Trigger finger (trigger finger syndrome; stenosing tenosynovitis; stenosing ligamentitis; snapping, spring, spring finger; Knott's disease; nodular tendinitis). The joint of the thumb hurts and clicks. The phalanx of the thumb clicks.

If the doctor has diagnosed trigger finger, treatment at home is supplemented with drug therapy, since the disease is accompanied by severe pain. The disease can occur with a concomitant infectious disease or injury, which causes hemorrhage into the ligament and the development of a hematoma. Let's take a closer look at what the disease is and why it may still occur.

Concept and causes of the disease

Snapping finger syndrome, or stenosing ligamentitis, is a disease of the hand that involves painful blocking and inability to straighten the finger, and it is constantly in a bent position. The thumb is often affected. The disease mainly affects mature females.

It is currently impossible to name the exact reasons why this disease occurs. It is for this reason that it is impossible to determine why one person developed the disease and another did not. But one thing is certain: ligamentitis is directly related to rheumatoid arthritis.

Most often, the small joints of the hand are affected and gout occurs, a disease that is accompanied by a violation of purine metabolism. The result is the deposition of uric acid salts in joints and tissues, and this is the background for the development of an inflammatory reaction, including tendons. It is also worth mentioning diabetes mellitus as the cause of the disease. In diabetes mellitus, carbohydrate metabolism in the body is disrupted and pathological protein is deposited in certain tissues. In this case, we can talk about connective tissue in which inflammation occurs due to protein deposition.

With increased loads on the fingers, tendon injuries, including microtraumas, can occur. People who engage in professional activities that involve constant squeezing of objects in their hands are most susceptible to tendon injuries.

If we talk about the occurrence of the disease in children, there are some nuances. The opinion of some researchers is that the development of trigger finger disease is associated with congenital tendon pathology. Others believe that the disease is caused by a primary inflammatory process. Some experts believe that stenosing ligamentitis in a child may appear against the background of uneven maturation of a certain structure of the musculoskeletal system.

What are the symptoms and signs of the disease?

Symptoms of stenosing ligamentitis are as follows:

when extending and bending, the finger may click, especially difficulties arise in the morning;
pain syndrome when pressing on the hand at the base of the affected phalanx;
when palpating the base of the affected phalanx, you can feel a dense tumor;
as the disease progresses, the pain syndrome can radiate to the shoulder area and throughout the arm;
impaired mobility of the affected phalanx.

All symptoms can be divided into 3 groups depending on what stage of the disease is diagnosed:

Stage 1– Mild discomfort at the base of the affected finger, periodic clicking when flexing and extending the phalanx.

Stage 2– Thickening of the tendon, extension of the finger with great difficulty, pain syndrome when palpating the area of the palm in which the tendon passes.

Stage 3– Fixation of the finger in a bent position without the ability to straighten it independently. In this case, only surgery will help.

Treatment

As a rule, after identifying the symptoms, the doctor can make a diagnosis. But additional ultrasound and magnetic resonance imaging are still necessary, thanks to which it is possible to determine how affected the tendon-ligament apparatus is.

The doctor determines the treatment complex based on the nature of the progression of ligamentitis and the age of the patient. The appointment of an individual treatment regimen is carried out taking into account the severity of symptoms, the activity that the person is engaged in, and the effectiveness of the treatment that was carried out previously.

It is possible to prescribe both conservative and surgical treatment methods. You can supplement the main treatment with folk remedies, which will be discussed below. In any case, all measures should be taken that should be aimed at stopping the progression of the disease.

Conservative treatment with folk remedies, as well as medications, is indicated if the disease is diagnosed in the early stages of its development. To eliminate the pain syndrome and stop the inflammatory process, special medications are prescribed: non-steroidal drugs, glucocorticoid drugs. Regardless of who is diagnosed with the disease, a child or an adult, hydrocortisone must be taken in the acute and subacute stages of its course.

In addition to medications, physiotherapy procedures are indicated, for example, baths followed by the application of compresses. No less effective are mud therapy (peloid therapy), phonophoresis and electrophoresis. Severe pain is recommended to be treated with laser therapy. Although some doctors recommend immobilizing the hand for ligamentitis, this is still not entirely advisable, since active movements help improve blood circulation and reduce congestion.

If there is a chronic course of the disease, severe limitation of finger movement can be eliminated by administering injections with hyaluronidase-active drugs.

