Orthopedics-Online

Snapping thumb

introduction

The disease of a flickering thumb (medical: Tendovaginosis stenosans) describes a pathological, inflammatory change in a certain tendon of the hand. It falls under the syndrome of tendinitis and is usually triggered by overloading the flexor tendon of the thumb. In the event of an overload, the tendon thickens and so-called tendon nodules develop. These are responsible for a kind of "sticking" of the tendon on a certain ring-shaped ligament. When moving the thumb, the tendon nodules must be moved through the ligament, which can only be achieved with increased effort due to the thickened tendon. As soon as the knots are moved through the ligament, the phenomenon of the thumb flicking occurs.

causes

Although the cause of a flickering thumb is inflammation of the tendons, neither bacteria nor viruses are responsible for causing the condition. Rather, it is an overload of the flexor tendon of the thumb. A variety of different activities can trigger such overload. This includes manual activities as well as playing certain musical instruments. Overloading the tendon leads to small injuries to the structure and thus triggers an inflammatory reaction in the body. Small knots then form on the tendon, which can increase in size as the disease progresses.The flexor tendon must be moved through the so-called annular ligament, a ring-shaped ligament, when the thumb is moved. The knots prevent the tendon from fluidly moving through this ligament, resulting in a flicking thumb.

Please also read:

Quick thumb from optic vaginal inflammation
De Quervain's tendovaginitis

rheumatism

The thickening of the flexor tendon, which is responsible for a flickering thumb, is mostly caused by an inflammatory process. This can be triggered, for example, by overload. Often, however, autoimmune diseases from the rheumatic group are also the basis for the development of the flickering thumb. The immune system attacks the body's own cells and produces countless sources of inflammation throughout the body. If the thumb is also affected, the flexor tendon can become inflamed and thickened, causing the thumb to snap.

pregnancy

A flickering thumb is usually not triggered by pregnancy alone.

Nevertheless, the symptoms can become noticeable after pregnancy. In this case, there is already previous damage to the flexor tendon of the thumb. However, these are not necessarily noticeable before pregnancy. During pregnancy, the hormonal balance in the body changes. Towards the end of pregnancy in particular, the connective tissue in the body becomes a little softer and therefore more flexible. A narrowing of the ring ligament on the flexor tendon of the thumb can be loosened again. After the birth, the condition of the connective tissue normalizes again, so that the thumb can suddenly cause discomfort.

Symptoms

Depending on the severity of the disease, a flick of the thumb can cause different symptoms.

Typical of the disease and responsible for the name is the noticeable "flickering" of the finger when bending or stretching the thumb. This is related to the increased effort with which the tendon nodule has to be moved through the ligament. It can happen that the thumb can only be bent or stretched with the help of the other hand. A characteristic noise can typically be heard at the moment the nodule snaps through the ligament. Depending on the form of the nodule, it can be felt from the outside.

As the disease progresses, the affected thumb usually becomes more and more immobile. Trying to stretch or bend your thumb can also cause pain.

Pain

Pain with a flickering thumb usually does not appear until the disease is advanced. It is typical that the symptoms arise when trying to stretch or bend the thumb. The moment when the greatest effort is exerted without the tendon nodule being able to move through the ligament is expressed in the perceived pain.

If there is general pain in the thumb, other clinical pictures may also be the cause of the symptoms. Examples of this would be rheumatic diseases such as rheumatoid arthritis, metabolic diseases such as gout or wear and tear of the thumb joint which leads to osteoarthritis. A painful thumb requires a medical examination in order to diagnose the underlying disease and, if necessary, treat it.

therapy

A distinction must be made between conservative and surgical therapy of the thumb flick.

Conservative therapy: Conservative therapy is mainly based on protecting the affected tendon and taking anti-inflammatory drugs. Injecting cortisone into the tendon sheath of the affected tendon can also help treat the disease and improve the symptoms. Conservative treatment methods often help very well, especially in the early stages of the disease with a clear, known cause. If conservative therapy is unsuccessful, surgery for the disease should be considered.

Surgical therapy: Surgical therapy for a flickering thumb can usually be carried out on an outpatient basis and usually achieves a highly satisfactory treatment result. During the operation, the ring-shaped ligament, which is partly responsible for the rapid movement of the thumb, is cut. After a comprehensive diagnosis, the attending physician can best assess whether surgical therapy makes sense in individual cases.

