Trigger finger - home treatment without surgery. Thumb clicks when flexed Snap finger treatment

These processes lead to the inability to bend and unbend the arms. Palmar fibromatosis can be the result of rheumatoid arthritis, osteoarthritis, gout and other joint diseases. Treatment is provided by orthopedic surgeons. The main methods of therapy are conservative or surgical.

Why can't the finger on the hand be unbent?

Palmar fibromatosis affects the surfaces of the hands, sometimes affecting the interphalangeal joints. The causes of contractures of the hand and fingers have not been thoroughly studied.

The pathological condition appears in middle-aged and older patients due to age-related changes that worsen tissue trophism, tendon elasticity, and hemodynamics. The main factor provoking Dupuytren's contracture is heredity. Scientists put forward several versions of why the finger does not bend or the group of joints on the hands does not unbend:

• injury to the hand or forearm;
• infringement of carpal nerves;
• violation of metabolic reactions;
• infectious and aseptic inflammation of the tendon fibers;
• intense physical activity.

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How is it manifested?

During flexion, the patient's middle finger hurts. It rarely happens that the index finger on the hand hurts. This is most likely a manifestation of rheumatoid arthritis. Inflammations are symmetrical, the pain intensifies after a night's sleep and is accompanied by chills, general weakness. With polyosteoarthritis, the index and ring fingers hurt. The main symptom of this disease is the appearance of symmetrical nodules on the joint located next to the nail. This place is characterized by pain, burning, redness, swelling. The formation of nodules can be painless. Other symptoms:

• The patient has bad bending of the fingers in the morning. The condition appears if systemic diseases are diagnosed with a violation of metabolic processes (gout) or pathology of the spinal column, especially the cervical region. With metabolic disorders, when the movement of blood during sleep slows down, there is an intense deposition of salts in the articular elements.
• The little finger or ring finger does not bend on the right or left hand. This condition is possible with carpal tunnel syndrome. It is typical for people whose work involves daily manipulations involving fine motor skills of one of the hands, accompanied by an incorrect functional position of the wrist. The first signs are pain and numbness of the palm, aggravated in the evening.
• The thumb does not fully extend. This condition provokes the habit of "crunching" the phalanges of the fingers. The appearance of a pathological condition is associated with stretching of the joint and tendons, resulting in instability of the ligamentous mechanism. When the finger is straightened, there is a tension in the tendon tissues that prevents straightening.

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Diagnostics

Primary diagnosis is based on an external examination, a study of the patient's complaints, and anamnesis. It turns out the degree of deformation and the possibility of functioning of the hand, the presence of specific nodules in the tendon zone, the extensor angle of the phalanges of the fingers is assessed. When endocrine pathologies, diseases of the kidneys, liver, and musculoskeletal system are detected, appropriate laboratory and instrumental studies are prescribed.

Treatment of pathology

After the diagnosis, the doctor prescribes treatment. The choice of therapy depends on the severity and duration of the process, as well as on the degree of limitation of joint mobility and hand function. In the early stages of the disease, conservative treatment is used. The main methods of therapy also include:

• physiotherapy;
• the use of calipers (bandages);
• the use of ultrasound procedures;
• hormonal injections;
• anesthetic blockade.

Be sure to conduct daily gymnastics and massage to develop the hand and phalanges of the fingers.

Conservative treatment can slow down and anesthetize the course of palmar fibromatosis, but surgery is necessary to completely get rid of the pathology. The patient undergoes needle aponeurotomy or, in severe cases, arthrodesis. Aponeurotomy is a procedure for removing nodules using needles. Treatment with this method is started when the finger flexion angle is limited to 30 degrees. During the operation, the fascia and pathological strands of the tendon are partially excised. With arthrodesis, the joint is fixed in a completely immobile state.

To prevent damage to the hand and the phalanges themselves, patients need to avoid injuries, monitor the regime of work and rest. When working with a computer, every hour take a break for hand gymnastics. Workers of cutting shops - observe the hygiene of production, do not cut a large number of layers of thick fabric. This usually results in stenosing tendovaginitis. If there are diseases that provoke pathological conditions of the articular and muscle tissues, it is necessary to follow the doctor's recommendations so as not to aggravate the course of the disease.

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snap finger

Latched toe is a hand disorder in which one or more fingers become locked in a flexed or, less commonly, extended position. This disease is known as stenosing tendovaginitis, stenosing ligamentitis, spring finger, Knott's disease, nodular tendinitis, and trigger finger.

signs

A characteristic symptom of this disease is pain at the base of the affected finger. It hurts when pressed or when performing small movements. Often there is swelling over the affected area. At this stage, it is already possible to feel the compaction in the tendon on the palm at the base of the finger.

After a while, the pains begin to disturb not only in motion and with pressure, but also at rest. When bending and, especially, when unbending, the sufferer feels some kind of hindrance. To perform an action, you need to make more and more efforts. 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 unbent or bent position.

Description

The snapping finger was first described by A. Nott, after whom this disease is named. In 1850, he published an article "A study on a peculiar disease of the sheaths of the tendons of the hand, characterized by the development of knotting 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 carried out by Schönborn in 1887. The operation was successful, but much more important was the fact that during this operation, the doctors got the opportunity to figure out what is still happening in the fingers with Knott's disease.

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

With inflammation, not only the annular ligament narrows, but also part of the tendon thickens. It is when this thickened part is squeezed through the narrowed ligament that a 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 the fingers. At risk are electric welders, polishers, cutters, stampers, cutters and masons, as well as representatives of other professions in which there is a chronic injury to the hands. Any work in which a person constantly makes grasping movements or in which something presses on the palm in the area of ​​\u200b\u200bthe annular ligaments can cause a trigger finger.

It happens that the trigger finger develops in children. This is due to the tendon being too thick, which cannot slide normally in the tendon sheath.

Diagnostics

Diagnosis requires an examination of the patient, anamnesis data and an X-ray of the hand.

