Knott's disease ICD-10: trigger finger in children

Stenosing ligamentitis is a lesion of the tendon and ligaments of the hand. A characteristic symptom of the disease is blockage of one or more fingers. The disease causes problems with the functioning of the tendon. At the initial stage, this leads to problems with extension and flexion of the finger. Stenosing ligamentitis can occur independently or against the background of arthrosis and inflammation. The treatment regimen is determined based on the severity and root cause of the disease. Both conservative therapy and surgery can be used. In this article we will look at why hand ligamentitis occurs and how it can be dangerous.

Clicking finger - description of the disease

Stenosing ligamentitis is an inflammatory process localized in the ligaments of the hand or finger. Damage to the tendon-ligamentous apparatus leads to loss of performance. As the disease progresses, the person begins to experience discomfort and pain. Changes occur in the tissues, namely, stenosis (narrowing) of the tendon sheath occurs, which is responsible for the normal sliding of the tendon during movement. As a result, a nodule on the ligament that is invisible to the eye is formed. Most often, the disease affects the ligaments of the ring and thumb. In the early stages, ligamentitis may not manifest itself in any way, so contacting a specialist often occurs only during an exacerbation.

ICD-10 code

In accordance with the international classification of diseases, stenosing ligamentitis is assigned the code M65.3 . Some documents refer to the condition as “Snapping Finger.” ICD codes are used to quickly exchange information and draw up various morbidity charts. If a person is diagnosed in the form of a code, then to decipher it you will need to find the corresponding code in the ICD-10 classifier.

When diagnosing, the doctor must exclude similar diseases. The ICD code is used exclusively in the medical environment, so the average person does not need to know about it.

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.

Causes of development and provoking factors

Stenosing ligamentitis is an incompletely studied disease, so doctors find it difficult to pinpoint the exact causes of its occurrence. Many experts agree that the disease appears due to the following factors:

• constant loads that put pressure on the ligaments and tendons of the hand;
• microtraumas;
• rheumatisms;
• arthrosis of the hands

The most common factor that provokes the appearance of primary stenosing ligamentitis is the constant performance of the same finger action. At risk are:

• hairdressers;
• masons;
• seamstresses;
• musicians;
• people who often work with a computer.

The danger of the disease is that ligamentitis can become chronic, so a person may forever lose the opportunity for professional fulfillment. Pianists, journalists and esports players especially suffer from this.

Treatment of tendinitis of the wrist and hand at the Yusupov Hospital

Patients with various complaints and diseases come to the Yusupov Multidisciplinary Hospital. The medical facility’s specialists provide patients with a wide range of high-quality services every day.

The diagnostic center of the Yusupov Hospital is equipped with the necessary equipment to examine patients and identify possible problems. Highly qualified specialists have extensive experience and master effective techniques applicable in world medicine. In addition, specialists are committed to interdisciplinary cooperation, which makes it possible to treat not only the underlying disease, but also concomitant pathologies.

Tendonitis of the wrist and hand is a treatable disease with an integrated approach and adequate treatment methods, selected taking into account the specifics of the disease and individual characteristics. If you are concerned about the symptoms of the disease, make an appointment with a rheumatologist at the Yusupov Hospital by phone and get specialist advice without waiting in line.

Kinds

Depending on the location of the pathology, its type and characteristic symptoms are determined. When it comes to the hand, there are two most common localizations of the disease. In the first case, the disease affects the flexor tendons of the finger, in the second - the first canal of the dorsal ligament. The type of disease is revealed only during diagnosis. In most cases, an in-person examination is sufficient to determine the type of ligamentitis.

Knott's disease

Knott's disease is a disorder of the digital flexor tendon. It is this type of stenosing ligamentitis that gives the so-called “clicking symptom”. Knott's disease is characterized by rapid progression. At first, straightening the finger is somewhat difficult and is accompanied each time by a characteristic click. In the absence of therapy, scarring of the tendon tissue occurs, as well as a narrowing of the tendon sheath. This leads to complete blocking of the finger in a bent or straightened state. In most cases, surgery is used to remove the blockage.