Folk remedies

Many people wonder how to cure gout at home, which caused the development of ligamentitis? An addition to treatment are considered folk remedies, which are based only on natural ingredients and which will help get rid of one or another disease. Some of them include:

Treatment with clay at home. Grind the clay to a powder or buy ready-made clay, then dilute it with water. After this, the mixture has a creamy consistency. Next, add 30 ml of apple cider vinegar and mix. The treatment is ready. Compresses are made on the affected finger, securing it with cellophane on top. The procedure is carried out over 2 hours.
Horseradish treatment. You can make compresses with cabbage leaves and horseradish.
Treatment of a hematoma that causes ligamentitis can be carried out using dry heat. To do this, you need salt, which is heated in a frying pan and then poured onto a cloth. Apply a compress to the required area, while waiting for the salt to cool completely.

Hematoma can also be treated at home using wormwood. So, they grind the grass, place it in a jar and fill it with vodka. Leave the product to infuse for 7 days, then use it as compresses.
You can use ointments prepared at home. Grind calendula flowers and mix with any cream. Leave the product to brew for 24 hours in a cold corner of the room. After the prescribed time, lubricate the affected area.

When is surgery scheduled?

If the disease is diagnosed at an advanced stage, for example, at the 3rd stage, such a person must be sent for surgery. Individual surgical tactics are indicated if the patient is elderly, as well as with somatic pathologies. In some cases, the operation is canceled and conservative treatment is carried out. If conservative treatment is not effective, severe pain is observed, which makes it difficult for a person to self-care, the operation is performed without taking into account the person’s age.

The technique for performing the operation is as follows:

Making an incision.
Soft tissue dislocation to access the tendon sheath and annular ligament.
Next, the doctor bends and straightens the finger to determine the location of the stenosis.
Inserting a probe under the ligament and dissecting the tissue.
Flexion and extension of the finger to assess the condition of the tendon.
If everything is done accurately, the wound is washed and sutured.
Applying a bandage.

In the postoperative period, antibiotics, analgesics, and physical therapy are prescribed. Suture removal is usually scheduled on the tenth day after surgery.

In some cases, the doctor may perform a closed ligamentotomy, which involves cutting the ligament through a puncture. But after such an operation the likelihood of relapse increases.

In any case, treatment should only be prescribed by a doctor, because the risk of developing dangerous complications is present with every disease.

Snapping finger syndrome is a pathology that is accompanied by difficulties in flexing and extending the fingers. This phenomenon is the result of changes in the synovial cavity, during which the proper functioning of the tendons in the hands is disrupted. With this disease, the fingers have difficulty bending, and a sharp click occurs when straightening. This pathology in medicine is called stenosing tendovaginitis or ligamentitis, nodular tendonitis or spring finger.

Basic Concepts

Before starting treatment, it is necessary to understand the essence of the disease and the reasons for its occurrence. Trigger finger syndrome is one of the pathologies of the connective tissue and musculoskeletal system.

The majority of patients with this diagnosis are women. In representatives of the fairer sex, the first finger of the hand is most often affected; much less often, such symptoms appear on the 3rd or 4th finger.

Causes of the disease

In the body of a healthy person, the tendon-ligamentous apparatus is capable of producing a special fluid (synovial). It is this that protects individual parts of the joints from abrasion and rapid wear.

Under the influence of certain factors, the amount of fluid released decreases, the annular ligament thickens, and the lumen of the canal becomes smaller. Such changes lead to disruptions in the functioning of the tendon-ligamentous apparatus. Parts of the joints stop sliding and rub against each other. This causes microtrauma and the appearance of growths.

Risk factors

The following factors may increase your risk of developing trigger finger syndrome:

Increased load on the hands. This risk group includes people engaged in manual labor: seamstresses, drivers, mechanics, workers engaged in manual production of certain types of products.
Diabetes mellitus.
Pregnancy. During this period, women's blood circulation is impaired, which contributes to the appearance of foci of inflammation in the joints.
Incorrect (uneven) bone development in childhood and adolescence.
The presence of diseases such as gout and rheumatoid arthritis.
Anomalies and pathologies of the phalanx joints.
Heredity. If among close relatives there is a person diagnosed with nodular tendonitis, then the risk of the disease in the heirs increases.

