What are inflammatory and irritant states of the tendon gliding tissue?

Inflammation of the tendon sheath is a reaction of the tendon gliding tissue that can be accompanied locally by swelling, pain, overheating, redness and movement restrictions. It is not uncommon for tendosynovitis to be misused as a diagnosis of embarrassment for pain that cannot be accurately attributed. The diagnosis should be based on a careful examination to exclude other clinical pictures.
Inflammations of the tendon sheaths occur preferentially at bottlenecks of the tendon compartments.
The A1 ring ligament stenosis (also called "snap finger") is the most common tendon sheath inflammation. For treatment, the tendon is released from its constriction via a carefully selected access. The procedure takes place in a bloodless state and with the help of magnifying glasses to protect important structures such as nerves and blood vessels. If necessary, adhesions are loosened, the tendon smoothed and the damaged ligament or sliding tissue removed. Of all the treatment methods, surgery is the most effective method of permanently alleviating the symptoms. With appropriate aftercare, a small, fine, inconspicuous scar remains.

What's a trigger finger?

A snap finger is called A1 ring stenosis. The snap finger is the most frequent irritation of the tendons. A thickening of the tendon leads to a blockage of the tendon canal. The phenomenon can be compared to a thread knot that is pulled through a needle eyelet. When the narrowing of the tendon gliding bearing is overcome, the finger is stretched under a snapping noise and more or less severe pain. As a rule, pain and swelling precede the snap phenomenon. If the swelling persists, the finger or thumb may bend permanently. The typical snatching can usually be demonstrated, although it is often most pronounced in the morning. The A1 ring ligament is knotty, thickened and painful to the touch. With fist closure and finger extension, a piston-shaped swelling of the flexor tendons can be palpated proximal to the ring ligament. Women are more frequently affected. A1 ring ligament stenosis is most frequently found on the thumb, ring finger and middle finger. One snap finger can affect several fingers at the same time. Swelling of the flexor tendon sheaths in the palm of the hand can lead to carpal tunnel syndrome. The surgeon will therefore also examine you for signs of nerve constriction syndrome.

How do you fix a trigger finger?

I have the operation performed under local anaesthesia. The surgeon wears magnifying glasses to better distinguish the fine structures of the hand. The ring ligament is represented by a skin incision of about two centimeters in the area of the flexural fold of the finger base joints. After cutting the ring ligament, tendon adhesions are loosened and, if necessary, the superficial flexor tendon is smoothed. If the tendon sheath is thickened, it is removed in places. Immediately after the operation you should start with several fist closure and finger stretching exercises every hour.

How can you prepare for a trigger finger surgery?

  • All your questions about possible complications and alternative treatments should be answered in advance.
  • Keep nicotine and alcohol consumption to a minimum!
  • Surgeries limit the suitability for air travel. Therefore, do not plan any professional or private air travel in the 4 weeks after the operation!
  • Lay down ice cubes or cooling pads at home ready to cool the skin after the operation!

What do you need to keep in mind after a trigger finger surgery?

  • Raising and cooling the hand in the first 72 hours is very important.
  • Complete fist closing and finger stretching exercises should be performed several times per hour.
  • The skin threads are removed after 10 to 14 days.
  • Postoperative clinical controls are recommended on the 3rd postoperative day and after 1 and 2 weeks.
  • Independent scar massage from the 3rd postoperative week with moisturizing ointment (e.g. Bepanthen® wound and healing ointment, Linola® fat cream) helps to create inconspicuous soft scars.

Author's statement

Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

 

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