Trigger finger (Knott's disease)

Trigger finger syndrome is a pathology caused by changes in the synovial cavity. As a result of disruption of the correct functioning of the tendon, the affected finger bends with great difficulty, and a characteristic click is heard when straightened. The syndrome is also known as tendinitis, tenosynovitis or Knott's disease.

The disease most often affects women, as well as patients with rheumatoid arthritis or diabetes. Problems arise in the first (thumb) finger, less often in the middle or ring finger. Also at risk are those engaged in manual labor, those suffering from gout, pregnant women, people with congenital pathologies and hereditary predisposition.

The appointment is conducted by a microsurgeon

Bryukhanov Anatoly Valentinovich - microsurgeon.

Ask a question Read more...

Causes of Knott's disease

Often patients do not understand why their fingers click when unclenching their fist and mistake this for normal tissue behavior after tension. However, it is not. Prerequisites for the development of such a disease may be:

genetic predisposition;
severe physical stress on the hand, excessive finger tension;
violation of metabolic processes;
diseases of the joints and ligaments (arthritis, arthrosis);
systemic connective tissue diseases;
hand injuries;
inflammatory processes.

Knott's disease sometimes occurs in children. In these cases, the causes may be heredity and diseases affecting the connective tissue.

Causes and possible consequences

Knott's disease (trigger finger) is primarily an inflammatory process caused by fibrous deposits in tendon tissue. New growths growing inside gradually block access to the synovial fluid responsible for unhindered sliding. This can happen due to the following reasons:

inflammation as a result of injury;
muscle strain caused by the type of professional activity;
inflammatory processes in adjacent tissues and joints;
hereditary factors.

In children, there is a pathogenic imbalance between the rate of development of tendons and connective tissues. As a result of this conflict, compactions are formed that make bending difficult. The situation is aggravated by the fact that children find the click funny and deliberately and repeatedly repeat the movement that produces the sound, thereby provoking the development of the disease. Sometimes a similar anomaly is observed in infants; it is associated with the development of the grasping reflex.

Stenosing ligamentitis tends to progress. At an early stage, scar changes are insignificantly expressed and make themselves felt only by characteristic clicks, which are repeated occasionally and do not cause discomfort. This phase is most favorable for rapid successful treatment.

If therapeutic measures have not been taken, the scars gradually thicken, clicks become more frequent, more effort is required to bend and straighten the thumb, and continuous aching or acute situational pain appears. If left untreated, the finger completely loses mobility and irreversible processes begin.

Symptoms of a trigger finger

You can recognize the problem by the following signs (in order of appearance):

painful sensations at the base of the phalanx of the affected finger, which intensifies with pressure or movement;
swelling in the affected area and the formation of a compaction that is felt upon palpation;
difficulty in bending and especially straightening the finger: straightening with a painful sensation and a click, a noticeable delay (you have to make an effort);
the pain becomes stronger and is felt even at rest;
inability to straighten the finger with the force of the hand.

As the disease worsens, the symptoms become more pronounced and painful, and normal hand function is disrupted. Therefore, I recommend contacting a competent orthopedic traumatologist at a very early stage.

Symptoms of the disease

It is possible to confuse trigger finger syndrome with another disease or injury only at the initial stage, when the symptoms are mild. Subsequently, patients experience the following symptoms:

pain - at first it is weak and is felt only in the morning after waking up, then without treatment it begins to increase and is felt during physical activity and touching the sore spot;
decrease in motor activity - the finger does not straighten, the amplitude of its movement decreases.

With further progression of the disease, the following symptoms appear:

severe pain - occurs even without load and in a state of complete rest, radiates to the hand and shoulder;
clicks in the finger - felt every time it is bent and extended;
compaction at the base of the sore finger - appears during a complication, causing pain when pressed.

At the first stage of the development of the disease, a person does not feel discomfort, therefore, patients in the second and third stages often turn to the multidisciplinary medical center KIT. If you feel pain or limited movement in your fingers, you should contact us.

