How to treat stenosing tenosynovitis of the finger flexor tendons?

  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. On examination, a painful nodule or a strip of green bean size can be palpated on the lateral side of the affected finger near the metacarpal bone, and there is obvious local pressure pain. When the nodule is pressed and the patient is allowed to flex and extend the finger, the pressure pain is significantly increased and the sensation of bouncing is felt. Many patients suffer from recurring and prolonged symptoms, or improper treatment, causing great inconvenience to life and work.  The cause of tenosynovitis of the finger flexor tendons is due to the presence of a fibrous sheath around the finger flexor tendons, known as the tendon sheath. In the palmar side of the metacarpophalangeal joint, there is a bony shallow groove with the thickened transverse fibrous tissue of the tendon sheath of the finger flexor muscle, which is called the tendon sheath slide, and plays a protective role in binding the finger flexor tendon. 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 passes through the narrow tendon sheath carriage, and then the bouncing action of the finger occurs, and causes pain, resulting in limited flexion and extension of the affected finger. When the tendon sheath is degenerated and the adhesions are heavy, it will cause the finger flexor tendon to be embedded, and the affected finger will be fixed in the flexion or extension position passively, and it will be difficult to move.  In the past, the treatment of stenosing tenosynovitis of the finger flexor tendon mostly used local topical or internal blood-activating and anti-inflammatory drugs; or local closed injection of anti-inflammatory; or local physiotherapy, hot compress, acupuncture, massage and other treatments, although there are certain efficacy, but individual differences, and the efficacy is uncertain, and it is easy to relapse. In the past, for the finger flexor tendons appear embedded or finger activities have a typical “trigger finger” sign of the patient 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 of the pathogenesis of stenosing tenosynovitis of the finger flexor tendon, the orthopedic department of our hospital created the tendon sheath sliding knife (which was authorized by the national patent in 2005) on the basis of the above-mentioned treatment methods, and developed the treatment technology of precise positioning, tiny incision (3mm), and minimally invasive release in the direction of the tendon. After more than 2,000 clinical cases, the stenosis of the tendon sheath of the finger flexor tendon in all patients was immediately and completely released, and the affected finger was able to move freely in flexion and extension immediately after the treatment, and the pain disappeared quickly. This treatment technique with TCM characteristics is simple, economical (done in one visit to a general outpatient clinic), effective and safe (tiny incisions without sutures, minimal bleeding, no other side injuries), and almost recurrence-free, bringing hope for the early recovery of patients with stenosing tenosynovitis of the finger flexor tendons.