Trigger finger must be differentiated from arthritis and arthrosis. In contrast to this disease, those suffering from arthritis and arthrosis do not experience compaction in the palm at the base of the finger. The radiographs of the hand in 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, such as diabetes or gout.

Treatment

Trigger finger treatment can be either conservative or operative. Conservative treatment consists in eliminating the cause of the disease, immobilizing the finger, and physiotherapy. 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 does not help, the finger is still motionless and it hurts, then an operation is performed. During the operation, the annular ligament of the fingers is dissected. After being discharged from the hospital after surgery, the patient should develop the 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 about 3 weeks. However, it is possible to judge the success of the operation only after a year.

Prevention

Trigger finger prevention is about injury prevention and production hygiene. And the last one is very important. Workers have been known to develop a trigger finger because they violated the rules of the job, such as cutting 8 or more instead of 5 layers of fabric. The disease develops very quickly, therefore, at the first symptoms that arose in the hand when changing the type of activity or work order, you need to contact an orthopedist.

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Trigger finger causes and home remedies

Inflammatory disease of the ligaments, in which there is a significant narrowing of the tendon canals, is called stenosing ligamentitis or trigger finger. This is an unpleasant and painful condition in which a person cannot straighten his finger on his hand without pain and a characteristic click.

During the development of the disease, it is important not only to comply with therapeutic measures, but also to limit physical activity on the painful area. Timely diagnosis and the appointment of complex treatment is the key to a successful recovery and full restoration of functions.

Why does disease occur?

Most often, this disease occurs in cases where there is a constant increased load on the annular ligament of the finger. Normally, a special synovial fluid is produced in the tendon-ligamentous apparatus, which prevents the wear and tear of ligaments and joints. But if there are constant overloads of this area, then the ligament thickens, the lumen of the canal narrows significantly (its stenosis is noted), and the amount of this lubricating fluid becomes insufficient to ensure the normal functioning of the finger.

Such a disease can appear as a result of professional activity or in the presence of some other pathological processes in the body. Most often, the disease affects the thumb and occurs in such cases:

• with constant increased loads on this area among workers in the sewing, welding, locksmith, driver, shoe industry;
• in patients with diabetes mellitus and inflammatory diseases of the joints;
• in children due to congenital anomalies in the development of the phalanx;
• in pregnant women due to circulatory disorders and the development of inflammatory diseases of the joints of the hands.

Usually middle-aged women are susceptible to this disease (especially those who have an increased risk due to the nature of the profession), but in some cases the disease can occur in children and adult men.

Symptoms and Diagnosis

Initially, pain in the area of ​​the inflamed phalanx is periodic and worse in the morning after sleep. Sometimes it can be confused with swelling, so in the early stages, patients have difficulty diagnosing their condition. But over time, the pain becomes constant, its increase is noted even with minor loads on the inflamed area. Over time, outwardly, compaction and inflammation on the phalanx becomes visible, and pain is constantly present, even at rest.

It becomes more difficult to bend the finger with an increase in general symptoms. If at first this action simply brings discomfort and pain, then it is not possible to squeeze and unclench the phalanges without the help of the second hand. In this case, the patient is accompanied by severe pain and a clicking of the joints and ligaments is heard. A characteristic feature of the neglect of the disease is joint pain, which can spread to the area of ​​the entire hand, forearm and even reach the shoulder.

For diagnosis, an x-ray of the painful area is used, and an external examination, as well as the collection of informational details of the onset of the disease. In the picture, it is important to exclude the presence of arthritis, arthrosis and rheumatoid diseases. Depending on the stage of the disease, the patient may be recommended both conservative and surgical treatment. The earlier the disease is detected, the higher the chances of doing without surgery and being cured with affordable and simple methods.

How to deal with the disease without medication?

In the initial stages of the disease, effective treatment with traditional medicine is possible. With systematic use, they successfully relieve pain and inflammation in the joints and ligaments.

To relieve and relieve symptoms, you can use raw potatoes as compresses at night. It must be peeled, crushed to a pulp and heated to 38 ° C. Heated potatoes should be wrapped in a bandage or thin cloth and applied to the painful area. From above, this mass is fixed with a plastic bag or cling film. The next layer can be wool or any other natural fabric to enhance the thermal effect. Usually within 30 minutes relief comes due to the heating of the affected area and the patient can sleep peacefully with this compress. The course of treatment is up to 10 days.

Raw cabbage leaves have good anti-inflammatory and analgesic effects. They need to be applied at night to the affected area. For the same purpose, the leaves of coltsfoot or burdock are suitable.

Birch buds and birch sap are great for restoring small joints and ligaments of the hands. Birch sap must be drunk every day undiluted. And for baths, birch buds should be brewed at the rate of 1 tsp. vegetable raw materials per 100 ml of boiling water. Keep the solution in a water bath for 15 minutes, and after cooling, filter and use for local baths or lotions.

For rubbing, you can prepare an ointment based on calendula flowers. To do this, they must be crushed and mixed in equal parts with baby cream. You need to rub this ointment at night.

Pharmacy clay has also proven itself, which must be mixed with water to the consistency of thick sour cream. Add vinegar to this mixture (preferably apple or wine) on the basis that for 0.5 kg of clay you need to take 4 tbsp. l. vinegar. Moisten the bandage with the resulting mixture and apply in the form of compresses for 1.5 hours on the affected area. Usually the course of treatment is 5-10 sessions.

When treating at home, in addition to compresses and rubbing, it is important to limit the mobility of the joints of the affected phalanx and exclude the type of activity that led to the disease.