Snapping finger - treatment

To treat Nott's disease, both conservative and surgical treatment are used. Let me note right away: conservative treatment does not always help and takes a lot of time. To achieve this, the following measures are applied:

removing stress from the affected hand;
ensuring finger immobility;
physiotherapy;
taking anti-inflammatory drugs (if the disease develops against the background of inflammatory processes);
Injections with medications are given locally.

You can start with conservative treatment, but keep in mind that this may be a waste of time. If symptoms still persist after treatment, surgery is prescribed.

Knott's disease surgery is performed under local anesthesia. In this case, the pinching ring of the ligament is dissected - a very delicate job that can only be performed by an experienced orthopedic traumatologist.

After the operation, the function of the finger is restored immediately. The pain disappears. No rehabilitation required. The patient can immediately begin work. As with Dupuytren's contracture, there is a technique for dissecting the annular ligament without the traditional incision and sutures. During this time, the patient is under the supervision of a doctor.

To get more information about Knott's disease (trigger finger), call +7 (905) 640-64-27 or send your questions in a message from the Contacts section.

Hand Surgery Clinic

Stenosing ligamentitis (Nott's disease or "snapping" finger) is a disease of the hand, which is characterized by a typical "snapping" of the finger or fingers at maximum flexion into a fist, limitation of movements, pain at the base of the fingers when pressing, morning stiffness of movements in the hand. Often occurs against the background of systemic diseases - diabetes, gout, rheumatoid polyarthritis.

Typical signs of stenosing ligamentitis:

a characteristic clicking sensation when extending a finger or fingers
pain at the base of the finger when pressing
the presence of a dense, round formation at the base of the finger
feeling of stiffness, difficulty bending or straightening fingers, mainly in the morning

There are 4 degrees of the disease:

1 - pain, periodic clicking

2 - visible snapping of the finger, the finger straightens independently

3 - visible snaps, the finger can only be straightened with the help of the second hand

4 - it is impossible to straighten the finger even with the help of the second hand

Treatment

Depending on the extent of the disease, various treatment methods are used.

For degrees 1-2, a blockade with hormonal anti-inflammatory drugs is performed, and physiotherapeutic treatment is prescribed.

If the blockade is ineffective, as well as in cases of 3-4 degrees of the disease, surgical intervention is recommended - dissection of the A1 ligament at the base of the finger. This operation can be performed in two ways: openly, with a small skin incision, sutures and further dressings, or minimally invasive, through small punctures of the skin with a needle, without stitches and dressings.

What is needed for treatment in one visit?

Thanks to modern information technologies, solving many problems in one visit is quite possible. To do this, you only need to answer the questions and send photos of your hands to [email protected] . Our specialists will study the information received and draw up an individual treatment plan.

It is advisable to indicate in the letter:

Full name and year of birth
Contact phone number and city of residence
Do you have dense subcutaneous cords or deep folds in the skin of your palms and fingers?
Do you experience clicking or snapping of your finger or fingers when straightening?
Do your fingers go numb (do you wake up with the feeling that your hand has been resting?)
Can you forcefully straighten your finger or fingers using your other hand?
Did your hand problems appear after an injury?
Have you been operated on before? If so, where and when (it is advisable to send a copy of the discharge summary after the operation, and mark the postoperative scar on the photo of the hand with a marker)
Attach a photo of your hand (top, side view), it is advisable to indicate the problem areas on the hand with a marker or pen
Do you have chronic diseases - rheumatoid polyarthritis, gout, diabetes mellitus, etc.?

In any form, describe the problem (what is bothering you and for how long), who you turned to for help (what treatment you received and whether it had any effect), what studies were carried out (if any, you must attach copies of medical documents).

In addition, you can simply make an appointment by calling 8 (812) 406-88-88 for surgery for Knott's disease without answering questions or sending photos. If there are no contraindications, you may also be offered treatment in one visit.