With proper treatment, Knott's disease is completely curable. It is important to exclude provoking factors in order to achieve good results in therapy.

De Quervain's disease

De Quervain's disease is localized in the region of the first canal of the dorsal ligament. In this case, stenosing ligamentitis causes pain and affects the thumb. With a long course of the disease, inflammation may occur in the tendon sheath. This will cause swelling in the affected area and in the area of ​​the thumb. In most cases, this type of ligamentitis is chronic. In the initial stages, pain occurs only when the thumb is strongly bent. Subsequently, the pain syndrome does not disappear even at rest. To achieve maximum results in the treatment of stenosing ligamentitis of the thumb, it is necessary to isolate the work of the organ. To do this, a plaster cast or plastic splint is applied.

General information

Types and localizations of stenosing ligamentitis (ICD code 10 – M24)

They are distinguished by the type of localization.

Ligamentitis of the hands

Stenotic ligamentitis of the annular ligament of the hand (“snapping finger”) is an inflammation of the ligaments, the hallmark of which is immobilization of the finger in the “flexed” position. A similar ligamentitis occurs when the tendons responsible for the bending movements of the finger become inflamed. Also, this type of stenosing ligamentitis has another name: “carpal tunnel syndrome” (inflammation of the palmar and carpal transverse ligaments). This disease is also characterized by inflammation of the dorsal ligaments.

Spinal ligamentitis (Interspinous ligamentitis)

With spinal ligamentitis ossificans, inflammation of the ligaments in the lumbar region occurs. The interspinous ligaments of the spine are connected by the spinous processes of adjacent sections of the spine. The most voluminous formations are located in the lumbar region, less voluminous in turn in the cervical region. In most cases, the doctor’s conclusion most often sounds like pain in the lumbar region of unknown origin. Post-traumatic interspinous ligamentitis is characterized by pain when moving the spine. Checking the interspinous joints can be extremely painful.

Deltoid ligament ligamentitis

The ankle is a trochlear connection of the leg bones with the foot - a movable connection of the tibia, fibula and talus in humans.

Any element of the ankle can become inflamed; human upright posture is the main cause of ankle ligamentitis. Depending on the location of the inflammation, pain can occur in any area of ​​the ankle.

Painful sensations manifest themselves in movement or in a stationary state.

Ligamentitis of the elbow ligaments

Pinching of the canal in the extensor of the hand is the cause of ligamentitis in the elbow joint.

Ligamentitis of the knee joint

One of the consequences of an injury or Brucellosis disease is ligamentitis of the knee joint. With this type, there is severe pain and decreased mobility of the knee and patellar ligaments.

Foot ligamentitis

The foot consists of a number of bones connected to each other by a large number of small ligaments. One ligament contains a huge amount of collagen fibers, closely intertwined with each other. The defeat of these ligaments and their inflammation is called ligamentitis.

Causes

The most common causes of foot ligamentitis are:

• Serious foot injuries;
• wearing uncomfortable shoes;
• large and constant load on the legs;
• inflammation in adjacent joints and periarticular tissues of the foot.

Symptoms

Symptoms of ligamentitis, regardless of the location of the pain and the type of ligamentitis, are as follows:

• Pain in the area of ​​the affected ligament, felt when moving;
• Increased sensitivity;
• Manifestation of contractures;
• Decreased mobility of the affected joint;
• Numbness of fingers, fingers;
• The appearance of swelling over the affected joint.

There are specific symptoms for different types of ligamentitis. With stenosing ligamentitis of the annular ligament of the hand, there is pain in the finger when flexing and extending, clicking when “working” with the fingers, or pain when pressing on the palm.

It is recommended that if such symptoms occur, immediately seek help from a doctor.

Symptoms

Symptoms of stenosing ligamentitis depend on the type of disease, severity and root cause of its occurrence and resemble arthrosis of the fingers. At the initial stage, the disease is characterized by the following manifestations:

• clicking of the finger during extension and flexion;
• pain that makes itself felt during active work;
• feeling of obstruction when trying to straighten a finger.