Symptoms

The signs and symptoms of trigger finger syndrome are quite common. They can be confused with swelling or other pathologies only at the initial stage of development. It is at this time that symptoms manifest themselves extremely weakly. patients are observed:

Painful sensations. At the very beginning of the pathological process, pain rarely occurs. Most often this happens in the morning after waking up. At this stage, the pain is characterized as weak, passing if the hand is left without movement. Lack of treatment leads to increased pain.
Severe pain when touching the affected area and when exerting physical activity on the fingers.
Decreased motor activity and range of motion of the fingers (it becomes difficult to bend and straighten them).
Increased joint hardening and thickening.

Incorrect selection of treatment or its complete absence leads to increased symptoms and deterioration of the patient’s condition. As the disease progresses, the following are observed:

Severe pain is present even at rest and without stress.
Pain sensations are concentrated not only in the area of the affected joint, but also spread to the hand, forearm or even shoulder.
When you bend and straighten your finger, a click occurs.
A possible complication is the form of a large, painful lump located at the base of the finger.

Stages of the disease

In medicine, there are 3 stages of development of trigger finger syndrome:

1st stage. The very beginning of the development of the disease. Symptoms are mild and there is minor pain.

2nd stage. It is at this stage of the disease that many patients come to the clinic, as the symptoms become more pronounced.

3rd stage. This period is accompanied by complications and requires long-term complex treatment.

Diagnostics

Diagnosis (snapping finger) can be based on the patient's complaints and initial examination. During this procedure, the doctor checks the functionality of the joint, its condition, the presence of compactions and swelling.

In some cases, ultrasound diagnostics is required to obtain additional data. During an ultrasound examination, it is possible to obtain information about the condition of tendons and muscles.

Conservative treatment

People suffering from this disease often ask the question of what to do when they snap their fingers and whether it is possible to completely get rid of this pathology.

In cases where the disease is detected in the early stages and is not complicated by intense pain and hardening, conservative treatment is sufficient to restore the function of the joint. Doctors may prescribe several types of therapy depending on the characteristics and complexity of the diagnosis.

Fixation of the hand. Sometimes, to eliminate the symptoms and causes of the disease, it is enough to reduce the load on the arm. To do this, a special splint is placed on it, which fixes the finger.
Massage. Massage procedures are often included in complex therapy for nodular tendinitis. This effect restores proper blood circulation and helps reduce inflammation.
Therapeutic and preventive exercises. In many cases, when treating stenosing ligamentitis (trigger finger syndrome), therapeutic exercises are recommended. However, you should not do them yourself. For stage 2 and 3 disease, this approach is recommended to be used only at the recovery stage.
Cold compresses. Exposure to cold will reduce pain, but will not eliminate the cause of the disease.
Steroid drugs. The presence of pronounced symptoms requires a course of steroid injections. Such drugs act locally (in the affected area) and help eliminate inflammation, pain and other manifestations. In severe cases, several courses may be required intermittently.

Percutaneous release

How to cure trigger finger syndrome without surgery if medications and massage do not help? In such cases, doctors often resort to percutaneous release. This procedure is an impact directly on the source of pathology.

A needle is inserted into the area of the damaged joint, with the help of which tissues and formations that interfere with the normal functioning of the joint are destroyed. After this, additional therapeutic measures (massage, exercises) are prescribed.

Surgical intervention

Surgery for trigger finger syndrome is prescribed in cases where therapeutic methods of treatment do not give the desired result. During this procedure, the surgeon makes an incision at the base of the finger and removes the overgrown tendon tissue, as a result of which the motor activity of the joint is completely restored.

This operation takes little time, and the small incision facilitates a quick recovery.

In the postoperative period, the doctor may prescribe additional treatment, temporary fixation of the finger, and other treatment options.

Treating trigger finger syndrome at home

In addition to traditional methods of therapy, there are many folk recipes, but several features should be taken into account before using them.

If after 10-14 days of treatment according to the prescriptions of healers, there is no improvement and the intensity of symptoms has not decreased, it is recommended to abandon traditional methods of therapy and seek medical help.

The healers have the following recipes in their collection:

Compresses made from raw potatoes. To prepare the remedy, raw potatoes are peeled and crushed. This can be done using a blender or fine grater. The resulting pulp is heated to a temperature of 37-38 degrees, wrapped in a bandage or gauze and applied to the sore joint overnight. A scarf or woolen cloth is placed over the compress. This recipe will help quickly relieve pain and swelling.