Hand Surgery Center

Treatment for trigger finger

In my practice, I begin treatment with a local injection of steroids (diprospan). This procedure is very effective and relatively safe. If you ask the patient to move his finger before administering the drug, you can feel the tendons sliding at the tip of the needle. This sensation allows you to inject a small dose of the drug exactly where it is needed without damaging the tendon. As a rule, this quick manipulation gives an immediate effect.

Local injection in the area of the flexor tendons.

Stenosing ligamentitis

Stenosing ligamentitis (commonly known as Knott's disease or simply trigger finger) is a chronic inflammatory disease of the tendon-ligament system in which the tendon becomes unevenly thickened and its channel narrows, thereby impeding normal movement.

The patient complains of discomfort, pain, and “clicking” when moving his fingers. Sometimes after “snapping” the patient has to straighten the finger with the help of the second hand.

If you are familiar with these symptoms, we recommend that you immediately seek advice from an orthopedist . In this case, the specialist will be able to identify your problem and prescribe effective treatment to eliminate it.

Usually they start with physiotherapeutic treatment, prescribing anti-inflammatory drugs, blockades with steroid drugs, although often this approach does not give the desired result.

If such treatment is ineffective, the patient is recommended to surgically correct this problem. The essence of the operation is to intersect the annular ligament, thereby freeing up space for free movement of the tendon.

An experienced orthopedic surgeon will perform the operation at the Dopomoga Plus clinic under local anesthesia, and the patient will be able to go home on the day of the operation. The rehabilitation period is up to 2 weeks.

Make an appointment with an orthopedic traumatologist at the Dopomoga Plus clinic. With the help of modern laboratory and diagnostic facilities, new operating equipment and thanks to the experience of our orthopedic specialists, we will help you solve all problems with the musculoskeletal system, including the problem of “snapping finger” or stenosing ligamentitis.

Main symptoms

The trigger finger develops slowly. At the beginning, the disease is not noticeable. But at the final stage, characteristic symptoms appear:

decreased mobility;
clicking sound when extending fingers;
stiffness and pain in the affected area.

Pain and discomfort during the development of the disease can be felt not only in the ligaments of the affected finger, but throughout the entire hand. If the disease progresses, the ability to move the fingers can be severely impaired, and the hand will lose its functionality.

NOTT’S DISEASE OR SNAPING FINGER: HOW NOT TO “SCALE” THE DISEASE

Click, click, click. Such sounds can often be heard when bending the fingers of yourself or your loved ones. Don’t pay attention, it’s a joint clicking, it’s okay, it’s been happening for a long time. Many of us have heard these or similar answers in response to the question, what is it that clicks for you? But, do you have to be so careless and does it click? Let's figure it out.

The topic of our conversation today is snapping finger or Knott's disease.

WHAT IS NOTT'S DISEASE?

Knott's disease is a disease of the digital flexor tendon, in other words, it is a disease of the hand that is characterized by a typical “snapping” of the finger or fingers at maximum flexion into a fist, limitation of movements, pain at the base of the fingers when pressing, and morning stiffness of movements in the hand. This disease was first described by Alfred Knott back in 1850, which is why it received the name Knott's disease.

In medical terminology, the name of the disease is also used as stenosing ligamentitis. And among the people, because of the characteristic sound when bending a finger, this pathology is also called a snapping finger.

STATISTICS

According to statistics, this disease is most common in women over 40 years of age, and on average occurs in 2 people out of 100.

It should be noted that this lesion occurs quite often in children.

As a rule, this disease primarily affects the thumb and ring fingers.

As practice shows, the lesion most often occurs on the following fingers:

Ring finger – 44%.
Thumb – 26%.
Middle finger – 20%.
Little finger – 7%.
Index finger – in 3% of cases.

This disease occurs especially often in people whose professional activities involve grasping objects in the palm of their hand; screwdrivers, hair dryers, manicure tools, or using machines that apply pressure to the palm. These factors provoke inflammation of the palm, and, as a result, the occurrence of trigger finger disease.