As it develops, all manifestations will become brighter. The transition to the terminal stage is characterized by the appearance of the following symptoms:

• the clicking changes to contracture (limitation of movement) in a certain position;
• constant pain occurs that does not depend on the activity of working with the brush;
• seals appear in the affected area.

The sooner therapy is started, the fewer symptoms a person will encounter. You should not delay contacting a doctor, as the disease may become more complicated. Ultimately, the only way to cure advanced disease will be surgery.

Knowing the symptoms is not enough to make a diagnosis. The doctor must conduct a differential diagnosis, excluding similar pathologies.

Diagnosis and symptoms of stenosing ligamentitis

A trigger finger is characterized by the inability to straighten the finger independently after flexion. A thickened knot of tendon sheath (one or more fingers) passes the annular ligament with some resistance. Now the finger is “trapped” in a bent position and the patient is often unable to straighten the finger on his own, since the extensor strength is not enough for the tendon to overcome the narrowing of the annular ligament. Over time, flexion and extension begins to be accompanied not only by a click but also by pain. This suggests that the changes are already irreversible and conservative treatment will most likely be unsuccessful. There may be functional limitations in movement, such as loss of full finger flexion. Typically, painful restriction of movement is most noticeable in the morning after a long time without movement.

The diagnosis can be established quite easily during a face-to-face examination of the patient, since the disease causes the finger joint to click.

Stenosing ligamentitis in children

Stenosing ligamentitis extremely rarely affects children. If this happens, then in most cases problems arise with the mobility of the thumb. In childhood, the disease may appear due to the following factors:

• genetic predisposition;
• individual feature of the structure of the hand;
• the appearance of a grasping reflex.

For treatment in children, the same methods are used as in adults. Children usually recover quickly from damage to ligaments and tendons. Conservative therapy and further use of physical therapy are sufficient to forget about this disease forever. Stenosing ligamentitis can only be diagnosed after a person is 2 years old. Until this point, a mild disease is considered a variant of the norm.

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Surgery for stenosing ligamentitis (trigger finger)

The operation is a very effective method of treating trigger finger, as the annular ligament is cut and no longer restricts the movement of the tendons in the canal.

This minor outpatient surgery can be performed under local anesthesia. During the operation, a small incision is made in the skin of the palmar surface of the hand in the projection of the distal palmar fold, and the A1 annular ligament is dissected. To exclude the possibility of relapse, it is better to perform excision of the palmar surface of the ligament. Full range of motion is restored immediately after surgery.

Duration of the operation: on average 30 minutes.

Anesthesia: local or conduction

After the operation, the patient can go home.

Possible complications

Complications arise if a person does not take any action to treat the pathology for a long period of time. A dangerous complication is Dupuytren's contracture, which is characterized by the proliferation of connective tissue and narrowing of the tendon tunnel. Contracture is the most common complication of stenosing ligamentitis. In addition, the following complications are identified:

• tunnel syndrome (carpal tunnel syndrome);
• inflammation of the tendon sheath.

To reduce the likelihood of complications, you must follow your doctor's recommendations. It will also be necessary to carry out prophylaxis after the disease has been cured.

Complications may be reversible. Only old people may have problems with the complete elimination of certain pathological conditions due to the onset of degenerative processes in the body.

Features of therapy

The same principles are used to draw up a treatment regimen. At the initial stage, the most important point is pain relief. Non-steroidal anti-inflammatory drugs and glucocorticosteroids are used for this purpose. It is very important to immobilize the affected area. This requires a splint or plaster. For maximum effect, electrophoresis with hydrocortisone can be used.

Surgical treatment is used only in severe cases of the disease or in the absence of effect from conservative therapy. Doctors try to carry out minimally invasive interventions that quickly help to forget about stenosing ligamentitis.

Conservative

Conservative treatment is available if a person suffers from mild ligamentitis. The basis is hormonal and non-hormonal anti-inflammatory drugs. The most successful combination is to use NSAIDs orally and hormonal ointments topically. Among the most effective physiotherapy procedures are:

• phonophoresis;
• electrophoresis;
• magnetotherapy.

