Stenosing ligamentitis is a serious dysfunction of the hand, in which a failure occurs in its tendon-ligamentous apparatus. Self-diagnosis is unacceptable, because the disease is often confused with acute arthritis, osteomyelitis, pathological dislocation and even sepsis. The diagnosis of stenosing ligamentitis is made on the basis of an x-ray of the hand (if necessary) and after analysis of the current clinical picture.
The pathogenesis of dysfunction of the tendon-ligamentous apparatus of the hand causes controversy among specialists, because no one can yet voice the exact details of the formation of the pathology.
Its most reasonable interpretation is based on an analysis of the energetic work of the fingers during the day. They carry out their activities due to the uninterrupted functioning of tendons. In the channel, consisting of connective tissue, they slide so that the finger moves in different directions.
With a provoking factor in the form of inflammation, the tendon becomes more voluminous. Its new dimensions are not designed for the size of the canal, so the usual path of the terminal structure of the striated muscles may deviate. If significant edema forms, even such a modified route cannot be performed. It should be remembered that the formation of inflammation begins initially in the ligamentous area, and then spreads to the tendon territory.
Finger dysfunction with stenosing ligamentitis has the following numerical indicators of the number of patients for each of them:
large - 25%;
index - 3%;
average - 20%;
unnamed - 44%;
little finger - 8%.
There are no age restrictions for this disease. During the development of the body, problems usually arise with the thumb. However, experts do not diagnose a child under 2 years of age. The disease may disappear on its own as people get older, but in some cases it develops into a more serious form of ligamentitis. It is better for parents to initially play it safe and visit an orthopedist with their child at the first alarming symptoms.
The disease can be combined with certain pathologies, significantly worsening the general condition of the patient:
1. Epicondylitis. We are talking about inflammatory and degenerative transformations of the elbow joint.
2. Arthrosis. If it causes damage to the small joints of the hand, then its tandem with stenosing ligamentitis is dangerous.
3. Humeroscapular periarthritis. The lesion is fixed in the same area as with epicondylitis, but covers the periarticular soft tissue.
Why does trigger finger disease develop?
First, let's look at the reasons why the joints on the fingers click. So, why do the knuckles on your fingers click? This usually occurs due to constant increased loads and excess pressure on the ligaments and tendons of the hands. The joints of the fingers click and hurt more often in people whose profession involves regularly performing grasping movements, for example:
- welders;
- masons;
- gardeners;
- cleaners;
- cutters, etc.
Housewives who have a lot of housework to do often face the problem of a finger that clicks when bent and hurts.
In children, joints click when bending their fingers extremely rarely. The reasons lie in congenital characteristics or problems in the development of the ligamentous apparatus.
Often the primary cause of trigger finger syndrome is other inflammatory diseases of the musculoskeletal system. Stenosing ligamentitis is often combined with:
- arthrosis of large and small joints of the hands;
- epicondylitis;
- humeroscapular periarthritis;
- spondyloarthrosis.
All due to weakening of connective tissue, problems with metabolism and other disorders.
Anatomy of the finger tendon
The wrist flexor tendons slide in canals and are covered with a synovial membrane, which produces fluid for the normal gliding of the tendons. The tendons are held in the canal during flexion and extension of the fingers by annular ligaments. All people have anatomical stenosis in the area of the A1 annular ligament (at the junction of the palm and fingers), and therefore are predisposed to the development of this disease.
- Thickening of the tendon sheath
- Annular ligament A1
- Flexor tendon
But when the ligament or synovium thickens due to stress, such as repeated overexertion of the hand at work, then free gliding is impossible.
Symptoms of Knott's disease
Before moving from the causes of a trigger finger to a description of treatment and prevention, it is worth learning more about the symptoms of the disease.
The acute stage of Nott's syndrome manifests itself quite specifically. The patient demonstrates a key symptom - clicking of the phalanges in a certain position. If the patient does not see a doctor immediately, and the problem becomes protracted, then it is more difficult to establish the correct diagnosis. This is because the same “clicking” effect disappears, the finger goes into an extension or flexion contracture.
Also, in addition to the question of why the finger clicks when bent, patients are also concerned about pain. Moreover, pain is present both during movement and at rest. Feeling the base of the affected area, the doctor feels a lump, and the patient experiences pain.