Oils and paraffin as auxiliary methods

Essential oil blends and warming with paraffin therapy can help relieve pain and restore normal hand function. For this purpose, you can prepare such oil mixtures for local rubbing:

1. Take 2 tbsp. l. dry lavender flowers and pour them 4 tbsp. l. any base oil (olive, almond, peach) and heat in a water bath for 1.5 hours. After cooling with this oil, rub the painful areas without first filtering the mixture.
2. For 50 ml of apricot oil, you need to take 5 drops of eucalyptus essential oil and rub the joints with the resulting mixture.
3. Mix fir oil in equal parts with any vegetable base oil and rub into the painful area for 15 minutes.

For thermal procedures, it is necessary to melt the paraffin in a water bath to a temperature of 55-65 ° C and dip the brush into it, thus creating a dense paraffin glove. A disposable bag is put on top of it, which must be secured with a terry towel or a special warm mitten. Leave on the sore hand until it cools completely, then remove the paraffin and carry out a light massage with stroking movements without pressure.

Recovery period

With stenosing ligamentitis at the rehabilitation stage, it will be useful to perform therapeutic physical exercises that are aimed at restoring mobility and developing the ligamentous apparatus. It is important that this gymnastics is only preventive and does not create an extra load on small joints.

To consolidate the therapeutic effect, massage and heat treatment are useful. After the removal of symptoms, the patient needs some time (usually about a month) to refrain from the usual work regime in order to prevent the recurrence of the disease.

If, after conservative treatment and adherence to the regimen during recovery, the symptoms recur or the patient becomes worse, we can talk about surgical intervention. Therefore, with a long absence of improvement, you should not endure pain and self-medicate. To clarify the situation, you should seek help from a doctor.

Prevention of this unpleasant disease is the normalization of loads on the phalanges of the hands and the alternation of work and rest (especially if the load is associated with professional systematic activity). When forced to work with small parts, in which the same type of actions are performed, it is necessary to use special prophylactic fixators of the joints and tendons, which significantly reduce the tension and force on the ligaments.

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Treat Trigger Finger Syndrome at Home

Inflammation of the flexor tendon of one of the fingers and the ligaments adjacent to it is called Knott's disease, or trigger finger, treatment without surgery for this pathology is possible in the early stages, when the injured finger is still able to unbend, albeit with great difficulty.

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

After some time, pain appears when the affected finger moves and during its palpation. As the disease progresses, the pain spreads to the entire hand, wrist, forearm.

In the third stage of the disease, a dense, painful swelling forms at the base of the finger that makes a clicking sound. The fingers may become numb, the skin becomes pale with a bluish tinge. 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, ensuring the fixation of the phalanges. Eventually, the finger loses mobility and remains in a flexed state.

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

The most common injury is to the annular ligament of the thumb.

Trigger Finger Correction

Conservative and surgical treatment of Knott's disease is possible. If the finger has completely lost mobility, surgery is indispensable. But if flexion and extension is still possible, it is worth trying conservative methods for 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 determine how to treat stenosing ligamentitis with the best result, it is very important to correctly diagnose at an early stage in the development of the disease. X-rays are used to differentiate from arthritis and other diseases with similar symptoms.

First of all, the diseased hand needs complete rest to allow the tissues to restore their physiological integrity. At the first stage of the development of the pathology, if there is no pain syndrome, 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 a massage session, it is necessary to make 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. Massage is carried out as follows:

1. With the thumb of a healthy hand, circular stroking movements are made on the inside of the diseased palm, then the affected hand is stretched, spreading the fingers apart.
2. In a circular motion of the thumb of a healthy hand, knead the back surface of the damaged hand, laying it on the fingers of a healthy hand, straighten your fingers, stretch the wrist area. Movements should be neat, but tangible.
3. To deflect the diseased hand back as much as possible, extending the carpal joint, it is important that the process does not cause pain.
4. Knead the inner side of the palm with circular movements of the thumb of a healthy hand, starting from the wrist and moving through the pad of the thumb to the base of the little finger. Repeat the process on the back of your hand.
5. Work out all the metacarpal bones, ligaments, tendons and phalanges of the fingers.
6. With the thumb and forefinger of a healthy hand, grasp each finger of the diseased hand from the sides and hold with pressure from the top to the base, then repeat the movement on the front and back surfaces of the fingers.
7. Spread the fingers of the sore hand and work out the gaps between them, alternating stroking and pressing.
8. Finish the massage by rubbing each finger and the entire hand.

Physiotherapy

A sick hand also needs therapeutic exercises. To cure the disease, exercises should be done regularly, repeating each for 20-30 seconds. Gymnastics includes the following techniques:

1. In a sitting position, put your elbows on the table and shake your palms.
2. At chest level, press your palms to each other, spread your elbows to the sides, forming a straight line with your forearms. In turn, press the fingers of one hand on the fingers of the other, forcing them to unbend.
3. In the same position, without opening the fingers, spread and close the wrists several times.
4. Shake your palms and repeat the second exercise with more pressure.
5. In the same position, without opening the wrists, spread and close the fingers.
6. Again, put your hands on the table with your elbows, make rotational movements with your hands, play with your fingers on an imaginary pipe.

Other methods

To relieve inflammation, non-steroidal anti-inflammatory drugs are taken, which can be purchased without a prescription. Ibuprofen 0.2–0.4 g can be taken every 6 hours. Naproxen can also be used. It is taken at 0.5-0.75 g 2 times a day in the acute stage of the disease and 0.5 g twice a day as maintenance therapy.

The combination of various nonsteroidal drugs is unacceptable.

Treatment for Knott's disease may involve the application of dry heat. To do this, in the oven or in the microwave, heat the table salt in a linen bag. The hand is placed palm up and salt is placed in it. After the bag has cooled, the hand must be wrapped in a woolen cloth to prevent rapid cooling.

Folk methods to help

If stenosing ligamentitis is diagnosed at the initial stage, treatment with folk remedies should include the use of compresses, baths, applications, therapeutic creams and ointments, and paraffin therapy.

