Acupuncture for flexor tendon tenosynovitis
Tenosynovitis of the flexor tendon, also known as “snapping finger”, “trigger finger”
I. What is called tendon sheath: The tendon sheath
To grasp objects, our fingers rely on the contraction of the flexor tendons in the hand to pull the fingers into flexion. In order to make the finger flexion and extension smoothly, and flexion and extension of the flexor tendon will not be taut to the palm of the hand, in the tendon coat a tubular structure, this tubular structure is called the tendon sheath.
The tendon sheath is a double-layered, cannula-like, closed synovial tube outside the tendon, which is the synovial sheath that protects the tendon. It wraps around the tendon in two layers, with a cavity between the two layers, the synovial cavity, containing the synovial fluid of the tendon sheath. The inner layer is closely attached to the tendon, and the outer layer is lined inside the tendon fiber sheath, together with the bone surface, which has the function of fixing, protecting and lubricating the tendon from friction or compression.
Why does tendonitis occur?
Due to finger injuries, excessive strain. If you’re looking for a long term repetitive strain on your joints, such as typists, instrumentalists, cargo handlers or those who need to operate computers for long periods of time, the repetitive movement of several tendons that are fixed for long periods of time, the inner wall of the tendon sheath and the tendon rubs repeatedly, causing injury and inflammation. In the early stage, local congestion, edema and exudation occur. In the later stage, local hyperplasia, adhesions and hypertrophy occur. The tendon sheath undergoes fibrous degeneration and the wall of the tendon sheath thickens, causing narrowing of the sheath canal, and the tendon becomes thick and thin under the compression of the narrowed part of the sheath canal, and the movement in the sheath canal is restricted. Produce symptoms. Tenosynovitis of flexor tendons can occur in all fingers, with the thumb being the most common.
What are the clinical manifestations of flexor tendon tenosynovitis?
When flexor tendon tenosynovitis occurs, it is characterized by pain during finger flexion and extension, unfavorable flexion and extension, or popping, or even inability to flex and extend.
Clinically, there are three phases.
Phase I: Painful phase. This is characterized by pain during flexion and extension of the finger and inflexibility during movement. It tends to be more pronounced in the morning. During this phase, inflammation occurs in the tendon sheath, but the tendon stenosis is not yet severe.
Phase 2: The popping phase. This stage is characterized by an inflexible finger flexion and extension based on the previous stage. When flexing and extending, there is a popping sound and popping sensation. Therefore, the name is “popping finger” and “trigger finger”. In this stage, the stenosis of the tendon sheath has become more serious, and the tendons also appear to be of different thicknesses, and the thicker part of the tendon passes through the stenosis of the tendon sheath, resulting in a popping sound and pain. The thicker part of the tendon passes through the stenosis and becomes painful. A rice-sized pressure point can be palpated, and the popping occurs here.
Stage 3: Strangulation. This is characterized by the inability to flex and extend the affected finger. In this stage, the narrowing of the tendon sheath is so severe that the tendon cannot move within the tendon sheath.
Fourth, how to treat flexor tendon tenosynovitis.
In the painful period, because the stenosis of the tendon sheath is not serious, the patient can mostly relieve the symptoms through rest, local massage, or intra-sheath injection of anti-inflammatory drugs (also called intrathecal closure).
In the period of pain, if the time is not long, the intrathecal closure is also effective, but if the recurrence is not a problem of inflammation, but a structural stenosis of the tendon sheath, the stenosis must be loosened in order to solve the problem. Therefore, in the popping and locking phase, it used to be treated by surgery. Nowadays, it can be treated by acupuncture.
V. How does the surgical method and the needle knife method treat tenosynovitis and what are the advantages of needle knife treatment for tenosynovitis?
Surgical treatment: local anesthesia, an incision of about 2 cm is made at the transverse palm line of the affected finger, the tissue is separated, the tendon sheath stenosis is found, the stenosis is cut with scissors or scalpel, and the skin is sutured. The surgery is not complicated. The stitches are removed 2 weeks after surgery, and the basic recovery time is usually 1-2 months. The medical cost, according to the medical fee standard of Zhejiang Province, is 750 RMB for stenosing tenosynovitis surgery in our 3-A hospital, so the total medical cost is about 2000 RMB.
Needle knife treatment: local anesthesia, at the transverse palm of the affected finger, using a needle knife (0.8 mm in diameter, with a blade at the front), piercing the skin to loosen the stenosis of the tendon sheath, on the spot when the finger flexes and extends the elasticity disappears, flexing and extending freely. The time is 5-10 minutes. There is no bleeding and no scarring. 1-2 weeks for basic recovery. Most of the patients are successful in one visit. Our hospital charges about $200-300 for the procedure, and the total medical cost is about $500.
So the advantages of needle knife treatment for tendovaginitis are obvious. We have been treating tenosynovitis with acupuncture for nearly 20 years and have successfully treated thousands of cases, which is very mature. Due to the successful implementation of the needle knife treatment of tenosynovitis, the surgical method is basically no longer used. Now other hospitals often refer patients with tenosynovitis to our hospital for acupuncture treatment.
Sixth, what are the precautions after the needle knife treatment of tenosynovitis, and will there be a recurrence?
After acupuncture treatment, the needle hole must be protected locally for 3-4 days to prevent infection, and generally take anti-infective drugs orally for 3-4 days. The affected finger rests for 1-2 weeks to allow the loosened tendon sheath to heal gradually.
There is usually no recurrence. In a small number of patients with 2-4 finger tenosynovitis, swelling and pain in the affected finger may occur again after transitional exertion, but usually without popping. Often, after treatment, the pain disappears and the patient thinks that the disease has been cured, and the affected finger exerts itself prematurely, resulting in the tendon sheath and tendon not being well repaired. Of course the tendons and tendon sheaths of the flexor tendons are defective and weak in their structure after the occurrence and treatment of stenosing tenosynovitis, which should be present. Therefore, the transitional exertion of the affected finger may still cause local re-injury.