Aloe pulp. The medicinal plant aloe helps to quickly eliminate inflammation and swelling. Use it as a compress. A piece is cut from a fresh leaf, which is slightly larger in size than the size of the damaged joint. This fragment of the leaf is divided lengthwise into 2 halves and the pulp is applied to the skin. This compress is fixed with a bandage or gauze. You need to change the aloe leaf 3 times a day.
Cabbage leaf compress. The familiar white cabbage is an effective folk remedy for treating trigger finger. A piece of cabbage leaf is separated from the head of cabbage, lightly crushed (to make the leaf softer) and applied to the sore joint. Fix the sheet with a bandage. Repeat for 10 days.
Propolis. Propolis raw materials are mixed in equal quantities with vegetable oil. The resulting liquid is treated with the finger daily for 2 weeks. Propolis is famous for its anti-inflammatory properties, so this medicine is good at blocking many of the symptoms of Knott's disease.
Eucalyptus decoction. For 1 tbsp. a spoonful of dry crushed leaf of the plant requires 1 tbsp. boiling water Eucalyptus is brewed and left covered until it cools. This decoction should be used for compresses. To do this, gauze or bandage, folded in several layers, is moistened in the broth, lightly wrung out and applied to the sore joint overnight. This compress quickly relieves pain and alleviates the condition.
Clay and arnica compress. For this recipe you will need arnica tincture and medicinal clay. These ingredients are sold in every pharmacy. A small amount of ingredients (they need to be taken in equal parts) are mixed until a homogeneous mass is obtained. It should be of such consistency that it can be formed into a cake and applied to the joint. The first procedure should last no more than 40-45 minutes. The second session is about 2 hours. If such a remedy does not cause redness, leave the compress overnight. To prevent the mass from drying out quickly, apply a film and a bandage over it.

Prevention

The above methods and remedies fully answer the question of how to cure trigger finger syndrome. There are many treatment options now, but it is much easier and faster to block Knott's disease at the earliest stages of development.

The periodic appearance of swelling of the fingers, a feeling of numbness and tingling indicate that problems have begun. In this case you can:

Give your hands a long rest.
Alternate types of load.
Use Ibuprofen ointment to relieve inflammation, swelling and pain.

At the same time, you need to remember that you should not delay your visit to the doctor. Even treatment with effective means should be started only after a medical examination and diagnosis. The maximum effect is achieved when using complex treatment methods.

Stenosing digital ligamentitis is an uncommon condition. Its development is not preceded by an infectious process in the body, hormonal imbalance or traumatic injury. However, the patient suffers greatly from the symptoms of the disease. He cannot move his fingers, bend them or straighten them. Treatment should begin immediately after confirmation of the diagnosis. Otherwise, major surgery will be required.

Anatomical certificate

To understand the essence of the pathological process, it is necessary to consider how the tendon functions in a healthy person. Fingers perform a tremendous amount of movement every day. Such activity is possible only due to the continuous work of tendons and ligaments. When the finger is bent and straightened, the corresponding tendon slides in the connective tissue channel. If the inflammatory process develops, it increases in size. Therefore, during the next movement of the finger, the tendon may extend beyond the canal. Subsequently, it always returns to its place. In particularly serious situations and with severe swelling, the well-functioning mechanism of operation loses its functionality. Free sliding becomes impossible. In this case, they talk about the development of a disease such as stenosing ligamentitis.

Forms of pathology

Doctors distinguish several types of this disease. The separation occurs on the principle of determining the ligaments involved in the pathological process.

Knott's disease. It is popularly called the “snapping finger.” Lack of timely treatment threatens secondary joint deformation and limited hand mobility.
De Quervain's disease. Inflammation of the abductor muscle leads to friction between the sheaths of the swollen tendons and the walls of the canal in which they move. As a result, severe pain appears at the base of the finger.

Determining the type of pathological process helps the doctor prescribe effective therapy.

Features of stenosing ligamentitis of the thumb

Stenosing ligamentitis of the thumb manifests itself as a violation of flexion-extension function. The pathological process goes through several stages of development. It begins with the formation of a small compaction at the base of the finger. At the second stage, the patient already has some difficulties in straightening the phalanx. At the next stage, the clinical picture is complemented by the “jackknife” symptom. When the finger is bent, the tendon running under the thickened ligament is slightly delayed. During its extension, a characteristic click occurs. In the absence of quality therapy, the pathology leads to permanent deformation of the joint.

