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Crackling finger is one of the most common causes of hand pain and impaired functions. A snapping finger makes it difficult to grasp correctly, and thus - performing even the simplest everyday activities (e.g. tying a shoelace) with the sick hand is much more difficult. What are the causes and symptoms of a snapping finger? How is treatment and rehabilitation going? Is surgery necessary and when?

Trigger finger is also a finger that is shooting, jumping or snapping or jamming tendon sheath inflammation. The essence of the disease is inflammation of the annular ligament of the tendon of the flexor muscles of the finger of the hand, at the level of the metacarpophalangeal joint (specifically A1 ligaments).

Inflammation most often develops within the ring finger (which is located between the middle finger and little finger), often also the thumb, and then the middle finger, index finger, and least often the little finger. The disease usually affects one finger, although it is not uncommon to engage several fingers on one or both hands.

Crackling finger - causes and risk factors

The causes of the disease are not fully known. It is presumed that its development may be caused by mechanical injuries (e.g. squeezing hard objects) and repeated overloads in this area, to which they are exposed, e.g. people knitting, playing instruments, weaving by hand (e.g. carpets), stapling documents, etc.

The likelihood of a crackling finger is also higher in people with diseases such as rheumatoid arthritis (in this case the lesions usually affect the middle finger), diabetes, gout, amyloidosis, mucopolysaccharidosis.

Crackling finger is more common in women than in men, especially in those aged 40-60 years. Crackling finger can be a problem in pregnant women, which is a result of the increased impact of hormones.

Finger snapping - symptoms

  • problems (painless at first) with bending and extending the finger. When straightening the finger, the tendon jumps under the thickened ligament A1, which is accompanied by a characteristic click
  • finger pain over the metacarpophalangeal joint - joins later and first appears only when the finger is extended. Then ailmentsfinger pain may be permanent reddening of the skin on the finger affected by inflammation, and sometimes also swelling
  • small, often painful to touch, lump (this is a locally thickened tendon sheath) in the metacarpophalangeal area on the palmar side

As the disease progresses, the finger becomes significantly blocked in flexion, and the patient has to help himself by straightening the finger with the other hand. If not treated properly, contractures may develop in the proximal interphalangeal joints, resulting in impaired hand function.

Crackling finger - diagnosis

The above symptoms usually leave no doubt what kind of disease we are dealing with. The diagnosis is confirmed by an ultrasound of the altered area.

During the diagnosis, the doctor should rule out diseases such as: dislocation of the proximal or metacarpophalangeal joint, Dupuytren's contracture or de Quervain's disease.

Crackling finger - treatment, surgery and rehabilitation

If the inflammation affects only one finger and is short-lived, your doctor may suggest minimally invasive treatment. Physical therapy, oral anti-inflammatory drugs, or steroid injections into the flexor tendon sheath can all improve. The latter should be performed under ultrasound control so that the drug is administered precisely. Applying the steroid to the tendon (and not to its surface) can even lead to rupture!

If conservative treatment proves ineffective, surgery should be considered. Especially in situations where:

  • there are some fingers jumping around
  • inflammation lasts quite a long time (more than a few months)
  • the patient suffers from diabetes, gout and other abovementioned diseases

The cracking finger operationinvolves cutting the thickened ligament A1, thanks to which the tendon in the sheath can move freely. In patients with rheumatoid arthritis, sometimes the scope of the procedure should be extended to excise the inflamed tissues around the changed reticulum.

There are two methods of surgery - traditional, that is, open, and closed, consisting in the percutaneous cutting of the annular ligament with a thick injection needle using an ultrasound preview. If open surgery is performed correctly, the risk of recurrence is low.

In the case of closed surgery, the recovery period after surgery is shorter than after open surgery, but the risk of relapse is higher.

The operation is a standard and effective method of treatment, additionally it is not complicated,the risk of complications (hematoma, infection in the operated area) is very small. It enables a significant improvement in the function of the hand and a quick return to activity.

The operation takes less than 30 minutes and is performed on an outpatient basis. The patient can leave the hospital on the same day. After the surgery, finger straightening and flexion exercises should be started immediately to prevent relapse.

Expert comment

Author: Lek. Karolina Stępień, resident in the course of specialization in orthopedics and traumatology of the musculoskeletal system at the Carolina Medical Center

The latching finger is a disease that is relatively often consulted in orthopedic clinics and hand surgery. In a situation where we are dealing only with local soreness and jumping, we consider different treatment methods with the patient.

Depending on the patient's expectations, these may be attempts at conservative treatment (physical therapy, anti-inflammatory drugs) or invasive methods, e.g. percutaneous cutting of the changed reticulum. If there are clear difficulties with straightening the finger, it becomes blocked in the flexion, which can be overcome with the help of the other hand, non-surgical methods should not be used.

This requires surgical treatment as the risk of permanent finger contracture increases significantly.

Patients who decide to undergo surgery are usually very satisfied with its effects. Postoperative pain is slight, and the effect - smooth tendon movement - is visible immediately after the end of the procedure. The recovery period is short - about 2 weeks until the stitches are removed.

The occurrence of the disease is particularly favored by metabolic changes, such as diabetes or gout, so it is especially important to carefully control them. If the problem occurs in pregnancy, it is related to hormonal changes, and in this case there is a good chance that the symptoms will disappear after childbirth and the postpartum period.

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Spine, bones, joints