Stenosing ligamentitis (clicking finger)

Stenosing ligamentitis disrupts the normal sliding of the tendon of the finger and gradually complicates the usual movements of the hand. The person first feels stiffness, then painful clicks appear, and in the later stages the finger is fixed in a bent position.

Today we will analyze the mechanism of development of the problem, typical causes, main symptoms, diagnostic principles and treatment approaches. After reading the article, you will learn when observation and conservative tactics are enough, and when doctors consider surgery.

What is stenosing ligamentitis and why does the “click” of the finger occur

In international sources, this condition is usually described as trigger finger or stenosing tenosynovitis. Its essence lies in the fact that the flexor tendon passes through the narrowed area of the tendon canal in the area of the A1 ring ligament (A1 pulley), so the movement becomes uneven and painful.

Clicking occurs when a thickened area of a tendon or its nodule passes through a dense canal with a mechanical obstacle. In everyday life, this condition is sometimes described as a crunchy finger. During its clinical evaluation, attention is paid to the blockage, soreness at the base of the finger and the nature of the motor restriction.

The problem is localized in the tendon area and its sheath, and not in the articular cartilage or ligaments. That is why the pain intensifies during movement, especially with flexion and subsequent extension.

Causes of the development of a clicking finger

In modern clinical practice, repeated force movements of the hand, concomitant systemic diseases, older age and minor repetitive tendon injuries are singled out as the main risk factors.

Excessive load on the brush

The risk is increased by actions that require strong or prolonged engagement. These include:

• work with tools;
• frequent squeezing of objects;
• repeated movements with fingers;
• load, where the brush many times goes from a tight grip to relaxation.

In such conditions, the tendon rubs against the narrowed section of the canal. This supports irritation, local inflammation and subsequent thickening of the tissues, which causes the ligamentitis to progress faster.

Concomitant diseases

Most often, doctors call diabetes mellitus and rheumatoid arthritis risk factors. In patients with such chronic diseases, the problem occurs more often, and the response to injectable and other conservative treatments may be weaker than in people without concomitant conditions.

If there is already a history of systemic inflammatory disease, the doctor assesses not only the finger itself, but also the general condition of the hand. This is necessary in order not to miss other sources of pain and stiffness that give a similar clinical picture.

Age-related changes and microtraumas of tendons

Lesions are more often recorded in older people, especially after forty years. A separate role is played by microtraumas that accumulate gradually and do not always have one clear episode of damage in the anamnesis.

Due to repeated overload, the tendon sheath is irritated, and the tendon itself slips worse. Over time, this goes from early discomfort to a stable mechanical blocking of movement.

Main symptoms and stages of the disease

The clinical picture usually develops gradually. At first, the person feels uncomfortable during the first movements, and then pain, clicks and difficulties with full extension are added.

Early manifestations

At the initial stage, complaints are not always sharp. More often there is morning stiffness, sensitivity in the palm of the hand at the base of the affected finger and the feeling that the movement is not quite free.

Early signs:

• stiffness after sleep or prolonged rest;
• soreness in the palmar surface at the base of the finger;
• feeling of obstruction during movement;
• local sensitivity when pressed.

Such symptoms do not always interfere with household activities, but it is at this stage that the patient best notices the change in the usual movements of the hand.

Progression: pain, click, finger lock

Further, the symptoms become more pronounced. There is a painful click during movement, and the finger may suddenly linger in a bent position and extend only after additional effort with the second hand.

In more severe stages, the blockage is no longer episodic. In severe cases, described AAOS, the finger may not extend at all without the intervention of a medical specialist.

Which doctor treats and when to seek help

First, patients go to the family doctor, who evaluates the symptoms and selects the tactics for further action. If the problem does not go away, interferes with daily activities or progresses, the patient is usually examined by an orthopedic traumatologist, surgeon or other specialized specialist in hand pathology.

It is worth making an appointment with a doctor faster if:

• the clicking finger is regularly blocked and you have to extend it with the second hand;
• pain intensifies and interferes with grasping, writing or small household movements;
• symptoms do not decrease after reducing the load;
• there is concomitant diabetes, rheumatoid arthritis, severe swelling or rapid deterioration of function.

This approach reduces the risk of persistent contracture, prolonged stiffness, and more difficult recovery after treatment.

Diagnosis of stenosing ligamentitis

In most cases, diagnosis is limited to examination. The doctor clarifies the complaints, the duration of the symptoms, the type of load on the hand, the presence of diabetes or rheumatoid process, and then evaluates the movement of the finger itself during the examination.

Clinical examination

During the examination, the doctor looks for four basic signs:

1. Soreness over the tendon canal.
2. Thickening or swelling of the shell.
3. Active lock while driving.
4. Reducing the smoothness of tendon sliding.

It is this set of symptoms that in most cases allows us to draw a conclusion. The doctor also assesses whether complete passive and active extension is maintained. This is important because prolonged fixation of the finger affects the prognosis of mobility and the choice of further tactics.

Do I need an ultrasound or additional examinations

In most cases, X-rays and MRI are not needed. A typical picture is often established already during a conversation and physical examination.

Ultrasound is used selectively when it is necessary to clarify the condition of the tendon, shell or exclude other pathology of the hand. In modern reviews, ultrasound is described as a useful tool to visualize ligament thickening, tendon nodules, and causes of blockage during movement.

Surgical treatment: when it is necessary

Not every patient needs surgery. Initially, conservative treatment is usually considered: reducing the provocative load, night splinting, anesthesia, soft mobilization exercises and, according to indications, injection of a corticosteroid into the tendon canal area.

Indications for surgery

Surgical treatment is considered when conservative treatments do not provide adequate control of symptoms. A separate indication is the situation when the finger is already blocked in flexion and does not extend even after careful assistance with the second hand.

The main indications for the operation:

• stable finger lock;
• severe pain and loss of hand function;
• lack of effect after non-surgical tactics;
• relapse after injection treatment;
• increased stiffness with the risk of permanent restriction of movement.

The essence of the intervention is to release the ligament and restore the free sliding of the tendon. This operation is usually performed on an outpatient basis under local anesthesia, through a small incision or with the help of other minimally invasive techniques.

Recovery after intervention

After surgery, most patients are recommended to resume finger movements early. In the first days, pain, swelling in the palm and sensitivity in the incision area persist, and the complete disappearance of stiffness takes a few days longer than the skin to heal.

If the stiffness, swelling or pain lasts longer than expected, the doctor can connect physiotherapy. After surgery, it is important to follow the recommendations for dressings, loads and exercises, because this is what affects the return of the function of the hand.

Possible complications and relapse prevention

Without treatment or with late treatment, the disease can turn into a persistent lock and prolonged stiffness of the finger. After surgery, there are also risks, although they are less common: it is infection, damage to the finger nerve, preservation of the click, pain in the scar or incomplete restoration of the extension.

To prevent relapse, it is important to reduce the repeated force load on the brush, to correct the work regime in time, and not to ignore morning stiffness or repeated episodes of blocking. In the presence of diabetes or rheumatoid inflammation, monitoring the concomitant condition together with a specialist doctor is of additional importance.

‍