How can stenosing ligamentitis of the thumb be cured? The operation, carried out in a timely manner, allows you to relieve unpleasant symptoms and restore limb mobility. In young children, treatment of the disease usually begins with conservative therapy. However, only in isolated cases do such attempts bring the desired result.

Why does inflammation develop?

Stenosing ligamentitis of the fingers is usually associated with increased load on the ligamentous apparatus. Monotonous movements characteristic of manual labor require constant tension of the muscles of one group. As a result, the tendon canals narrow and the ligaments are compressed. Builders, cutters, installers and musicians most often find this type of problem.

Other factors that provoke the development of the disease among adults include:

Age and gender. The pathological process develops several times more often in women over 40 years of age.
The presence of systemic chronic diseases (gout, diabetes, rheumatism).
Conditions that cause water retention in the synovial membranes (hormonal imbalance that occurs during pregnancy or menopause).

Finally, doctors were unable to study stenosing ligamentitis. However, it is known for sure that the hereditary factor plays an important role in the development of the disease.

Causes of illness in young children

In pediatric practice, there are numerous cases of diagnosing stenosing ligamentitis. Doctors explain the development of this disease in childhood with various hypotheses. Some talk about the relationship between the pathological process and congenital tendon anomalies. Others believe that it is based on a primary inflammatory process. The third group of specialists considers the disease from the point of view of uneven development of various elements of the supporting apparatus.

The tendons of the hand muscles grow several times faster than the ligaments. Therefore, these structures are gradually compressed, and pathognomonic nodules appear in their place. As a result, the tendons cannot slide freely in their channels. This leads to limited mobility, and in the future - to permanent flexion contracture.

Clinical picture

Stenosing ligamentitis develops gradually. Each of its varieties is characterized by certain characteristics. The main symptom is pain. It can be localized exclusively in the area of one finger or palmar surface, but most often spreads to the forearm. This creates a feeling of numbness.

During the course of the disease, it is customary to divide several stages: acute, subacute and chronic. At the initial stage, pain is very pronounced. When pressing on the ligaments or performing any work, the discomfort increases. This stage can last up to 2 months.

The subacute stage is characterized by a wave-like course with a periodic increase in clinical symptoms. Patients note the appearance of a “snapping finger”. At the same time, work ability already suffers. The duration of the subacute stage is from 2 to 6 months. If you do not consult a doctor at this stage or a little earlier, the pathological process becomes chronic.

Diagnostic methods

If symptoms indicate stenosing ligamentitis appear, only a doctor can prescribe treatment. However, before this you will need to undergo an examination, the purpose of which is to confirm the disease. You can seek help from an orthopedist or traumatologist. First, the doctor examines the patient's medical history. After this, he proceeds to inspect the affected area. To clarify the diagnosis, MRI, ultrasound or x-ray of the fingers are most often prescribed. Laboratory tests may be required to determine the cause of the inflammation that has developed.

Based on the test results, the doctor confirms or refutes the preliminary diagnosis and prescribes treatment. Therapy for this disease can be either conservative or surgical. Let's consider each of the options in more detail.

Conservative methods of therapy

Surgical intervention for this disease can only be avoided if it was detected in a timely manner. First, the affected area must be immobilized. This will allow the ligaments to recover faster. The joint is immobilized for about 2 weeks.

Non-steroidal anti-inflammatory drugs and hormonal drugs are usually prescribed as medications. NSAIDs are used in the form of injections, tablets and ointments for local therapy. They allow you to relieve pain and stop the development of inflammation. Among the drugs in this group, the most effective are: Ibuprofen, Piroxicam, Tolmetin.

Hormonal medications help relieve swelling and eliminate inflammation. Among the variety of medications in this group, Hydrocortisone deserves special attention. Injections of this medicine are made directly into the affected area.

What other treatment is provided for stenosing ligamentitis? The use of physiotherapeutic procedures has a beneficial effect on the patient's condition. The most commonly used are paraffin applications, phonophoresis, and ozokerite. Massage sessions for this disease are not recommended, since impact on the affected areas can only aggravate the inflammation.

Surgical intervention

If stenosing ligamentitis of the hand cannot be treated conservatively, the doctor decides to perform surgery. It rarely causes complications, but allows you to eliminate unpleasant symptoms. For this disease, a procedure called ligamentotomy is recommended. It comes in two types.