In addition to external factors (unfavorable work, physical labor), the precursor of stenosing ligamentitis can also be an inflammatory process in the body associated with the musculoskeletal system (arthritis, arthrosis, osteoporosis, osteoarthritis).

SIGNS OF THE DISEASE, SYMPTOMATICS

In most cases, trigger finger disease begins asymptomatically. A person may feel a small lump, feel pain or slight numbness in the palm, or even notice swelling and a crunching or clicking sound when bending the finger. In addition, additional symptoms may also occur that cause discomfort, such as:

a feeling of obstruction that occurs when bending or straightening a finger;
blocking, inability to bend or straighten a finger;
pain that is localized at the base of the finger.

REASONS FOR THE APPEARANCE

Knott's disease very often occurs against the background of systemic diseases - diabetes mellitus, gout or rheumatoid polyarthritis. Patients themselves believe that the joint itself is clicking, but this is self-deception.

It is important to note that in children from 1 year of age, Knott's disease often appears due to developmental characteristics. The fact is that the finger flexor tendon has annular ligaments. They prevent the tendon from moving to the sides, especially when moving. In young children, it often happens that the tendon grows much faster than the ligament, as a result of which it compresses it. Accordingly, in this place the tendon becomes significantly denser. When the seal passes through the narrow channel of the ligament, a clicking sound is produced. Over time, the tightness can cause the tightness to become larger, causing the tendon to be unable to move and therefore leaving the finger in a bent position.

The mechanism of development of pathology in adults is no different, but the root causes of its appearance are completely different. If an adult is diagnosed with Knott's disease, the reasons, in addition to the above, may be the following:

regular stress on the fingers, performing monotonous hand movements (typing, driving);
inflammatory process localized in the hand;
injuries and damage in the area of thickening formation;
hereditary predisposition;
atherosclerosis;
thyroid diseases;
constant compression of the ligaments;
physical labor with a load on the hands.

In most cases, Knott's disease causes an inflammatory process provoked by constant stress. The risk group includes women, as well as people who, due to their occupation or hobby, constantly perform the same movements (for example, sewing, knitting or embroidering) or have chronic diseases. Due to problems in metabolic processes and due to weakened connecting materials, as well as other reasons, stenosing ligamentitis can also develop against the background of such abnormalities as:

arthrosis;
spondyloarthrosis,
spondylosis;
epicondylitis;
glenohumeral periarthritis.

It is very important for the patient to realize that the main danger of the disease is that if left untreated, the finger can become fixed in a bent state, and it will be almost impossible to straighten it without the intervention of a doctor. As a rule, with a very advanced stage of Knott's disease, limited mobility appears.

But you shouldn’t get upset ahead of time, since this pathology can be successfully treated today, so if you have such a problem, you should never put off visiting a doctor for too long. At the medical center, you can receive qualified advice from experienced orthopedists who will conduct a comprehensive diagnosis and prescribe treatment for you depending on the stage of the disease. A diagnosis by an orthopedist, as a rule, occurs on the basis of a patient interview, palpation and obtaining a complete clinical picture, if necessary, using radiography.

VARIETIES OF THIS PATHOLOGY

Depending on which ligaments of the patient were affected in medical practice, the following classification is distinguished:

Knott's disease.
The primary signs of pathology are a painful clicking of the finger when it moves back and forth. Secondary symptoms of the disease are already becoming a serious problem, in which the hand, with an existing deformed joint, begins to function with difficulty.
De Quervain's disease.
Stenosing vanginitis is a problem with the abductor muscle, which swells, which leads to the effect of friction of the inflamed tendons against the osteofibrous canals, while the pathological process provokes significant pain at the base of the mobile limb of the hand.
Carpal tunnel syndrome (carpal tunnel syndrome).
In this area, the patient sometimes experiences compression of the median nerve, which is responsible for sensory and motor skills of the hand.