After achieving the result, you will need to undergo rehabilitation. Therapeutic exercise will allow you to restore tendons and ligaments, and will also help in the prevention of this lesion.

It is necessary to correctly combine the use of different medications. Before prescribing a specific medicine, an examination is carried out for possible contraindications.

You can learn about synovitis of the wrist joint with ICD 10 code by clicking on this link.

Surgery and restoration of the hand

Surgery is used as a last resort. During the operation, the ligament tissue is cut. If necessary, the same is repeated with the tendon sheath. After the effects of the stenosis are removed, the wound is sutured. The postoperative period takes place in the hospital. In some cases, the person is discharged from the hospital the next day. During the recovery period, antibiotics are used to prevent infection. Further recovery takes place with the help of physiotherapy and physical therapy.
Surgery is performed in a hospital setting under local anesthesia. In most cases, the operation takes place as planned. Until this point, painkillers and anti-inflammatory drugs are used . After the operation, you need to undergo proper rehabilitation. For several months you will need to forget about heavy loads on your hand.

Is it possible to do without surgery?

Many people try to avoid surgery. It is possible to do without surgery when treating stenosing ligamentitis if the lesion is mild or moderate. For conservative treatment, all available means are used. Positive dynamics from the use of medications should be noticeable 4-5 weeks after the start of their use. If the condition worsens, then surgery is prescribed.

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What are the likely consequences after suffering ligamentitis?

In 99% of cases, treatment is successful. After all manipulations, medications and operations are completed, it is recommended to develop the treated area in order to avoid fusion of the ligaments with the tendons.

It is important to know! If you experience the symptoms mentioned above in this article, you should pay attention to the signals of your body and immediately go to the hospital. Otherwise, this can lead to more severe consequences, sharp and long-term pain, and complete immobilization of the affected joint.

Prevention

To prevent the disease from returning or appearing for the first time, you need to do the following:

• Eliminate root causes . If the cause of the disease is work that puts excessive stress on the hand, then you will need to change it or reduce the load;
• Apply strengthening complexes. It is necessary to take vitamins regularly. Collagen can be used to strengthen tendons;
• Treat pathologies that can lead to the reappearance of stenosing ligamentitis.

It is very important to exclude work activities that cause excessive stress. If you do not change your occupation, the probability of encountering defeat again is above 50%.

conclusions

1. Stenosing ligamentitis is an inflammatory disease that affects the ligaments of the hand.
2. There are two types of the disease depending on the location. These are Knott's disease and De Quervain's disease.
3. The pathology most often affects people whose activities involve regular stress on the wrist joint. These are office workers, journalists, musicians.
4. Ligamentitis can also be diagnosed in a child. The final diagnosis is made no earlier than 2 years of life .
5. In the early stages, the disease responds well to treatment. Depending on the severity of the case, complex conservative treatment or surgery is selected.

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Symptoms of tendinitis in the wrist and hand

A feature of hand tendinitis is the local form of its manifestations at the site of inflammation. With primary tendinitis of the hand, the patient experiences the following symptoms:

• pain that intensifies with movement. Pain may radiate to nearby areas;
• crunching sound when moving your hand;
• stiffness of movements;
• joint swelling;
• increased body temperature at the site of inflammation;
• lumps under the skin.

In cases where other disorders are the cause of hand tendinitis, patients experience symptoms characteristic of them. When patients come to the Yusupov Hospital with these complaints, the rheumatologist carefully examines the existing signs and checks the mobility of the joint. Laboratory and instrumental studies can confirm hand tendinitis:

• blood analysis;
• joint fluid analysis;
• X-ray examination of the joint;
• ultrasound examination to exclude arthritis and bursitis;
• Magnetic resonance imaging.

Providing high quality medical services and providing customer-oriented service are the priorities of the Yusupov Hospital staff. When receiving treatment in a multidisciplinary hospital, the patient can at any time receive information about the plan and cost of therapy, as well as receive consultation from a specialist at a convenient time.