1. For compresses, mashed potatoes are used. Before applying to the brush, the mass must be heated to t 38 ° C, wrapped in a clean cloth and applied to the damaged area for 30 minutes. The procedure is repeated for 10 consecutive days. A compress with potatoes relieves pain well.
2. Treatment of Knott's disease is also effective with the help of a compress from the pulp of aloe, which has an anti-inflammatory and decongestant effect. A sheet cut along the length is applied with pulp to the damaged area and fixed with a bandage. For the same purpose, you can use the leaves of burdock, coltsfoot and cabbage, which must first be kneaded with a rolling pin.
3. Home treatment may include applications of white and blue clay. A plastic mass is prepared from clay and a small amount of water, which is applied to a sore spot, you can completely cover a finger or a whole palm with clay. You can add a small amount of apple cider vinegar to the gruel. Then the hand is wrapped in polyethylene and a warm cloth. Such applications must be done twice a day for 2 weeks.
4. For applications, you can use molten paraffin. You can buy it at a pharmacy or grind a few paraffin candles. Paraffin is melted at t 60–62°C, poured out evenly on tissue paper, and then placed on a sore arm. From above, the application is covered with a warm cloth. Hold until the paraffin cools.

You can cure stenosing ligamentitis with homemade ointments. To do this, propolis, powder from calendula flowers or wormwood herbs, alcoholic tincture of arnica are added to a baby cream or other fatty base. For 100 g of the base, 50 g of medicinal raw materials are used. Such ointments effectively relieve pain and inflammation.

Trigger finger syndrome is cured more quickly if the patient eats beef bone broth. It is boiled for 5 hours over low heat, drunk warm 3-4 times a day, 1 cup. The broth promotes the restoration of articular cartilage and tendon fibers.

For the prevention of the disease, industrial gymnastics for the hands, a relaxing massage, baths with a decoction of herbs are effective.

It is important to consult a doctor at the first click and confirm the diagnosis.

Then self-medication and folk remedies will cure the trigger finger syndrome without the use of medicines.

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snapping finger

(trigger finger syndrome; stenosing tendovaginitis; stenosing ligamentitis; snapping, springy, spring finger; Knott's disease; nodular tendonitis)

Diseases of bones and joints

general description

Trigger finger syndrome is a fairly common pathology of the hands, manifested by painful blockage in the bent state of one or more fingers. As a rule, women of mature age suffer from this disease. The thumb is often blocked.

• genetic determination;
• systemic connective tissue diseases;
• metabolic pathology;
• overexertion of the fingers in the conditions of work.

Clinical picture

At the very beginning of the disease, slight pains in the distal part of the palm disturb, pressure on the corresponding finger intensifies this pain. Later, a pathognomonic symptom begins to be observed - extension with a clicking sound (often violent) of the distal phalanx of the finger, often the thumb. The bending of the finger itself becomes difficult and painful. Over time, a persistent contracture of the interphalangeal joints is formed.

Diagnostics

Diagnosis is not difficult. Diagnosis is based on history, examination and palpation of the hands. Additionally, an X-ray examination is carried out.

Trigger Finger Treatment

In the initial stage of the disease, the hand is immobilized with a removable plaster splint, pain and inflammation are relieved, and physiotherapy is performed. Subsequently, a subcutaneous dissection of the annular ligament is possible, allowing the patient to freely bend and unbend the finger. The operation is performed under local anesthesia on an outpatient basis.

Essential drugs

There are contraindications. Specialist consultation is required.

Preparations containing ketorolac tromethimine with analgesic action.

• The drug in tablets - up to 30 mg.
• The drug in both dosage forms:

*Identical also for patients with impaired renal function.

daily intake: once every 6 hours, 40 mg.

maximum dosage in 5 days: 15 doses.

daily intake: once every 6 hours, 15 mg;

maximum dosage for 5 days: 20 doses.

* This group includes patients with chronic renal failure.

With any method of administration of the drug (intravenously or intramuscularly), the maximum dosage for patients over 65 years of age, patients with chronic renal failure and people weighing less than 50 kg is 60 mg (per day). For elderly patients weighing more than 50 kilograms, a dose of 90 mg (per day) is recommended. The course of treatment (5 days) should not be increased.

• Intramuscular injection: deep injection of the drug into the muscle. The procedure must be carried out slowly.
• Intravenous injection: slow introduction. Procedure time: at least 15 seconds.

• decrease in pain intensity;
• reduction of inflammatory processes;
• general therapy to reduce symptomatic manifestations.

The drugs do not affect the progression of the disease.

Incidence (per person)

What to do if you suspect a trigger finger

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(how often the symptom occurs in this disease)

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Trigger finger is a disease of the hand in which the finger gets stuck in a bent position. This limits the performance of the hand and gives the person pain.

If other methods of treatment have not been successful or the condition of the hand remains severe, then with the help of surgery it is usually possible to restore the mobility of the affected area of ​​​​the hand.

Recovery from trigger finger surgery is usually short, and the surgery itself usually has a high chance of success.

The content of the article:

What is a snapping finger?

Finger snapping is a painful condition in which the fingers freeze in a certain position. Usually in a bent or "crooked"

Trigger finger or stenosing tenosynovitis (tenosynovitis) is a disease in which the finger remains in a constant position in one or more joints. It is usually difficult for a person to move this finger or use it during daily life activities. This disease also causes discomfort and pain.

The disease can affect any finger, including the thumb. In addition, it can affect both one finger and more.

Tendons connect bones and muscles, providing their mobility. The tendons are protected by a special coating, which is commonly called a sheath. When the tendon sheath becomes inflamed, the area of ​​the body where the inflammation occurs can be difficult to move. Sometimes this results in a snapping finger.

Trigger finger symptoms

Trigger finger symptoms include:

• pain in the lower part of the finger when trying to move or when pressed;
• hard clicking sound when moving a finger;
• as the condition worsens, the finger may twist and freeze in this position, and then suddenly straighten;
• loss of ability to bend or straighten a sore finger;

The condition in question can affect any finger of the hand, but usually the ring, thumb, and little fingers are affected.

