The term stenosing ligamentitis is commonly referred to as a pathological change in the state of the tendon and its surrounding ligaments, which leads to a constantly bent position of the finger (less often, several fingers) of the hand. Due to the fact that at the beginning of the disease, a click is heard when the phalanx is extended, it has another name - “trigger finger”.
History of the study of stenosing ligamentitis
For the first time this disease was mentioned in 1850 by Dr. Knott (by the way, later the disease was named after him). He spoke about the phenomenon in which patients complain of problems that arise when trying to straighten or bend a finger. And in 1887, Dr. Schoenburn performed the first operation, during which he cut the "pathological cord".
Since then, many reports have appeared in specialized publications, the topic of which was stenosing ligamentitis, treatment and methods for diagnosing this disease. And since 1966, the Russian doctor N. P. Shastin proposed the use of the methodsurgery, which he called a minimally invasive ligamentotomy.
What is this disease
Stenosing ligamentitis refers to polyetiological (i.e. arising for many reasons) disorders of the tendon-ligamentous apparatus in the hand. It is characterized by the infringement of the tendons in the lumen of the fibrous channels, caused by an inflammatory process of a compressive nature in the cord that connects the muscles to the bone.
On the hand of each person there are so-called annular ligaments that hold the bent finger in this position, preventing it from unbending itself. Here, most often, compressive inflammation occurs with Knott's disease. In this case, the ligaments narrow, and the tendon thickens, which over time causes the main symptom of the disease - a constantly bent finger.
Who is most susceptible to stenosing ligamentitis
To date, the causes of stenosing ligamentitis of the fingers have not been studied enough. It is generally accepted that this disease is based on microtrauma and overstrain of the hands, caused by the same forced position of them for a long time.
This happens mainly to people working at the machine, or to those who are forced to make frequent grasping movements during work. Therefore, the disease is classified as professional. And most often it affects musicians, cashiers, welders, cutters and masons.
Various chronic inflammation often leads to the named pathologyligaments and joints: polyarthritis, rheumatism, etc., as well as the presence of diabetes.
Some authors argue that ligamentitis is also a hereditary disease. But studies that can confirm or refute this statement have not been conducted.
The course of the disease in children
Stenosing ligamentitis in children is quite rare. And the main reason for its occurrence, doctors call the rapid growth of individual structures and tissues in the hand. That is, the diameter of the tendon in this case increases faster than the lumen of the annular ligament, which leads to a kind of conflict between them, causing chronic inflammation. Over time, it leads to degenerative changes in the tendon-ligament apparatus.
Most often it affects children from one to three years old and in most cases on the thumb. Unfortunately, there is still no sufficient explanation for this phenomenon.
Parents may notice that the child has difficulty extending the finger, and at its base there is a small, pea-sized thickening. This should be the reason for the obligatory appeal to a specialist, otherwise the disease will lead to a persistent forced position of the finger.
Main symptoms of stenosing ligamentitis
Stenosing ligamentitis has severe symptoms: for example, when pressing on the base of the disturbing finger, the pain becomes more acute.
- The finger's functionalopportunities.
- Pain, by the way, does not focus only in it, it can radiate to the hand and even to the forearm.
- A painful hard bump can be felt at the base of the finger, and it or one of its joints may swell.
- The finger often goes numb.
- After prolonged immobility of the hand, the symptoms become especially pronounced.
And of course, the main symptom is a click that occurs every time you try to bend or unbend the affected finger.
Stages of disease progression
Stenosing ligamentitis of the thumb, as well as other fingers, develops in stages. In the first stage, clicking and soreness are not very common.
But, as soon as you have to make serious efforts to straighten your finger, you can talk about the onset of the second stage of the development of the disease. The tendon usually thickens at this stage, and a bump develops under the troubling finger.
The last, third stage is characterized by the inability to straighten the affected finger. But, of course, you should not wait for this, it is better to consult a doctor in time and get rid of the disease.
Diagnosis
If stenosing ligamentitis is suspected, an otopedic traumatologist is consulted. The doctor examines the affected hand. In addition, the patient must make her x-ray, which allows you to distinguish this disease from arthrosis or arthritis. Additional testing is usually not required.
Due to the fact that the described pathology, asas a rule, it develops very quickly, at the first sensations of discomfort or pain when moving a finger, you should contact an orthopedist.
Methods of treating stenosing ligamentitis
The treatment taken at the diagnosis of "stenosing ligamentitis" directly depends on the stage of the disease and the general condition of the patient. In the early stages, the use of physiotherapeutic procedures is recommended, in the form of electro- and phonophoresis with drugs that improve microcirculation, as well as applications using paraffin and medicinal compresses.
At a later period, and in the event that physiotherapy does not give the expected results, additional medications are prescribed - these can be anti-inflammatory and painkillers. Injections of hydrocortisone into the area where there is a thickening are very popular.
The patient undergoes mandatory immobilization of the finger. An important condition is a change of work, as well as diligent avoidance of traumatic factors.
Stenosing ligamentitis: surgery
If the measures taken do not give the desired result, or in the case when the patient asked for help at the third stage of the disease, he is shown surgery.
During it, the patient undergoes a dissection of the ligament, which prevents the movement of the tendon. According to the method of N. P. Shastin, this operation is done through a pinpoint puncture using special disposable instruments. This does not require hospital conditions and local anesthesia is sufficient.
During an open ligamentotomy, a patient under general anesthesia makes an incision that does not exceed 3 cm. And then the ligament is dissected. After this operation, the hand is fixed with a plaster cast.
Each of these operations has its drawbacks and positive qualities, therefore, only a doctor can decide how exactly the surgical intervention will be carried out.
Folk treatment
Stenosing ligamentitis, in addition to the prescribed procedures, can be treated with folk remedies after consulting a doctor. The most popular of these is the so-called dry heat. To do this, sea or table s alt is heated in a frying pan, which is then poured into a tight canvas bag. The brush is turned palm up, and the bag is placed on it. Such heating can be done twice a day, avoiding hypothermia between treatments.
Mud compresses are also good, for which any healing clay is diluted to a state of thick sour cream and 5 dessert spoons of apple cider vinegar are added to it. This gruel is smeared with a thick layer on the sore finger, put on top in cellophane. Remove the compress after 2 hours. After that, the hand needs complete rest and warmth.
But remember that with a diagnosis of stenosing ligamentitis, treatment with folk remedies cannot give any significant results.
