fruit into a mushy mass, which must be heated to 38 degrees, then wrapped in a piece of burlap. Application is to put potatoes on your finger every day and at night and cover the top with plastic wrap, and then bandage the finger tightly. Repeat the procedure until the click in the finger is eliminated.
Medicinal mixture No. 2	The mixture is prepared from ammonia and gum turpentine, which are mixed in equal quantities. Add raw chicken eggs (2 pieces) to the resulting mixture and beat until a composition with a creamy consistency is obtained. Processing is carried out daily three times a day.
Aloe	Taking into account the peculiarities of this plant, it helps eliminate swelling and relieve inflammation inside the tissues. In order for aloe to work, it should be applied with its pulp to the unhealthy finger and secured with film and bandage. This compress should be changed three times a day.

Baths to prevent finger snapping

In addition to using the above folk techniques, it is possible to use special baths that will speed up recovery:

For the bath you will need a sprig of needles. First, grind it, then add a liter of water and boil for a couple of minutes, and then leave to simmer for 30 minutes over low heat. Having completed the simmering process, the composition is filtered and when the temperature becomes tolerable for putting your hand into it, the procedure begins. The duration of the procedure is about 15-20 minutes.
A salt bath, which is prepared using sea salt and a few drops of pine needles, will have a quick, anti-inflammatory effect. You need to keep your hand in the bath for at least 20 minutes. Suitable for everyday use.
An elderberry bath is prepared from dry plant materials, which are filled with 800 ml of water at a temperature of 98 degrees. After this, you need to infuse for 30 minutes, and lower your hands for a 20-minute period of time. This recipe can be used twice a day.

Essential oil therapy for joint clicking

Another method that can be used at home to heal fingers and hands is the use of essential oils.

Splints - reducing the load on the trigger finger

When the trigger finger does not go away, and treatment with folk remedies for some reason does not help or is impossible, then an alternative measure is wearing splints that fix the finger in an extended state. This is necessary in order to prevent unwanted stress on the hand when bending. The duration of wearing such a device is up to six months. You can free your fingers from the splint only to do finger stretching exercises.

Help: you can make a splint from a splint and waterproof medical tape, which can be purchased at a pharmacy.

place your palm on a hard, flat surface;
with the other hand, press flat on the hand very slowly and carefully, while slowly stretching the ligaments;
It is recommended to fix the hand ligaments in a stretched position for no more than 30 seconds;
Perform no more than 5 repetitions at a time;
3 times a day.

Important: all movements when performing the exercise must be smooth and in no case cause sharp or sharp pain.

There is another option for doing hand exercises. They consist of pressing on the knot that has formed in the area of the hand, while simultaneously pulling back the finger that clicks.

Diet for joint restoration

It's no secret that good Vitamin B6 is an assistant in joint restoration. To promote rapid healing from finger clicking, we introduce into the diet foods that contain this element. It will also be mandatory to consume such products after the disease has subsided in order to maintain the diet. It is recommended to supplement the following:

raw garlic;
nuts (hazelnuts);
liver;
fish;
sunflower seeds;
pistachios.

In addition to food, there is an option to resort to consuming vitamin B6 in solutions or tablets. A course of injections of B vitamins would also be a good remedy.