Knott's disease is characterized by a relatively slow development, so patients do not worry about why their fingers click for quite some time. Unpleasant symptoms and pain are minimal at first and increase gradually. Pathology can be determined by the following manifestations:
- a clicking sound when flexing/extending the affected limb;
- a feeling of stiffness and numbness in the affected area;
- pain that increases with pressure on the base of the affected phalanx;
- hand pain;
- deterioration in mobility and coordination of movements of the affected hand.
Stenotic ligamentitis is characterized by several developmental phases that clearly differ from each other.
- Initial phase. It is characterized by pain when pressure is applied to the palm and base of the affected area. And also problems when trying to fully bend or straighten the phalanx, especially in the morning.
- The second stage, when “snapping” brings tangible inconvenience to the person. After the click, the pain remains, the compaction at the base of the phalanx also becomes painful.
- The third stage, when arm movements are increasingly limited, a stable contracture develops. Changing the position of the finger can only be done with the help of the other hand. The patient is bothered by long-term pain that occurs after the “snap.” They spread throughout the palm and can extend into the shoulder and forearm.
Types of pathology
The classification of the disease is based on the fact which ligaments were affected:
1. 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.
2. De Quervain's disease. Stenosing vanginitis is a problem with the abductor muscle that swells. It ultimately leads to the effect of friction of the inflamed tendons against the bone-fibrous canals. The pathological process provokes significant pain at the base of the mobile limb of the hand.
3. Carpal tunnel syndrome (carpal tunnel syndrome). In this area, the median nerve, which is responsible for sensory and motor skills of the hand, is sometimes compressed.
Diagnostic methods
Now we will tell you how to identify the causes and select treatment for trigger finger, what diagnostics are used.
Usually, it is not difficult for a qualified doctor to make the correct diagnosis after collecting anamnesis and clinical examination, identifying the symptoms listed above. If the treatment of a trigger finger on the hand involves surgery, then an x-ray must first be taken to weed out the causes of the disease related to the condition of the bones and calcification of soft tissues.
In children, the problem is noticed by parents or a doctor during examination. The thumb is always in one position, and the child screams when adults try to straighten it.
At the first and second stages of the disease, it is not difficult to make a diagnosis. Difficulties often arise in the third stage. In this case, the doctor carefully collects anamnesis, analyzes occupational risks, and the patient’s age and gender characteristics.
Differential diagnosis with Dupuytren's contracture helps to correctly determine the causes and prescribe treatment when the joints of the fingers click. In contrast, with Nott's disease, the patient does not have nodes and cords on the palm and fingers. The lesion is limited to one finger; pain is detected when pressing on the annular ligament. X-rays help rule out problems in small joints. This is an important diagnostic method that allows the doctor to prescribe the correct treatment for the spine and joints.
Stages of disease development
Depending on many factors, there are three degrees of progression of the pathology:
1. Initial stage. The disease at the start of its development does not bring significant discomfort. At most, the victim feels minor pain in the finger area, which quickly subside. At the same time, he begins to be alarmed by the characteristic weak click heard after moving his finger.
2. Middle stage. With further tightening of the tendons, unpleasant symptoms cannot be avoided. A phase has arrived when the affected finger has difficulty changing its position, and the tubercle that appears in the problem area hurts when pressed.
3. Late stage. If you ignore the alarming symptoms of the first two stages of development of stenosing ligamentitis, the finger cannot return to its original position without additional help. The only way out of the situation is surgical intervention.
Methods for treating stenosing ligamentitis
What to do when your finger clicks during flexion and extension? Treat! And the doctors at our clinic will help you do this correctly.
At the first suspicion of Nott's disease, you should consult a doctor. The doctor will easily make the correct diagnosis after the initial examination if this is the initial or second stage of the disease. In rare cases, X-ray confirmation is needed. The doctor decides how to treat trigger finger syndrome, taking into account the stage of the disease, age and provoking factors.
Conservative therapy
At the initial stage of treatment, you need to reduce the load on the hand. Then conservative techniques and procedures are sufficient. These include:
- massotherapy;
- iontophoresis and electrophoresis;
- exercise therapy;
- baths with medicinal plants.
Drugs from the group of glucocorticosteroids are also prescribed; they are administered directly to the site of the lesion. Medicines eliminate inflammation and compaction. Therapy lasts quite a long time. But if the provoking factors are not eliminated, then the risk of relapse is high. In some cases, patients have to change their profession. Or at least give your hands a regular break from repetitive monotonous movements.