Private method. During the operation, the doctor makes a small puncture through which he cuts the annular ligament at the site of the seal. Then the wound is treated with an antiseptic solution and a bandage is applied. The operation lasts no more than 20 minutes and involves the use of local anesthesia.
Open method. The doctor makes a small incision in the palm of the hand, through which he gains access to the inflamed annular ligament. Then he cuts it open. Sutures are placed on the wound, and the hand itself is fixed with a plaster cast. After about 2 weeks, all cosmetic defects are eliminated.

Surgery is possible even in small patients diagnosed with stenosing ligamentitis. The operation allows you to eliminate the pathology in one day. After this, physiotherapy in combination with physical therapy is recommended.

Help from traditional medicine

In some cases, conservative treatment of the disease can be supplemented with alternative medicine recipes. However, you should first consult your doctor. What remedies do traditional healers recommend?

Stenosing ligamentitis of the finger is characterized by a specific localization, and therefore responds well to treatment with compresses and lotions. For example, you can make medicine using potatoes. The raw tuber must be grated and slightly squeezed. The resulting pulp should be applied to the joint, and then covered with a gauze bandage. It should be changed several times a day.

Dry heat also helps with this disease. You can heat coarse sea salt in a regular frying pan. Then it must be transferred to a fabric bag or scarf and wrapped. The resulting product should be applied to the affected area until the salt cools completely.

The listed recipes are the most effective, according to patients diagnosed with stenosing ligamentitis of the thumb. Treatment exclusively in this way and without the use of surgical manipulations is not recommended. In this case, it will not be possible to avoid negative consequences.

Forecast

If the patient consults a doctor in a timely manner and undergoes the prescribed treatment, the prognosis is favorable. Hand functions and ability to work are completely restored.

When complications arise during therapy, the patient can expect very unpleasant consequences. It is worth noting that after surgery the percentage of relapses is much lower when compared with conservative treatment. Therefore, today many doctors prefer to perform surgery immediately. The only exceptions are cases of illness among young patients.

Prevention measures

It is easier to prevent any disease than to treat it later. This statement is also true for such a problem as “snapping finger”, or stenosing ligamentitis. Prevention of pathology consists of eliminating overstrain in the area of joints, ligaments and tendons. If the load is unavoidable, it should be dosed, and breaks should be taken during work.

A characteristic symptom of this disease is pain at the base of the affected finger. It hurts when pressing or performing small movements. Often a swelling forms over the sore spot. At this stage, you can already feel the compaction in the tendon in the palm at the base of the finger.

After some time, the pain begins to bother you not only with movement and pressure, but also at rest. When bending and, especially, when extending, the sufferer feels some kind of interference. To perform an action, you need to exert more and more effort. Often patients feel a click in the area of the last joint, after which the finger is fixed in a bent position.

And then there comes a period when it becomes impossible to bring the finger into an extended or bent position.

Description

The snapping finger was first described by A. Nott, after whom this disease is named. In 1850, he published the article “Research on a peculiar disease of the tendon sheaths of the hand, characterized by the development of nodularity of the tendon canal of the flexors of the fingers and an obstacle to their movement.” And the first operation to get rid of this disease was performed by Schönborn in 1887. The operation was successful, but what was much more important was that during this operation the doctors had the opportunity to figure out what was really going on in the fingers with Knott's disease.

Stenosing tenosynovitis is a compressive inflammation of the tendon sheath. A tendon is a cord of fibrous tissue that attaches a muscle to a bone. They are surrounded by a protective sheath - the tendon sheath. It prevents friction when the flexor and extensor tendons slide. The tendons of the finger flexor muscles exit through the carpal tunnel into the palm, and from there diverge to the fingers. Moreover, only one flexor tendon goes to the first finger, and two to the others. And to fix the flexor tendons and prevent the extension of the fingers, there are annular ligaments. As a rule, compressive inflammation occurs in the area of the annular ligament. It develops when the ligaments are overloaded or under constant pressure on them.

With inflammation, not only does the annular ligament narrow, but part of the tendon also thickens. It is when this thickened part is squeezed through the narrowed ligament that the click occurs. And after some time, the thickened part cannot pass through the ligament and gets stuck in front of it.

