What Is Flexor Tenosynovitis?

Finger flexor tenosynovitis, also known as stenosing tenosynovitis or trigger finger, is one of the most common hand surgical diseases. It is mainly manifested by the patient's feeling of soreness and pain on the palm side of the metacarpophalangeal joint during flexion and extension. In severe cases, there will be popping and even twisting, which will cause dysfunction of flexion and extension of fingers. Although this disease can occur in both adults and children, its causes and treatment methods are different.

Basic Information

nickname

Stenosing tenosynovitis, trigger finger

Visiting department

surgical

Common locations

hand

Common causes

Refers to strain

Common symptoms

Soreness and pain on the metacarpophalangeal joint

Causes of finger flexor tenosynovitis

Pediatric finger flexor tenosynovitis, also known as congenital stenosing tenosynovitis, is caused by the abnormal thickening of the A1 tendon sheath and narrowing of the sheath tube. The flexor tendon forms a sclerotic enlargement at the proximal end of the A1 tendon sheath, resulting in finger flexion and extension dysfunction. . However, whether the cause of the disease is congenital or acquired is still controversial.

The cause of adult finger flexor tenosynovitis is more related to the injury of the injured finger. Due to repeated flexion and extension of the injured finger within a short period of time, aseptic inflammatory changes in the tendon sheath tissue occur, eventually leading to thickening of the tendon sheath and narrowing of the sheath. On the other hand, due to strain or changes in women's (pregnancy or menstrual) hormone levels, the flexor tendon of the finger swells, and the volume of the tendon sheath is limited, so it can also form a narrow entrapment relative to the swollen tendon.

In addition to the above-mentioned causes, there are still some exacerbating factors of the disease, such as cold irritation, diabetic patients, peritonitis synovitis, and rheumatoid patients.

Clinical manifestations of finger flexor tenosynovitis

The early manifestation of finger flexor tenosynovitis is that the patient feels soreness and pain on the palm side of the metacarpophalangeal joint during flexion and extension of the fingers. In more severe cases, there will be popping and even twisting, which will cause flexion and extension of the dysfunction. These symptoms are more severe when you wake up in the morning, some symptoms are alleviated in the afternoon, and cold irritation can often aggravate the symptoms. In children, flexor tendinositis of the fingers involves the thumb, and all fingers can be affected. Physical examination showed tenderness at the level of the A1 pulley. Some patients could touch the sclerotic enlargement near the A1 pulley, and the enlargement could slide back and forth with the flexor tendon during flexion and extension. In more severe cases, the affected finger can show a fixed flexion deformity (lock), and both active and passive straightening can be restricted.

Finger flexor tenosynovitis examination

Finger flexor tenosynovitis can usually be confirmed through clinical physical examination. For less typical cases, a B-ultrasound can be used to confirm the diagnosis. Although the sensitivity of magnetic resonance is also very high, considering its high price, it is still not suitable for it. Preferred secondary inspection.

Finger flexor tenosynovitis diagnosis

Usually, a clear history of strain, combined with progressive flexion, pain, popping, and twisting, can generally make the diagnosis easier. For atypical cases, B-ultrasound can also be performed to help confirm the diagnosis.

Finger flexor tenosynovitis treatment

Conservative treatment

For adult cases with first-onset disease, conservative treatment may be effective. Conservative treatment includes finger braking, avoiding cold stimulation, physical therapy, and the use of drugs that promote blood circulation, swelling, and pain.

For pediatric patients, local massage, straightening of the affected fingers, and fixation with braces are reported. About 40% of these cases can be cured with conservative treatment.

2. Closed treatment

Prednisolone preparations can be used in combination with a small amount of local anesthetic to inject A1 tendon sheath to play an anti-inflammatory and detumescent effect. Some patients have obvious curative effects, but if they continue to strain after closure, it is easy to relapse, and it should not be closed multiple times. Repeated injections, as there have been reports of multiple tendon ruptures caused by closed injections. In addition, closed treatment is not appropriate for pediatric patients.

3. Small needle knife or thick needle percutaneous release treatment

This type of treatment is a minimally invasive treatment that can be completed in an outpatient setting. It is percutaneously cut with a small needle knife or thick needle to loosen the A1 pulley. This type of operation requires an experienced doctor to operate, because it is not performed under direct vision. There is a risk of picking off tendons, damaging peripheral nerves and blood vessels. In some children, the radial digital nerve of the thumb just crosses the A1 pulley, so it is not recommended to use a small needle knife or thick needle to treat children's flexor tendinositis.

4. Surgery

If the above treatments are not effective, surgical treatment is feasible. The surgery can protect the digital nerves and blood vessel bundles under direct vision, and release the A1 block accurately and thoroughly. If the operation is performed under local anesthesia, the patient can also be allowed to actively bend his or her fingers to determine the slippage of the tendon and whether it has a popping sound. The exercise of flexion and extension of the fingers should be started on the second day after the operation, otherwise tendon adhesions are likely to cause finger movement disorders after surgery.

Finger flexor tenosynovitis prevention

There is currently no clear prevention method for pediatric flexor tenosynovitis. But for adults, flexor tenosynovitis can be prevented by reducing strain, avoiding cold irritation, controlling blood sugar well (for diabetic patients), and early treating periotenitis and rheumatoid arthritis.