Shrink-finger is the source of a great deal of finger pain. Generally presenting as a discontinuous blockage of the flexor tendon in its sheath, it can also lead to total blockage of the finger in extension or flexion, or even simple isolated pain. As the disease progresses, it can lead to joint stiffness, requiring specific treatment in addition to that of the jerky finger, or to tendon damage requiring repair.
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It may affect one or more fingers, including the thumb, and may be bilateral and symmetrical. Examinations are not helpful in making a diagnosis, which is based primarily on clinical observation.
There are many causes of trigger finger. Generally speaking, it is caused by inflammation of the synovial sheath surrounding the flexor tendon, creating a nodule inside the tendon which, little by little, creates a real obstacle to mobilization of the finger. The cause can also be rheumatic. Tendon inflammation is sometimes the result of repetitive mechanical movements. Surgical treatment of carpal tunnel syndrome can also cause spring finger, although it cannot be considered a complication of this type of operation. More rarely, it occurs as a result of a partial wound on a flexor tendon. The congenital form of spring finger appears in early childhood.
Treatment is initially medical, with corticosteroid infiltrations in the area of the nodule, with rapid but often temporary efficacy. The finger or hand may be painful for up to 48 hours. Infiltrations can be repeated, but cannot be multiplied, as cortisone weakens tendons, with a risk of secondary rupture.
Surgical treatment may then be proposed, or even directly from the outset. The procedure is usually performed on an outpatient basis, under local or regional anaesthetic. The surgeon makes an incision a few centimetres proximal to the palmar flexion crease, to partially open the flexor tendon pulley. This quick, painless procedure is generally definitive. The blockage disappears as soon as the anesthetic effect wears off. The patient must immediately mobilize the operated finger actively, as quickly as possible, but gradually, to regain full flexion and extension of the finger. If, on the other hand, the patient is too reluctant to fully extend the finger, the joint may become stiff, which is a secondary complication that can easily be avoided. If difficulty in fully extending the finger persists for several weeks, which is more common in older forms of spring finger with tendon damage, an orthosis should be worn to straighten the finger and prevent joint ankylosis.
Complications arising from the procedure, although delicate and performed by an experienced surgeon, are relatively rare. The main complication is stiffening of the finger joint, generally due to poor postoperative work by the patient, who may not have mobilized the finger sufficiently; in this case, a brace and rehabilitation are necessary. Infection is possible, diagnosed by the presence of unusual, pulsatile pain, severe swelling and abnormal redness; easily controlled when detected in time, it sometimes requires a new operation.
The price for this type of intervention varies between 100 and 300 euros. The mutual insurance company may reimburse part or all of the excess fees.
France 3 report on hand surgery and Dr David
