This condition is also known as a narrowed tendon sheath that prevents smooth movement of the thumb or other fingers. It affects one or more fingers of the hand. It is a stenosing tenosynovitis, an “inflammatory” disease of the tendons and their sheaths (tendon sheaths and so-called “pulleys”), where the tendons glide freely. In certain cases, they become “thickened”. The smooth gliding of the tendons in the area of the base (MP) joint of the finger is restricted, at the level of the A1 pulley - a fibrous band - a fibrous “ring” attached to the base joint of the finger, which defines the space through which the tendon glides during its movement. The triggering mechanism is post-inflammatory states, post-traumatic states of the tendons, or etiologically unclear causes, which can lead to narrowing of the tendon sheath in its affected section A1 pulley, causing difficulty in tendon movement.
Symptoms
- The affected finger, when bent into the palm and then trying to straighten it, jumps and hurts, which is accompanied by a characteristic click. The clicking phenomenon is caused by a disproportion between the flexor tendon and the fibrous ring (A1 pulley).
- The most commonly affected fingers are the third and fourth.
- The most commonly affected are middle-aged women, secondarily occurring in rheumatoid arthritis, gout, but also other metabolic diseases, such as diabetes.
Cause
The flexor tendons of the fingers run in the palm and wrist in tendon sheaths and are held to the bones by so-called pulleys. Overloading, repeated strain, or post-inflammation can cause swelling on the tendon, which can restrict the movement of the tendon in the sheath under the pulley.
Diagnosis
The diagnosis of trigger finger is based on the clinical finding of painful finger jumping, pain along the flexor tendon of the finger, and palpable swelling on the tendon. An X-ray excludes other causes of pain.
Basic information about the procedure
- Conservative treatment involves local injection of steroids and immobilization. In this case, recurrence is common (repetition of difficulties), as the treatment is not causal.
- The most effective and essentially the only treatment is surgical.
- The procedure itself involves longitudinal, often only partial, cutting of the A1 pulley with a scalpel from a small incision in the palm (15 mm incision, approximately in the area of the natural transverse palmar crease at the level of the affected finger), so that the tendon can again glide freely and without restrictions in its sheath without clicking phenomena.
- The procedure is most often performed under local anesthesia (local numbing).
- The procedure takes approximately 30 minutes, and you can usually leave the facility immediately after the operation.
Postoperative care
The patient is advised to keep the upper limb elevated (e.g., sling, scarf), which minimizes swelling and possible bleeding. Passive and active exercises prevent possible re-adhesion of the tendon and its sheaths. Stitches are removed approximately on the 14th day after the procedure. Subsequently, scar care, pressure massages, and application of silicone sheets on the scar (Epiderm, Scarban) are necessary. Return to work for manual workers is from 2 to 3 weeks. For others, even sooner.