At the second stage of the disease, conservative treatment is not as effective, but is still advisable. Because the chances of recovery without surgery are quite high.
How to treat Knott's disease (or trigger finger) at this stage? The doctor prescribes active resorption and anti-inflammatory therapy using enzyme preparations.
Immobilization of the sore finger is also carried out, massage, exercise therapy and electrophoresis are prescribed. Chlorethylene (local irrigation) and a warm local shower help reduce pain. For severe pain and inflammation, novocaine and glucocorticosteroid blockades are used. Treatment takes several months. If all is well, then to prevent relapses, you need to eliminate traumatic factors, perhaps change jobs.
If conservative treatment at the second stage does not have an effect, then surgery is indicated for patients of working age.
Surgical treatment
At the third stage of Knott's disease, patients of working age are prescribed surgery immediately. For older people and those who suffer from severe concomitant diseases, the doctor determines treatment tactics individually.
But if conservative treatment does not produce results, the pain does not go away, and interferes with the patient’s normal life and self-care, then surgical intervention is indicated regardless of age.
Surgery is very effective in treating trigger finger syndrome. The surgeon cuts the annular ligament, and it no longer interferes with the free movement of the tendons in the canal. Such operations are usually performed on an outpatient basis under local anesthesia. The patient can go home immediately after the procedure.
During the operation, the surgeon makes a skin incision on the surface of the palm in the projection of the distal palmar fold. The annular ligament is divided through this small incision. To prevent relapse of the disease, it is recommended to excise the palmar surface of the ligament.
The mobility of the finger and the entire hand is fully restored immediately after surgery. Here's how to treat trigger finger with the help of a surgeon.
Causes of ligamentitis
The causes of ligamentitis are varied, which is why this disease can be called polyetiological. The reasons for the development of ligamentitis can be :
- Consequences of trauma;
- Consequences of a chronic infectious process in soft tissues.
- A profession that is accompanied by a constant load on the fingers, incorrect position of the hands, and high tension;
- Increased load on the thumb or index finger (for example, when squeezing objects tightly and for a long time).
In addition, systemic diseases such as:
- Gout;
- Rheumatoid arthritis;
- Diabetes.
Forecast and measures to prevent the disease
The prognosis is positive. But it is important to remember that successful treatment of stenosis does not guarantee that the disease will not return. It may develop on other fingers.
An effective way of prevention is to change professions and reduce household stress on the hands. If the patient considers it impossible to change jobs, then he is taught to hold his hands correctly while working, regularly relax them, and give the muscles a rest.
Hand surgeons say work habits mean that patients with trigger finger syndrome rarely relax their hand muscles, even when resting.
Another factor that provokes excess muscle tension is a defensive reaction to pain. Sometimes it persists even when the pain is gone. Therefore, an effective way to reduce the load on the arm muscles and reduce the risk of relapse of the disease is to develop new motor habits.
Prolonged use of a computer keyboard and carpal tunnel syndrome
Carpal tunnel syndrome is traditionally considered an occupational disease for activities that require repetitive flexion/extension or twisting of the hands, or involve exposure to vibration. It is widely believed that prolonged daily computer work that requires constant use of a keyboard is a risk factor for developing carpal tunnel syndrome.
A number of scientific studies indicate that there are no significant differences in the incidence of this syndrome in the group of constantly working with a keyboard when compared with the general population. Simply put, carpal tunnel syndrome is not usually caused by prolonged use of a keyboard.
At the same time, carpal tunnel syndrome occurs in every sixth computer worker they examined. According to their data, those users whose hand is extended by 20° or more relative to the forearm when working with the keyboard are at greater risk.
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.
You can read about synovitis of the right elbow joint in this article.
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.
Prevention of the disease
To prevent ligamentitis of the knee joint, experts recommend adhering to the following rules:
- Lead a healthy lifestyle and give up bad habits, which will have a positive impact on your overall health.
- Eat a balanced diet and take daily walks in the fresh air.
- Play sports only under the guidance of an experienced trainer. Avoid excessive stress on the knee joint, and increase the complexity of all workouts gradually, starting with the easiest exercises.
- If you experience any pain or other signs that your knee ligaments are damaged, you should immediately seek the help of a specialist.
With the correct treatment and the patient following all the doctor’s recommendations, the ligaments of the knee joint can fully recover within two weeks. And prevention of ligamentitis will help avoid the occurrence of the disease and its negative consequences.