This is an occupational disease that occurs mainly in young people whose work requires a lot of stress on their fingers. At risk are electric welders, polishers, cutters, stampers, trimmers and masons, as well as representatives of other professions in which chronic trauma to the hands occurs. Any job in which a person constantly makes grasping movements or in which something puts pressure on the palm in the area of the annular ligaments can cause trigger finger.

It happens that trigger finger develops in children. This occurs because the tendon is too thick and cannot slide normally in the tendon sheath.

Diagnostics

To make a diagnosis, an examination of the patient, medical history and an x-ray of the hand are required.

The trigger finger must be differentiated from arthritis and arthrosis. In contrast to this disease, those suffering from arthritis and arthrosis do not develop a lump in the palm at the base of the finger. X-rays of the hand for these diseases will also differ. However, often the trigger finger develops against the background of arthritis and arthrosis, and then the diagnosis becomes more complicated.

Also, this disease must be differentiated from various injuries and Dupuytren's contracture. Symptoms of this disease can also appear in diseases associated with metabolic disorders, for example, diabetes mellitus or gout.

Treatment

Treatment for trigger finger can be conservative or surgical. Conservative treatment consists of eliminating the cause of the disease, immobilizing the finger, and physiotherapeutic procedures. Anti-inflammatory drugs are also prescribed.

Conservative treatment can take a long time, but it does not always lead to a cure. And if it doesn’t help, the finger is still motionless and hurts, then surgery is performed. During the operation, the annular ligament of the fingers is cut. After discharge from the hospital after surgery, the patient should exercise his fingers, but not overload them. This must be done to avoid contractures and fusion of the tendons of the fingers. After the operation, the patient is unable to work for approximately 3 weeks. However, the success of the operation can only be judged after a year.

Prevention

Prevention of trigger finger involves preventing injury and maintaining good industrial hygiene. And the last one is very important. There are cases where workers developed trigger finger because they violated work rules, for example, cutting 8 or more layers of fabric instead of 5. The disease develops very quickly, so at the first symptoms that arise in the hand when changing the type of activity or work procedure, you need to contact an orthopedist.

Doctor Peter

Trigger finger syndrome (stenosing tenosynovitis) is an inflammation of the tendon tissue and the sheath that covers it. This is a fairly painful condition in which the finger snaps or jams when bent. When the disease becomes severe enough, the finger becomes stuck in a bent position and then releases with a click, like pulling a trigger. The risk group includes people whose professional activities involve frequently repetitive movements, as well as those suffering from arthritis and diabetes. When prescribing treatment, the doctor will take into account the severity of the disease, as well as its causes. Therefore, an accurate diagnosis is of great importance.

Steps

Part 1

Treatment at home

Give yourself a rest if your work involves frequently repetitive movements. In most cases, the cause of stenosing tenosynovitis is constant stress on the hand or frequent flexion of the thumb or index finger. Farmers, typists, workers or musicians are at risk because people in these professions constantly repeat monotonous movements with their thumb and forefinger. Even smokers are at risk because they constantly use a lighter. If possible, stop or limit repetitive finger movements and the pain and discomfort will likely improve on their own.

Apply ice. A cold compress is a very effective remedy for the treatment of almost all minor injuries of the musculoskeletal system, including stenosing tenosynovitis. Apply an ice pack (ice wrapped in a thin towel or a frozen gel pack) to the inflamed tendon (it usually looks like a small bump or nodule on the bottom of the finger or palm and is very tender to the touch) to reduce swelling and pain. Apply ice every hour for 10-15 minutes. This will reduce pain and swelling.

Apply ice to the damaged area and secure with a bandage or elastic bandage. This will reduce the inflammatory process. However, do not tie the elastic bandage too tightly, otherwise completely restricting blood flow may cause further damage to the finger.

Take non-steroidal anti-inflammatory drugs, which can be purchased without a prescription. Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, or aspirin are used as symptomatic treatment. These drugs are recommended to relieve pain and inflammation. The dosage for adults is usually 200-400 mg, taken orally, every 4-6 hours. Please note that these drugs have side effects: abdominal pain, as well as liver and kidney dysfunction. Therefore, do not use these medications for more than two weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastritis and ulcers.
Stretch the affected hand. Follow this advice if the problem has not yet taken a serious turn, the disease is only at the initial stage. Place your palm on the table. Gently stretch the ligaments of the hand by pressing the entire palm onto the table surface. Lock the position and hold for 30 seconds. Repeat three to five times a day. As an alternative, try stretching the sore finger with your other hand, applying gentle pressure and massaging the sore nodule (if noticeable).