Types of trigger finger operations

There are three types of surgery that can help with trigger finger.

Open operation

The surgeon makes a small incision in the palm of the hand and then cuts the tendon sheath to give the tendon more room to move. The surgeon then sews up the wound. Usually the patient is at this moment under local anesthesia and does not feel any pain.

Percutaneous (percutaneous) surgery

This type of surgery is also performed under local anesthesia. The surgeon inserts a needle into the bottom of the finger to cut the tendon sheath. After such operations, the wounds do not remain.

Excision of the synovial sheath of the tendon

Doctors recommend using this procedure only if the first two options are not suitable, for example, in patients with rheumatoid arthritis. Excision of the synovial sheath of the tendon involves the removal of part of the tendon sheath and allows the finger to regain free movement.

Specialists usually recommend open surgery because they are associated with the lowest risk of complications. There is a small chance that blood vessels or nerves located in close proximity to the tendon sheath will be damaged during percutaneous surgery. However, percutaneous surgery has advantages in that it does not leave scars and is more financially beneficial. A small 2016 study found that people who had open and percutaneous surgery had roughly the same long-term effects. Usually the operation lasts about twenty minutes, and patients after such procedures do not need to stay in the hospital. During percussion and open operations, the patient remains awake, but does not feel any pain.

Recovery and convalescent care

Fresh bandages should be applied to the finger for several days after surgery.

Initially, the operation may cause some pain. To remove them, the doctor should recommend painkillers that are sold in pharmacies without a prescription.

Immediately after the operation, the patient should be able to freely move all the fingers of the affected hand. However, one should not rush to load a sore finger- full working capacity will return to it in one or two weeks.

During the first few days after open surgery, the patient should wear bandages. After the last dressing is removed, the wound must be kept clean. using mild soap and water.

If a person has stitches left, the doctor should remove them two or three weeks after surgery. Absorbable surgical sutures will dissolve within three weeks.

The patient should ask their doctor when they can resume daily physical activity, such as driving a car or using a computer. A longer recovery period may be needed for those people who have had two or more trigger finger surgeries.

Some people are given special exercises or additional therapy to regain full range of motion in the affected finger.

Who Needs Trigger Finger Surgery?

If left untreated, the trigger finger can get stuck in one position regularly. When the affected finger bends and stays in this position, it becomes difficult for a person to perform their daily tasks.

However, trigger finger in most cases can be successfully treated without surgery.

Non-surgical treatments include:

• stretching and applying a splint to immobilize;
• taking anti-inflammatory drugs;
• injecting steroids into the base of the finger to reduce swelling
• reduction or temporary cessation of the activity that causes pain.

If these therapies do not help, surgery may be required. Before making a decision regarding the operation, the attending physician considers three points:

1. How much pain is the patient experiencing;
2. How seriously the disease affects his daily activities;
3. How long has the patient been in pain for?

Between 20 and 50% of people with snap fingers may need surgery to improve their condition.

Trigger finger can also occur in children, but in such cases, surgery is usually not recommended. Trigger finger in this age group can often be treated with stretching and splinting.

Complications

All three types of trigger finger surgery are considered simple and safe, so complications are unlikely.

However, there are small risks, and the doctor should explain them before the operation. These risks include:

• scarring;
• infections;
• pain, numbness and decreased mobility of the finger;
• nerve damage;
• incomplete recovery, that is, when after the operation the finger receives partial mobility.

Causes of trigger finger

Surgery is not always necessary to treat trigger finger. The treatment plan depends on the individual case

Anyone can develop a trigger finger, but the following groups of people are at higher risk of developing the condition:

• people aged 40 to 60;
• women;
• people who have had hand injuries in the past;
• people suffering from rheumatoid arthritis;
• people with diabetes.

Repetitive movements such as grasping the steering wheel or playing the guitar can cause a trigger finger. However, in most cases, the causes of the disease remain unknown.

The snapping finger is associated with certain disease states. Rheumatoid arthritis causes swelling of the joints and their tissues, and these inflammations can spread to the fingers. If the tendons of the fingers become inflamed, this can lead to a trigger finger.

People with diabetes also have a higher risk of developing the disease in question. Trigger finger occurs in 20-30% of people with diabetes and only 2-3% of others. The link between diabetes and snapping fingers is unclear.

conclusions

Trigger finger surgery is usually successful, and surgery rarely causes problems. Both open and percutaneous surgery are almost always effective, and recovery from them is relatively fast.

Latched Finger Treatment can be conservative and operational (surgical).

Conservative treatment of snap toe

Back in 1911, Baunian spoke out against any manipulation of the tendon, considering its deformity to be secondary, and suggested limiting itself to dissection of the tendon sheath alone. The same point of view on this issue was expressed by Hauck, Kjoh, Winterstein and others.

For a correct understanding of the nature of the disease and the choice of the most rational method of operation, the work of I. P. Kallistov was of great importance, who came to the conclusion that: 1) the strangulation caused by the annular ligament should be eliminated during the operation; 2) spindle-shaped thickening of the tendon does not require correction. I. P. Kallistov considers the excision of the annular ligament to be a mistake, since the ligament is a groove in which, without deviating to the sides, the tendon slides during movements. VP Gorbunov (1956) later came to the same conclusions.

In addition to the difficulties associated with opening the tendon sheath and manipulations to correct the deformed tendon, such operations require large incisions in those areas of the palm where the subsequent formation of a large, dense, painful scar permanently deprives the patient of his ability to work. Already Smitt, describing the first operation for a snapping finger, noted that the skin incision was 4 cm long. A. Ya. Schnee, M. I. Kuslik, I. P. Kallistov and others draw attention to the inevitability of large sizes.

