The term stenotic ligamentitis is usually called a pathological change in the state of the tendon and the ligaments surrounding it, which leads to a constantly bent position of the finger (less often, several fingers) of the hand. Due to the fact that a click is heard when the phalanx is extended, it has another name - “clicking finger”.
The history of the study of stenosing ligamentitis
For the first time, Dr. Nott mentioned this disease in 1850 in his works (incidentally, the disease was later 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. Schönbern underwent the first operation, during which a “pathological cord” was dissected.
Since then, in specialized publications a lot of messages have appeared, the topic of which was stenotic ligamentitis, treatment and methods for diagnosing this disease. And since 1966, the Russian doctor N.P. Shastin proposed the use of a surgical method, which he called minimally invasive ligamentotomy.
What is this disease
Stenosing ligamentitis is referred to as polyetiological (i.e., arising for many reasons) disorders of the tendon-ligamentous apparatus in the hand. It is characterized by the infringement of tendons in the gaps of the fibrous canals, caused by the inflammatory process of compressive nature in the striae that connects the muscles with the bone.
On the brush of each person there are so-called ring-shaped ligaments that hold the bent finger in this position, preventing it from unbending to unbend. Here, most often, compressive inflammation occurs in Nott's disease . At the same time, the ligaments narrow and the tendon thickens, which eventually causes the main symptom of the disease - a constantly bent finger.
Who is most prone to stenosing ligamentitis
To date, the causes of stenotic ligamentitis of the fingers have not been studied enough. It is generally accepted that the basis of this disease are microtrauma and overstrain of the hands caused by the same forced position for a long time.
This happens mainly for people working at the machine tool, or for those who are forced to make frequent grasping movements during work. Therefore, the disease is classified as professional. And most often they suffer from musicians, cashiers, welders, cutters and masons.
Often, various chronic inflammations of the ligaments and joints lead to this pathology : polyarthritis, rheumatism, etc., as well as the presence of diabetes mellitus.
Some authors argue that ligamentitis is also a hereditary disease. But studies capable of confirming or refuting 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-ligamentous apparatus.
Most often, children from one to three years old are exposed to it, and in most cases on the thumb. Unfortunately, there is still no sufficient explanation for this phenomenon.
Parents may notice that the child hardly extends his finger, and at its base there is a small, pea-sized thickening. This should serve as a reason for compulsory appeal to a specialist, otherwise the disease will lead to a persistent forced position of the finger.
The main symptoms of stenosing ligamentitis
Stenosing ligamentitis has a pronounced symptomatology: for example, during pressure on the base of a worrying finger, the pain becomes more acute.
- The finger is reduced functionality.
- The pain, by the way, does not focus only on it; it can be given to the hand and even to the forearm.
- At the base of the finger, you can feel a painful, dense lump, and he or one of his joints may swell.
- The finger is often numb.
- After prolonged immobility of the hand, the symptoms become especially vivid.
And of course, the main symptom is a click that occurs every time you try to bend or straighten the affected finger.
Stages of the development of the disease
Stenosing ligamentitis of the thumb, as well as other fingers, develops in stages. At the first stage, clicking and pain are not manifested too often.
But, as soon as you have to make serious efforts to extend your finger, you can talk about the onset of the second stage of the development of the disease. The tendon at this stage usually thickens, and a bump appears under the disturbing finger.
The last, third stage is characterized by the inability to straighten the sore 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 stenotic ligamentitis is suspected, they turn to an opedologist-traumatologist. The doctor examines the affected brush. In addition, the patient must be given her x-ray, which allows to distinguish this disease from arthrosis or arthritis. Additional analyzes are usually not required.
Due to the fact that the described pathology, as a rule, develops very quickly, at the very first sensation of discomfort or pain when moving with your finger, you should consult an orthopedist.
Methods of treating stenosing ligamentitis
The treatment undertaken with a diagnosis of stenotic ligamentitis depends on the stage of the disease and the general condition of the patient. At 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.
In a later period and if physiotherapy does not give the expected results, additional medications are prescribed - these can be anti-inflammatory and painkillers. Injections of hydrocortisone in the area where there is a thickening are very popular.
The patient is required to immobilize the finger. An important condition is the change of work, as well as the careful avoidance of traumatic factors.
Stenosing ligamentitis: operation
If the measures taken do not give the proper 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 is dissected ligament, which prevents the movement of the tendon. According to the method of N.P. Shastin, this operation is done through a puncture using special disposable instruments. This does not require hospital conditions and enough local anesthesia.
When conducting an open ligametotomy, the patient under general anesthesia makes an incision that does not exceed 3 cm. And then the ligament is cut. After this operation, the brush is fixed with a plaster cast.
Each of these operations has its drawbacks and positive qualities, so only a doctor can decide exactly how the surgery will be performed.
Alternative treatment
Stenosing ligamentitis in addition to prescribed procedures can be consulted with a doctor, and treat folk remedies. The most popular of these is the so-called dry heat. For this, sea or table salt is heated in a pan, which is then poured into a dense bag of canvas. The brush is turned palm up, and the bag is placed on it. Such heating can be done twice a day, avoiding hypothermia between the procedures.
Mud compresses are also good, for which any medicinal clay is bred to a state of thick sour cream and 5 dessert spoons of apple cider vinegar are added to it. This slurry is smeared with a thick layer on the sore finger, put on top in cellophane. Remove the compress after 2 hours. After which the hand needs complete peace and warmth.
But remember that with a diagnosis of stenotic ligamentitis, treatment with folk remedies cannot give any significant results.