Part 2
Medical treatment
1. Choose finger splints. Your doctor may recommend that you wear splints at night to keep your fingers extended while you sleep. You will have to wear splints for about six weeks. Thanks to the use of a splint, you will not put your fingers into a fist while sleeping, which aggravates the course of the disease.
  - During the day, remove the splint to do finger stretching exercises and gentle massage.
  - Alternatively, you can make your own splint. To do this, purchase an aluminum splint and waterproof medical tape from the pharmacy.
2. Ask your doctor about corticosteroid injections. Steroid injections into the tendon area help reduce inflammation and restore normal finger movement. As a rule, corticosteroid injections are prescribed primarily for stenosing tenosynovitis. Usually the doctor prescribes two injections (with an interval of 3-4 weeks). This is a fairly effective treatment method; recovery occurred in 90% of cases. The most common drugs are prednisolone, dexamethasone and triamcinolone.
  - Possible complications with corticosteroid injections include infection, bleeding, decreased tendon reflexes, muscle wasting, and nerve irritation or damage.
  - If corticosteroid injections are not effective, your doctor may suggest surgery.
3. Surgical intervention. The main indications for surgery are the ineffectiveness of corticosteroid injections, wearing a splint or other methods discussed above. Additionally, your doctor may suggest surgery if your finger is severely bent or sticks when flexed. For this pathology, two types of surgical intervention are used: open ligamentotomy and percutaneous ligamentotomy. With an open ligamentotomy, an incision is made at the base of the sore finger, which releases the annular ligament layer by layer. The dissection is performed along its lateral surface. With percutaneous ligamentotomy, the ligament is dissected without making an incision in the skin using a thin needle.
  - As a rule, these types of surgical interventions are performed on an outpatient basis under local anesthesia.
  - Possible complications after surgery include infection, allergic reaction to the anesthesia, nerve damage, and prolonged swelling/pain.
  - The relapse rate is only about three percent. The operation may not be effective if the patient suffers from diabetes.
Part 3
Prevention of possible complications and diagnosis of other diseases
1. Treat the infection or allergic reaction. In some cases, trigger finger syndrome is caused by an infection of the synovium. If the joints or muscles of the finger are red, warm to the touch, and inflamed for several hours or days, seek immediate medical attention because these signs indicate an infection or a possible allergic reaction to an insect sting. Standard treatment is incision and drainage, warm water and salt baths, and in some cases antibiotics may be necessary.
  - Diseases caused by bacteria are the most common. The risk of infection is higher if the wound is poorly treated. Additionally, ingrown toenails and puncture wounds can lead to serious infections.
  - Allergic reactions to insect bites are quite common, especially bee, wasp and spider stings.
2. Treat a dislocated joint. A dislocated finger joint is sometimes mistaken for stenosing tenosynovitis because the patient experiences pain as well as a visible change in the joint similar to that seen in trigger finger syndrome. This type of injury is often caused by a blow to the joint with a blunt object. Snapping finger syndrome, in turn, is associated with constant tension. Therefore, if you suspect a dislocated finger joint, seek medical attention immediately. In this case, the doctor will realign your joint. After your doctor adjusts your joint, he will give you recommendations similar to those for trigger finger syndrome: rest, anti-inflammatory medications, ice, and splinting.
  - Fractures and dislocations are not always easy to distinguish. In some cases, additional research methods, such as x-rays, are required.
  - You can see an osteopath, chiropractor and physiotherapist in addition to your GP.
3. Treat arthritis. Trigger finger symptoms are very common in rheumatoid arthritis and gout. Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. Prescription anti-inflammatory drugs and immunosuppressants are prescribed for rheumatoid arthritis. Gout is an inflamed joint condition caused by the deposition of uric acid salt crystals. The joints of the whole body are at risk, but the fingers and toes are most affected. Gout is associated with shortening of the tendon, which in turn leads to contracture (flexion of the finger joints).
  - Rheumatoid arthritis usually affects the hands and wrists. Over time, arthritis can lead to joint disfigurement.
  - Your doctor may ask you to have a blood test to look for specific markers of rheumatoid arthritis.
  - To reduce your risk of gout, limit your intake of foods rich in purines, such as organ meats, seafood and beer.