I. P. Kallistov was the first to draw attention to the fact that in some cases the elimination of the latch does not mean the recovery of the patient, who, due to scars soldered to the underlying tissues, cannot continue work associated with pressure on the palm. V. P. Gorbunov also notes that often long-term disability after surgery is due to pain in the postoperative scar. In addition, the scars on the palm remain sensitive to pressure and friction for a long time. These circumstances to a large extent discredited the surgical treatment of the snap finger and, of course, did not contribute to its spread.

The following observation is very instructive in this regard.

Dr. Y., aged 37, a pianist who teaches and often gives concerts, has been ill for about two years. After a bruise in the right palm, the third finger began to snap, because of which he was forced to stop his concert activity and confine himself to teaching, which also became difficult. Long-term and vigorous treatment with paraffin, mud, novocaine blockades was ineffective (there was no hydrocortisone in those years). The 2nd phase is clearly expressed. Operation. Under local anesthesia with a cut of about 4 cm, a thickened and very dense annular ligament is exposed, which is dissected. A ligament strip 3 mm wide was excised. The tendon sheath is not changed, the tendon is spindle-shaped thickened in a limited area. The wound is sutured. Healing by primary intention. Histological examination of the excised area of ​​the annular ligament showed that it was built according to the type of aponeurotic tissue. In some places, the fibers of the ligament are hyalinized, cartilage cells are visible in places, inclusions of lime salts diffusely impregnate the fibers of the ligament (Prof. P. V. Sipovsky). A large dense hypertrophic scar developed in the postoperative period. Finger flexion and extension are limited and painful. Playing the piano is very difficult. It took several years of persistent treatment before the movements in the club were fully restored, the soreness in the scar disappeared, and he was able to return to concert activity.

Unsatisfactory outcomes of the operation due to large and painful scars have led some surgeons to resort to somewhat unusual approaches and incisions. For example, Compere (1939) used in a patient suffering from snapping of both first fingers, incisions along the outer surface of the first finger, which started from the base of the terminal phalanx and reached the middle of the first metacarpal bone. From this incision, the tendon sheath was dissected, and the deformity of the tendon was eliminated. After such an operation, applicable only when the first finger is snapped, extensive scars are also formed.

Thus, the large incisions required for access to the annular ligaments and painful postoperative scars greatly devalue the results of the operation, the purpose of which is not only to restore free flexion and extension of the finger, but also not to disturb other functions of the hand. The disadvantages of large incisions, inevitable with open access to the annular ligaments, were noted by M.A. Elkin. when studying the long-term results of surgery in 72 patients (14 men and 58 women). 46 of them had snapping of the fingers of the right hand, 21 had the fingers of the left hand, and 5 had snapped fingers of both hands. In these 72 patients, 83 fingers were operated on (I-56, II-1, III-12, IV-13, V-1). The following operations were performed: dissection of the tendon sheath - 12, dissection and excision of the tendon sheath - 24, dissection of the tendon sheath and correction of the tendon - 9, dissection of the annular ligament - 38. As a rule, longitudinal skin incisions were made from 2.5 to 4 cm and only when simultaneous disease of several fingers on one hand, the incision was transverse; in 4 patients an incision was made according to Compere. All these patients were operated on in the hospital, where they stayed from 3 to 18 days (average 9.8 days). In 3 patients, the wound festered, in 9 patients hypertrophic painful postoperative scars formed, due to which the ability to work was sharply limited. In some cases, in addition to a painful scar, there was a limitation of flexion and extension of the finger.

Thus, even such a minimal intervention as the dissection of the annular ligament is fraught with many dangers if performed from a large incision. In order to make this operation flawless, large incisions had to be abandoned. This turned out to be possible with closed access to the annular ligament from a puncture - incision, which is called a closed, or subcutaneous, ligamentotomy.

Closed, or subcutaneous, ligamentotomy was made by Elkin M.A. et al. 172 patients on 208 fingers. After processing the surgical field, local infiltration anesthesia is performed with 1 or 2% solution of novocaine (3-4 ml), which is injected with one injection over the head of the corresponding metacarpal bone, first under the skin, and then under the annular ligament, the passage of which is easily recognized by its density. After a 3-4-minute wait, the head of the metacarpal bone is determined by palpation, and above it, strictly along the middle line of the finger, the skin is pierced with a narrow scalpel, and then, at a depth of 5-6 mm, the annular ligament is dissected with careful dashed movements.

Subcutaneous dissection of the annular ligament (schematically).

The passage of the annular ligament is recognized by its large, often cartilaginous, density. The completeness of the dissection of the annular ligament is determined in two ways. Firstly, when the finger is flexed and extended, the feeling of resistance that the patient and the doctor experienced when palpating a typical place of the palm disappears. Secondly, the patient begins freely, without experiencing any interference, to bend and unbend the finger. Such a check must be done several times with short breaks. On the wound, the size of which is not more than 6-7 mm, sutures are not applied. The operation ends with the application of a small gauze-cotton bandage to the wound. Finger immobilization should not be performed. On the contrary, it is strongly recommended that patients begin active finger movements immediately after the operation. The bandage is removed 6-7 days after the operation. By this time, the wound heals with a barely noticeable linear scar, which is not painful when pressed on it. Pain in the postoperative scar stops already 3-4 days after the operation, but pressure on it causes pain for another 3-4 weeks.

Closed ligamentotomy can be performed with a conventional scalpel, but a pointed, narrow ocular scalpel is best for this, which is used for most operations. For subcutaneous ligameptotomy, special ligamemtotomies have been proposed (Lorthioir, 1957; L. D. Lee, 1962), but there is no particular need for them.

A surgeon embarking on a closed ligamentotomy should be prepared to switch to a large incision if necessary. The need for a large incision may arise with rare variants of the structure of the annular ligament, which is wider than usual. There are also cases when, in addition to the annular ligament, there are additional strands located proximal or distal to a typical place (V. P. Gorbunov). In such cases, free sliding of the tendons is possible only after crossing the annular ligament and additional strands.

