Flicking finger
| Classification according to ICD-10 | |
|---|---|
| M65.3 | Flicking finger |
| ICD-10 online (WHO version 2019) | |
With trigger finger (also snap fingers , Spring fingers , lat. Tendovaginosis stenosans , tenosynovitis stenosans or Digitus saltans ) is called a system-related disease in which the flexor tendons of a finger (usually the thumb ) over the bending side metacarpophalangeal joint (at the transition from the palm thickens to finger) and can therefore no longer slide freely through the annular ligament there (more precisely A1-annular ligament) (so-called annular ligament stenosis ). This results in a 'snap' of the finger when bending or stretching into the normal position, and stretching often requires help.
left: position of the A1 ring ligaments in the hand (blue), middle: thickened flexor tendon that does not slide through the ring ligament when the finger is stretched, right: extended finger with thickened tendons behind the ring ligament
Tendovaginitis stenosans results from overstressing the flexors of the hand. Thus, this type of inflammation is not a bacterial infection. It is often an occupational disease, for example piano players, athletes, craftsmen or people who work longer at the computer often suffer from this disease. A poor posture and the stereotypical sequence of movements lead to minor injuries to the tendons. If this happens more and more often, inflammations develop, which leads to an even stronger inflammatory reaction due to the associated swelling. In tendovaginitis stenosans, this results in the formation of tendon nodules that have to pass through the ring ligament (annular ligament) with every finger movement and thus create the phenomenon of the finger flicking. For this reason, targeted muscle treatment can be used as a conservative treatment in order to eliminate muscular imbalances. This can be done, for example, through trigger point therapy . At the same time, the patient should be given a gentle and relieving exercise program in order to remove the muscular overload more quickly. The triggering factors such as playing instruments, sport and manual activities should be temporarily avoided until the symptoms no longer occur. Since tendovaginitis stenosans is an overuse injury, it is particularly advisable to change the practice techniques under the guidance of an experienced therapist when practicing a musical instrument in order to avoid further health impairments.
The diagnosis is made clinically, that is, based on the physical examination. In addition, x-rays are carried out to rule out bone changes, possibly also an ultrasound examination ( sonography ) and, in rare cases, a layer examination.
The therapy consists of a small surgical procedure in which the skin above the ring ligament is incised at an angle under local anesthesia and after applying a tourniquet ; Then the ring ligament is carefully exposed while protecting the blood vessels and nerves running parallel to the tendon sheath and completely severed across the tendon . Now the free gliding of the tendon is checked and then the skin is closed again (sewn up) and a bandage is applied. Free finger mobility is restored after the anesthesia has subsided. The threads are removed after about a week. Physiotherapy or occupational therapy exercise treatment is rarely necessary. After hand surgery, the extremity (hand or arm) should always be elevated to prevent excessive swelling.
Alternatively, a mixture of an anesthetic and a decongestant ( local anesthetic and corticosteroid ) can be carefully introduced (injected) into the tendon sheath (and not into the tendon) under sterile conditions.
In young children, there is a congenital variant of this disease on the thumb called pollex flexus congenitus (congenital curved thumb). In this case, the thumb on the end link is in a flexed position. In addition to the A1 ring ligament, another oblique ligament must be cut over the base of the thumb (oblique pulley).
Tumors of the tendons, connective tissue or bones are very rare causes.
literature
- Al Hasan Makkouk, Matthew E. Oetgen, Carrie R. Swigart, Seth D. Dodds: Trigger finger: etiology, evaluation, and treatment. In: Current Reviews in Musculoskeletal Medicine. Volume 1, No. 2, June 2008, p. 92, doi : 10.1007 / s12178-007-9012-1
- Anna Sander, Ingo Marzi, Johannes Frank: The treatment of tendovaginosis on the hand. In: Hand Surgery Scan. Volume 05, No. 01, March 14, 2016, p. 69, doi : 10.1055 / s-0041-107103 , online at thieme-connect.com .
