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    What is a snap finger?

    In the video above you can see the restricted movement of a snap finger in severity II. In addition, the result of the operation is visible in the last part of the video (place of the inconspicuous scar and unrestricted movement). But what exactly is a snap finger and what causes it?

    A snapping finger is inflammation of the flexor tendons of the fingers or thumb. A knotty thickening interferes with the sliding of the tendon. When the resistance is overcome, the finger or thumb is jerked into extension with more or less severe pain. In popular parlance, therefore, the names of jerking fingers (lat. Digitus saltans) or jerking thumbs are common. The snap phenomenon is also known as clicking fingers, spring fingers or trigger fingers. The cause of this type of tendovaginitis (tendovaginitis stenosans) are not pathogens.

    The flexor tendons connect the fingertips to the muscles on the forearm. The tendons are passed through ring-shaped bands like a fishing line through the rings of a fishing rod. The ligaments of the tendon sheaths can be divided into ring ligaments and cruciate ligaments according to their shape. With a snap finger, the sliding obstacle occurs on the first ring band (A1) of the finger or thumb. This is where the technical term A1 ring ligament stenosis comes from. The inflammation and rubbing damage the tendon, making it difficult to flex the fingers. The severity of a snap finger is divided into four stages, which differ in terms of symptoms:

    • Grade I: A painful swelling in the palm can be palpated
    • Grade II: The finger snaps, but can still be stretched
    • Grade III: The finger can only be stretched with the help of the healthy hand
    • Grade IV: The finger can no longer be made completely straight

    In a personal consultation , the attending physician will examine your symptoms and determine the disease and its degree, and explain the various treatment methods to you.

    What are the symptoms of a snap finger?

    Occasionally a touch sensitivity of the palm of the hand is noticed first. Closing the fist causes pain in the affected finger. If the hand is then opened again, a jerky extension of the finger occurs. The complaints develop over days to weeks. The snapping of the finger is most noticeable in the morning. The change from lying to standing and the movement of the fingers leads to a redistribution of the tissue water. Due to the decongestant swelling during the day, snapping improves. If the swelling of the tendon increases, the finger snaps permanently. Stretching the finger becomes more laborious and painful. If the jumping of the finger has been going on for months, a spontaneous improvement is unlikely. If the finger is not stretched for days because of the pain, the ligaments shorten and the middle joint stiffens. Not infrequently, similar complaints are felt on other fingers of the same or the other hand. Over 40 percent of those affected also suffer from carpal tunnel syndrome (Kumar P, et al., 2009, J Hand Surg Eur Vol). In this case, the fingers may feel numb, especially at night.

    What are the causes of a snap finger?

    One-sided work on the computer promotes tendinitis

    Causes and triggers are often confused when talking about the development of tendinitis (tendovaginitis stenosans). The difference can be illustrated using the example of a heart attack. Exercise can trigger a heart attack, especially in people who are sedentary. Exercise, on the other hand, helps prevent a heart attack.

    In the case of a snapping finger, the clinical picture, i.e. the snapping and the pain, is triggered by the movement of the fingers. The possible causes of the tendon thickening on the A1 ring ligament, however, are due to the condition (stenosis on the A1 ring ligament). Changes in hormone metabolism favor the development of a snap finger. Lack of exercise and sudden unaccustomed stress in both professional and private life can lead to injuries and diseases of the musculoskeletal system. Regular physical exertion, whether as endurance training or strength training, on the other hand, leads to an adaptation of the body. Therefore, the tendon sheath of the fingers of sport climbers is demonstrably more resistant [1]. There are no reports of the frequent occurrence of jarring fingers among sport climbers or concert pianists. In the case of other tendinitis of the hand, such as de Quervain’s tendovaginitis stenosans, the suspicion of being caused by overuse has been refuted [2] .

    How common is a snap finger?

    The flickering finger is one of the most common diseases of the hand. The probability of developing a snap finger in the course of a lifetime is 2.6 percent. The incidence was given as 28 new cases per 100,000 population [3]. The incidence of disease in the general population is about one percent [4]). Women are more often affected (1: 4) [5]. Schnappfinger most often appear in the age of fifty. Usually the thumb, ring finger or middle finger is affected [6].

    How is a snap finger detected?

    The painful, rapid movement is quite typical for a snap finger. Since the disease develops gradually, the affected patients cannot remember exactly when the symptoms began, except in rare cases. During the examination by the doctor, a swelling can be felt in the palm of the hand below the affected finger. Pressing this area usually causes pain. When moving the finger, the sliding of the thickened tendon can be felt. Snapping can also be caused by an injury to the extensor tendon (extensor hood rupture, dislocation of a extensor tendon lateral rein). Rarely, a misalignment of the finger (gooseneck deformity) can trigger a rapid jump. These injuries and the misalignment can, however, be separated from a snap finger by a hand surgeon during an examination. The plastic surgery specialist can make a clear diagnosis of the thickening of the tendon on the patient’s A1 ring ligament.

    What to do if I have a snap finger?

    Many portals will be happy to provide you with information when it comes to healing or alleviating common complaints. When it comes to your health, recommendations should always be based on facts. Scientifically proven facts give you more confidence to make the right decision. The benefits of ointments, globules, bandages, ultrasound and electrotherapy as well as extracorporeal shock wave therapies are not certain with regard to the snap finger. The application of cold, exercises and physiotherapy are important after an operation. Exercise alone, rest, immobilization or a change of job cannot prevent or cure inflammation of the tendon sheaths. An ergonomic work environment, for example with a palm rest and an ergonomic keyboard and mouse, on the other hand, are good tips to support the healing of the tendon at the level of the ring ligament A1.

    What are the side effects of cortisone treatment of a snap finger?