STAGES OF THE DISEASE

Knott's disease has several stages, such as:

The initial stage, in which pain is noticeable during palpation of the palm in the area of the base of the finger. There may also be intermittent difficulty in straightening and/or flexing the affected finger, which is especially pronounced in the morning.
The second stage, in which constant clicking brings severe discomfort to the patient. The blocking of the finger becomes more noticeable, and overcoming it naturally becomes more difficult - often a person has to bend and straighten the finger with the other hand. Unpleasant sensations persist after snapping; palpation of the thickening at the base of the finger also causes pain.
The third stage is characterized by an increase in limited mobility, at which a persistent contracture is already formed. Changing the position of the finger is achieved only with the help of the second hand. Once the affected finger does snap, the patient experiences prolonged pain throughout the entire palm, forearm, and even shoulder.

TREATMENT METHODS FOR NOTT'S DISEASE

Depending on the degree of the disease, various methods of treating trigger finger are used in medical practice.

When diagnosing stage 1-2 of the disease, a blockade is usually performed using hormonal anti-inflammatory drugs, and additional physiotherapeutic treatment is prescribed.

In the initial stages, Knott's disease can also be cured using conservative methods such as:

reducing physical stress on the hand;
drug treatment with anti-inflammatory drugs;
the use of physiotherapeutic procedures (electrophoresis, magnetic therapy).

If conservative methods and the blockade are ineffective, as well as in stage 3 of the disease, doctors recommend surgical intervention - dissection of the A1 ligament at the base of the finger.

SURGERY FOR NOTT'S DISEASE

For Nott's disease, surgery can be performed in two ways:

Open method
, in which a small skin incision is made with sutures and further dressings. In this method, under local anesthesia, an orthopedic surgeon dissects the annular ligament, which limits the movement of the tendon.
Using a minimally invasive method called needling
, in which only small punctures of the skin are made with a needle, without stitches or dressings.

FORECAST

Orthopedists give a favorable prognosis for this pathology. As a preventive measure for stenosing ligamentitis, doctors usually recommend changing the main type of activity and reducing the load on the hand in everyday life. The patient is also taught the correct positioning of hands, self-massage and other effective independent influences on the problem part.

The medical treatment of stenosing ligamentitis is carried out at the highest level, after which you or your loved ones will forever forget about the problem of the trigger finger.

You are always welcome!

Your Ladisten Clinic.

Who is most likely to have trigger finger disease?

Trigger finger disease can occur in completely healthy people for no apparent reason. According to statistics, this disease is most common in women over 40 years of age, and on average, occurs in 2 people out of 100. This disease is especially common in people whose professional activities involve grasping objects in the palm of their hand; screwdrivers, etc. or using machines that apply pressure to the palm. These factors provoke inflammation of the palm and, as a result, the occurrence of trigger finger disease. Sometimes, trigger finger disease can occur as a side effect of other medical conditions; rheumatoid arthritis, amyloidosis, diabetes mellitus, carpal tunnel syndrome and in persons undergoing dialysis procedures. In addition to the reasons described, healthy people who are not associated with professional activities with deformed palms may also develop trigger finger disease.

For what reason does this disease develop?

There is no clear, precisely established cause of trigger finger disease. This disease can be caused by inflammation of the tendons or an injury that develops due to damage to the tendon sheath. Tendons are the dense tissues that connect muscles to bones. The tendons that extend from the forearm also connect our fingers to the bones. In short, the normal functionality of our fingers depends entirely on the mobility of these tendons. And the tendon sheath is tissue with an elastic structure that surrounds the tendons in the form of a tunnel and protects them from damage. Normally, the tendons move freely within the sheath, but in patients with trigger finger disease, likely due to inflammation of the sheath and loss of necessary elasticity, the finger becomes stiff, immobile, and locked in a bent, trigger-like position.

Non-surgical treatment for trigger finger (Knott's disease)