Closed ligamentotomy was performed by Elkin et al. 172 patients in whom 208 annular ligaments were dissected. In 117 cases, the annular ligament of the first finger was dissected. All these patients were treated before surgery with various conservative methods, including hydrocortisone injections. There were no complications after the operation, and recovery occurred 2-3 weeks after the operation. The operated patients (the vast majority of them working with great pressure on the palm - cutters, carpenters, electric welders, ironers, stampers, etc.) returned to their permanent jobs after the operation.

When several fingers were snapped, the annular ligaments of each of them were dissected from a separate incision. In cases where the fingers of both hands fell ill, the operation was performed first on one, and after 2-3 weeks - on the second.

The advantage of closed ligamentotomy is especially noticeable if the operations were performed in the same patient in an open and closed way.

3-va, 37 years old, moulder with 4 years of experience. In 1958, she was operated on in the hospital for latching of the third finger of the right hand, where she stayed for 2 weeks. Dissected annular ligament from open access. After discharge from the hospital, she was treated on an outpatient basis for 4 weeks due to pain in the postoperative scar. A few years later, the third finger of the left hand began to snap into place. Paraffin therapy, novocaine blockades and hydrocortisone injections do not give a noticeable improvement. During the examination: on the right palm along the course of the third finger there is a dense and painful scar 4.5 cm long when pressed. Finger movements are free, but pain appears in the scar when it is maximally bent. Distinctly expressed 2nd phase of snapping of the third finger of the left hand. Closed ligamentotomy was performed on an outpatient basis. The dressing was removed after 7 days. 20 days after the operation, she began to work in her specialty. Observed throughout the year. No complaints.

Scars after open (right) and closed (left) ligamentotomy.

Closed ligamentotomy according to our method was successfully used by F. U. Kulakhmedova, I. Sh. Tseykhin, N. S. Okun and N. M. Chukhnova, I. V. Sheremet and S. Ya. They were discharged for work for 18 days and did not complain for a year.

Accessibility, very little trauma and complete radicality of subcutaneous dissection of the annular ligaments make this intervention the operation of choice. It must be assumed that this operation will become widespread, and its timely use will save many patients from unreasonably long conservative treatment and long-term disability.

Examination of working capacity with a snapping finger

In the first phase of the disease, when finger snapping occurs relatively rarely and is actively eliminated without much difficulty, when mild pain is determined by palpation of a typical site, and the nodule may not be present, conservative treatment is necessary with the release of the patient from work for 3-4 weeks and subsequent transfer for work not related to pressure on the palm (up to 4-6 weeks).

In the second phase of the disease, the working capacity of patients who often have to perform flexion and extension of the fingers is especially reduced; the working capacity of workers suffers to a lesser extent, whose fingers take a fixed position for a long time (when working with a hammer, ax, etc.). In this phase, one should not expect much from conservative treatment, and patients need to be operated on.

In the third phase, recovery can only be achieved by surgery, and the failure of conservative treatment, no matter how long it may be, cannot serve as a basis for referring the patient to VTEK.

Only stenosis not eliminated by the operation or large painful postoperative scars can serve as a basis for referring the patient to VTEK for the purpose of temporarily transferring him to disability with subsequent retraining.

Proper treatment of patients with snap fingers virtually eliminates the possibility of permanent disability in any profession.

Inflammatory disease of the ligaments, their damage and change in the direction of increase is called stenosing ligamentitis or trigger finger.

In the international classification of diseases of the tenth revision, there is only a simple name for such an ailment, its code for microbial 10 is M 65.3. Class - diseases of the musculoskeletal system and connective tissue, subgroup - damage to the synovial membranes and tendons.

This is a condition that causes intense pain. In this case, the finger clicks or jams when bent. Fingers cannot move freely.

In advanced development, trigger finger syndrome causes the finger to become stuck in a flexed position and extend with a click, as if pulling a trigger.

People who suffer from such a disease think that it is impossible to overcome the disease without surgery. But this is not so, there are other options for getting rid of such a pathology as a trigger finger - treatment at home with the help of folk remedies.

During the development of the disease, it is important to observe all precautions and avoid loading the damaged area as much as possible.

People who suffer from arthritis or diabetes are most often affected by such a misfortune. And also if their activity is associated with constantly repetitive movements.

Timely diagnosed pathology makes it possible to completely remove all traces of the disease and restore functions.

Trigger finger syndrome most often appears with constant increased stress on the annular ligament of the finger.

In the normal state, the tendon-ligamentous apparatus produces a special synovial fluid. It performs a protective function, prevents abrasion and wear of ligaments and joints.

But with constant overloads of this area, the ligament thickens, the lumen of the canal narrows, and an insufficient amount of this fluid cannot ensure the normal functioning of the finger.

Often, such a pathology is the result of professional activity or the presence of certain diseases of the body. In most cases, stenosing ligamentitis affects the thumb, this is provoked by such factors:

1. If the main work is related to the sewing, locksmith, driver, shoe industry - where there is a constant load on this area.
2. Joint disease or diabetes.
3. With congenital anomalies in the development of the phalanx.
4. During pregnancy, blood circulation may be disturbed - this contributes to the development of inflammatory diseases of the joints of the bones.
5. Predisposition due to heredity.
6. In children, such a pathology may appear as a result of the rapid growth of individual parts of the hand.

Basically, this disease affects middle-aged women, especially those who are at risk. Much less often the problem affects men and children.

Trigger finger syndrome has severe symptoms. Only in some cases it can be confused with puffiness. This makes it difficult to diagnose in the early stages of development.

Main symptoms:

Stenosing ligamentitis: what to do if the finger does not straighten?

Diagnosis of the disease

When the first symptoms appear, you should consult a doctor. In medical institutions, an X-ray of the painful area, an examination and a detailed description of the symptoms of the disease are used for diagnosis. Image analysis makes it possible to exclude other diseases.

