In the finger, the flexor tendons (superficial and deep flexor tendons) pass through a tunnel system (= tendon sheath), which is reinforced at defined points. These reinforcements are called pulleys and they serve to hold the tendon close to the bone. If the tendon sheath is narrowed or the tendons thicken, the gliding ability of the tendons is impaired. The result is that the tendon gets pinched at the level of the first pulley at the tunnel entrance and the active extension of the finger is associated to a snapping phenomenon. In extreme cases, the finger is blocked in the palm of your hand after you bend it. The causes of the narrowing can be repeated overloading during unusual activities, but also chronic inflammatory diseases such as rheumatoid arthritis or gout. But other diseases such as diabetes mellitus can also be associated with thickening the tendon sheath.
Initially, one experiences pain at the base of the fingers or at the base of the thumb. Snapping of the fingers in the morning after getting up is typical. With time, snapping of the fingers occurs after each fist closure. In extreme cases, the finger gets completely blocked in the palm of the hand.
A clinical examination is usually sufficient, no further diagnostics are required.
The operation is done on an outpatient base under local anaesthetic at the wrist. The skin incision is transverse at the base of the thumb or diagonally in the palm, keeping arteries and nerves aside. The Pully is incised longitudinally and some of the inflammatory tissue wand the tendons may have to be removed. Only the skin is suture, bandage with an elastic bandage.
Move the finger immediately, use your hand for everything possible, but keep the wound clean and dry until stitches are removed 12-14 days after the operation.