    The anti-inflammatory drug cortisone can be used as part of a so-called conservative treatment. The effectiveness of a cortisone injection is well documented in numerous scientific studies [7]. However, the risks, benefits, and alternative treatments should be carefully considered prior to any treatment with cortisone. After a cortisone injection, a clicking finger returns in up to 48 percent of cases [8]. Repeated cortisone injections damage the tendons and suppress the body’s own collagen production [9]. This can lead to the previously damaged tendon tearing. The effectiveness of the anti-inflammatory cortisone injections is reduced in the case of recurring or long-lasting spring fingers. In contrast to conservative therapy, treatment with a minor surgical intervention permanently removes the snap in almost 100 percent of cases [10].

    Snap fingers and snap thumbs for children and babies

    Even toddlers and babies can suffer from a snap finger or snap thumb. Parents often report that their child cannot straighten a thumb, which is due to the difficulty of sliding on the corresponding ring ligament. The congenital narrowing of the flexor tendon becomes noticeable between the first and fourth year of life. The thumb is by far the most commonly affected (Pollex flexus congenitus or rigidus). A snap finger occurs in fewer than three out of a thousand newborns [11]. Both sides can also be affected. During the examination, a nodular thickening of the flexor tendons is felt in the metatarsal crease. A sonography (ultrasound examination) can also confirm this.

    The problem with the ring ligament can heal on its own even after several years. Scientific publications and experience in hand surgery show that a small surgical procedure can quickly and reliably remove the bottleneck in the tendon. The surgical treatment is characterized by very good results [12]. Since short general anesthesia is required for small children, it is recommended that the operation be performed after the age of six months.

    Which doctor treats a snap finger?

    The treatment of diseases of the hand requires a high level of expertise and care. A three-year training course provides the necessary understanding of the complex interplay between tendons, nerves and joints in a very small space. A hand surgeon specializes in the detection, prevention, and treatment of disorders affecting the hand. In this way, he also identifies rheumatic diseases of the hand, for example when the flexion of the fingers is blocked. Furthermore, other diseases such as osteoarthritis of the finger or a Rhizarthrosis treated. The so-called Dupuytren’s contracture is a case for the hand surgeon. In contrast to the snap finger, the connective tissue of the palm of the hand hardens.

    Microsurgical techniques are learned in training as a plastic surgeon and in additional training as a hand surgeon. A plastic surgeon is particularly experienced in handling fine instruments. The mastery of techniques for tissue displacement enables a plastic surgeon and hand surgeon to optimally treat even rare complications. If the specialist also specializes in aesthetic surgery, this is of course an advantage.

    The operation for the treatment of the snap finger

    The tendon can be released from its constriction with a 15-minute outpatient procedure under local anesthesia. Once the obstruction has been removed, the inflammation heals on its own. Before an operation, it is recommended to wash the hand carefully with soap. Long nails, varnished nails and artificial nails make disinfection more difficult and should therefore be avoided. Immediately before the operation, the skin is disinfected with an alcohol solution. The nerves of the palm of the hand are specifically anaesthetized with finest cannulas. Bloodless, optical magnification and microsurgical techniques help to preserve important structures and allow a better assessment of the tendons. The short skin incision of one to two centimeters is carefully planned by the hand surgeon. The constricting ligament is split. If necessary, adhesions are loosened, the tendon is smoothed and the damaged ligament or thickened sliding tissue is removed. The hand surgeon makes sure that the tendons slide freely during the operation. Of all treatment methods, surgery is the most effective method for permanent relief of symptoms (Amirfeyz R, et al, 2017, J Hand Surg (Eur Vol)). With appropriate follow-up care, a small, fine, inconspicuous scar remains.

    Complications such as inflammation, restricted mobility or follow-up surgery are rare. Accompanying diseases such as diabetes, cigarette smoking, overweight and old age increase these risks. In general, the risk of movement restriction is 0.8 to 1.6 percent. The risk of inflammation is 0.5 to 0.6 percent (Werner BC, et al., 2016, J Hand Surg Eur Vol.). Other rare risks are a complex regional pain syndrome, a bowstring phenomenon and nerve injuries.

    How can you prepare for a snap finger surgery?

    • All your questions about possible complications and alternative treatments should be answered in advance.
    • Limit nicotine and alcohol consumption to a minimum!
    • Surgery restricts the ability to travel by air. Therefore, do not plan to travel by air for business or private reasons in the 4 weeks after the operation!
    • Patients should prepare ice cubes or cooling pads at home. When you come home from the practice after the outpatient operation, these can be used directly to cool the skin!

    What do you have to consider after snap finger surgery?

    • It is very important to keep the hand elevated and cooled in the first 72 hours.
    • Complete fist closing and finger extension exercises should be performed several times every hour. This should be viewed as part of the therapy.
    • The skin sutures are removed after 10 to 14 days.
    • Postoperative clinical checks are recommended on the 3rd postoperative day and after 1 and 2 weeks.
    • Independent scar massage from the 3rd postoperative week onwards with moisturizing ointment (e.g. Bepanthen® Wound and Healing Ointment, Linola® Fat Cream) helps to create inconspicuous soft scars.

    Experience reports on the Schnappfinger OP

    Nowadays, patients place enormous value on patient reports and ratings that they can find on the Internet. Many patients who have been treated or operated on at CenterPlast have documented their experiences on various pages on the Internet. We have made a link available to you on our testimonials page under the menu item “About us” to bundle such patient voices.

    Before and after pictures of a Schnappfinger operation

    At the beginning of this page you will find a video in which you can see a before and after recording. It is an operation performed by Centerplast. The video is more suitable than before and after pictures. You can find more information on our Page before and after pictures to treatments.

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    The author

    Dr. med. Stéphane Stahl

    “We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

    Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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