Rationale for minimally invasive finger flexor stenosis tenosynovitis with the push-cut knife

  Stenosing tenosynovitis of the finger flexor tendon, also known as “popping finger” and “trigger finger”, can occur in any finger, mostly in the thumb, index and middle fingers, and in a few patients, multiple fingers can also develop at the same time, which is a very common chronic soft tissue injury disorder of the hand. It is a very common clinical condition of chronic soft tissue injury of the hand. It is usually seen in manual workers, such as carpenters, packers, weavers, accountants, computer operators, etc. The clinical manifestations are limited voluntary flexion and extension of the affected finger, painful flexion and extension of the finger with force, and a bouncing action, such as pulling the trigger, with a popping sound. In severe cases, tendon entrapment occurs, and the affected finger is passively fixed in the flexion or extension position, and cannot straighten itself due to pain. The symptoms are more severe in the morning and after work, and are relieved after activity or heat application.  The cause of tenosynovitis of the finger flexor tendons is due to the presence of a fibrous sheath around the finger flexor tendons, i.e., the tendon sheath. In the palmar side of the metacarpophalangeal joint, there is a bony shallow groove with the finger flexor tendon sheath local thickening of the transverse fibrous tissue composed of bony fibrous tube, called the tendon sheath slide, the finger flexor tendon play a binding protective role. When the patient is engaged in hand work for a long time, the blood does not honor the tendon, or feels cold, causing the finger tendon to constrict and develop. When the affected finger repeatedly flexes and extends for a long time, or holds hard objects for a long time, the finger flexor tendon and the tendon sheath pulley repeatedly rub and squeeze and local congestion and edema occurs, followed by local degeneration and adhesion, making the tendon sheath locally narrow and forming a buttonhole shape. The finger flexor tendon is squeezed and thinned, and the two ends are expanded into a gourd shape. When the finger flexes and extends, the enlarged part of the tendon slides through the narrow tendon sheath, resulting in a bouncing movement of the finger and pain, resulting in limited flexion and extension of the affected finger.  The treatment of finger flexor tendon stenosis tenosynovitis used to use local topical or with internal blood anti-inflammatory drugs; or to take local lesion closed injection anti-inflammatory; or to take local physiotherapy, hot compress, acupuncture, massage and other treatment, although there is a certain efficacy, but individual differences, and the efficacy is uncertain, easy to relapse. In the past, for the finger flexor tendons appear embedded or finger activities have a typical “trigger finger” sign of patients to take the finger flexor tendon tendon sheath slip local lesion removal, tendon release surgery treatment. Although the efficacy of this surgery is certain, there are also problems such as greater surgical damage, longer recovery time, and scar adhesions of the surgical incision.  In recent years, the use of Chinese medicine small needle knife puncture peeling, loosening treatment has been reported. However, due to the narrow blade of the small needle knife, multiple stabbing and peeling are required in the process of relaxation, and sometimes the relaxation is not complete. In addition, the vertical penetration of the small needle knife blade is very likely to cause collateral damage to the finger flexor tendon and surrounding blood vessels and finger nerve tissue. After an in-depth study on the pathogenesis of stenosing tendinitis of the finger flexor tendon, the orthopedic department of our hospital created the tendon sheath sliding car release push cutter (which has been authorized by the national patent in 2005) based on the comprehensive treatment methods mentioned above, and developed the treatment technology of precise positioning, tiny incision (3mm) and minimally invasive release in the direction of the tendon. After more than 2000 cases of clinical application, the stenosis of the tendon sheath of the finger flexor tendon in all patients was immediately and completely loosened, and the affected finger moved freely in flexion and extension immediately after the treatment, and the pain disappeared quickly, and the disease was cured in 7-15 days on average, with very few recurrences and a one-time cure rate of more than 98%. This treatment technique with TCM characteristics is simple, economical (done in one visit to a general clinic), effective, and safe, with almost no recurrence, bringing hope for the early recovery of patients with stenosing tenosynovitis of the flexor tendons.