Depending on the stage, the patient is prescribed treatment. It is very important to identify such an ailment in a timely manner, then there is every chance to get rid of it without surgery using available methods at home.

This disease has three stages of its manifestation:

• in the first stage, pain and clicking are irregular, may disappear and do not bother often;
• the second stage is characterized by the fact that efforts must be made to extend the finger, the tendon thickens;
• the finger loses the ability to move, a painful bump forms under it.

Only timely treatment will help to quickly get rid of the disease, you should not pull until the last stage.

Treatment options for stenosing ligamentitis without surgery

Treatment of such a pathology as a trigger finger without surgery is aimed at the physiological restoration of all damaged tissues.

If the finger simply clicks during extension and this is not accompanied by pain, then it is enough to strengthen the tendon, ligaments and muscle tissues. In this case, massage, therapeutic exercises and reflexology will become effective.

At the initial stage, you can use traditional medicine recipes at home. Treatment of a stenosing ligament without surgery depends on how severely the articular tissues are affected.

If the pathology is running, regular repeated courses of therapy will be required.

One of the ways to overcome a disease such as stenosing ligamentitis of the thumb is treatment with medications.

You can independently use such means that are dispensed without a prescription. These must be non-steroidal anti-inflammatory drugs..

Among them:

1. Ibuprofen - eliminates pain and relieves inflammation in the hand. It should be taken every 6 hours for 200-400 milligrams.
2. Naproxen - 0.25 milligrams taken, then 0.5 milligrams 6 hours later.

These drugs must not be combined with each other. Use only one of them to avoid mixing various components that may be incompatible and harm the body. And also you need to know at what stage of development the disease is.

These drugs will be effective only at the beginning of the development of the disease. The doctor will help to draw the right conclusions and determine the degree of neglect.

If stenosing ligamentitis is diagnosed at an early stage, treatment with folk remedies will be highly effective. With systematic use, it will help relieve pain and inflammation in the joints and ligaments. The most effective recipes:

For prevention purposes, the hand and fingers should not be overloaded during manual work. Work must be alternated with rest.

If professional activity consists in working with small details and the same type of actions, then you need to use special fixators that fix joints and tendons. They are very effective, as they reduce tension and force on the ligaments.

If the method of treatment for trigger finger syndrome is chosen correctly, the functions of the hand will be fully restored. The only exceptions are cases in the treatment of which complications arose.

Folk remedies will eliminate the pathology, but on condition that the disease is at an early stage of development or as an additional therapy. It is best to consult a specialist before using any non-traditional method.

Trigger finger syndrome is a fairly common pathology of the hands, manifested by painful blockage in the bent state of one or more fingers. As a rule, women of mature age suffer from this disease. The thumb is often blocked.

The immediate cause is narrowing of the tendon sheath in the area of ​​the annular ligament on the proximal side of the main joint of the finger or thickening of the tendons. This is facilitated by:

• genetic determination;
• systemic connective tissue diseases;
• metabolic pathology;
• overexertion of the fingers in the conditions of work.

Clinical picture

At the very beginning of the disease, slight pains in the distal part of the palm disturb, pressure on the corresponding finger intensifies this pain. Later, a pathognomonic symptom begins to be observed - extension with a clicking sound (often violent) of the distal phalanx of the finger, often the thumb. The bending of the finger itself becomes difficult and painful. Over time, a persistent contracture of the interphalangeal joints is formed.

Diagnostics

Diagnosis is not difficult. Diagnosis is based on history, examination and palpation of the hands. Additionally, an X-ray examination is carried out.

Trigger Finger Treatment

In the initial stage of the disease, the hand is immobilized with a removable plaster splint, pain and inflammation are relieved, and physiotherapy is performed. Subsequently, a subcutaneous dissection of the annular ligament is possible, allowing the patient to freely bend and unbend the finger. The operation is performed under local anesthesia on an outpatient basis.

Essential drugs

There are contraindications. Specialist consultation is required.

Main drugs:,.

Preparations containing ketorolac tromethimine with analgesic action.

1. Tablets

In the absence of severe pain syndrome: inside once 10 mg.

In the presence of severe pain syndrome: inside up to 4 times a day, 10 mg.

When switching to internal administration from parenteral administration, consider the following dosage recommendations. On the day of the transition:

• The drug in tablets - up to 30 mg.
• The drug in both dosage forms:

*Identical also for patients with impaired renal function.

2. Solution

Inject the solution (ketorolac) - intravenously or intramuscularly. The dosage corresponds to the intensity of the pain. With severe pain, opioid analgesics are additionally prescribed (in a small amount).

Age	The weight	The introduction of the drug	Dosage
from 16 to 64 years old	> 50 kg	intramuscularly	single dose with oral: no more than 60 mg; daily intake: once every 6 hours, 40 mg.
from 16 to 64 years old	> 50 kg	intravenously	single dose with oral: 30 mg; maximum dosage in 5 days: 15 doses.
* from 16 to 64 years old	< 50 кг	intramuscularly	single dose with oral: no more than 30 mg; daily intake: once every 6 hours, 15 mg;
* from 16 to 64 years old	< 50 кг	intravenously	daily intake: once every 6 hours, 15 mg; maximum dosage for 5 days: 20 doses.

* This group includes patients with chronic renal failure.

With any method of administration of the drug (intravenously or intramuscularly), the maximum dosage for patients over 65 years of age, patients with chronic renal failure and people weighing less than 50 kg is 60 mg (per day). For elderly patients weighing more than 50 kilograms, a dose of 90 mg (per day) is recommended. The course of treatment (5 days) should not be increased.

The introduction of the drug

• Intramuscular injection: deep injection of the drug into the muscle. The procedure must be carried out slowly.
• Intravenous injection: slow introduction. Procedure time: at least 15 seconds.

Treatment results

• decrease in pain intensity;
• reduction of inflammatory processes;
• general therapy to reduce symptomatic manifestations.

The drugs do not affect the progression of the disease.