Depending on the degree of progression and the causing symptoms of the flickering thumb, different treatments can help to improve the symptoms or even to treat the cause of the disease permanently. Conservative treatment can usually help in the early stages to prevent the progression of symptoms and to alleviate them. It is important here to consistently protect the affected thumb so that the body's inflammatory reaction is not intensified.

Surgery of the flickering thumb

An operation of the flickering thumb is a relatively short procedure that can usually be performed on an outpatient basis. The hand is locally anesthetized by a plexus anesthesia or regional anesthesia and made "bloodless". The surgeon now exposes the annular ligament through which the flexor tendon of the thumb is moved. The ligament is severed and the tendon is checked for proper movement. Then the surgical wound is sutured and a bandage is applied. After the operation, the hand should be raised to prevent swelling. Any pain that occurs after the operation can be treated with pain reliever medication. It should be noted that activities that put a lot of strain on the thumb should only be carried out again after approx. 2 weeks.

Taping the flicking thumb

The application of a tape usually plays a subordinate role in the therapy of the flickering thumb. This is due to the underlying cause of the condition. Tape bandages are usually used for muscle tension and are intended to help relieve the muscles or promote blood flow to the affected area. However, since the problem of the flickering thumb is not related to muscle injury or tension, a tape cannot have any effect on improving the symptoms of a flickering thumb.

Attaching the tape can make sense if it helps to protect the affected finger. As a result of the rest, the lumps can partially recede and the symptoms of the triggering finger improve. Before applying a tape bandage, the doctor treating you should discuss the options for the therapy of the flickering thumb. It may be the case that, as part of conservative therapy, it makes sense to apply the tape bandage while protecting the thumb.

You might also be interested in this topic:

Tap your fingers - this is how it works
Tape bandage

Can Exercise Help?

Since the quick thumb is often triggered by a muscular imbalance, strengthening exercises for the hand muscles can be used for prevention. This is particularly useful for professional groups that need their hands intensively for work. If symptoms already arise, relieving movements should be trained. It is important to maintain full flexibility of the thumb. At the same time, however, the flexor tendon should not be subjected to great force.

Homeopathy and naturopathy

The rapid thumb results from an often inflammatory thickening of the flexor tendon in the thumb. Therefore, anti-inflammatory homeopathic remedies can help prevent the disease from progressing.

In addition to anti-inflammatory globules, local naturopathic treatments are also available. For example, classic hydrotherapy (warming or cooling with a water bath for the hand) is a good way to temporarily relieve symptoms such as pain and restricted mobility. Neural therapy, in which local anesthetics are injected into painful areas, can also alleviate the discomfort of the jerky thumb. Acupuncture is also used occasionally.

The quick thumb for toddlers / children

The symptom of a flickering thumb typically occurs at an advanced age and is very rare in children and young children. An exception is the congenital form of the disease, which also leads to a flickering thumb. It is noticed as Pollex flexus congenitus disease usually a few weeks after the birth of the child. The thumb is usually in a bent position and cannot be stretched either by the child or when the parents try. Conservative therapy has no prospect of success in this form of the disease. In some cases, however, the clinical picture regresses spontaneously, which is why surgery is generally only recommended after about 6 months. The operation is similar to that for affected adults, since cutting the ring-shaped ligament also leads to therapeutic success in children.

diagnosis

At the beginning of the diagnosis of a flickering thumb, there is a detailed doctor-patient conversation. Due to the mostly typical symptoms, the suspected diagnosis of a flickering thumb can usually be made very quickly. In addition, there is the examination of the thumb, in which the problem can often be felt. Before starting the therapy of the flickering thumb, however, other diseases of the thumb should be ruled out so that serious symptoms of the hand are not overlooked. Imaging may be necessary to rule out any joint changes, especially if the symptoms and the physical findings are not clear.

forecast

The prognosis of the flickering thumb is usually very favorable. Often, even conservative methods can improve the symptoms. An operation can improve the symptoms in the long term and prevent the disease from recurring.

How long will you be on sick leave?

The length of incapacity for work with a flick of the thumb depends heavily on the type of occupation.

If you only need your hands a little and / or do not have to perform any grasping movements with your hand, you can usually go back to work after one to two weeks. After this period, the threads on the surgical incision are pulled and the swelling has subsided. Nevertheless, pain may still persist at that point, which is why a longer sick leave is definitely justified. In contrast, those who do a lot of work with their hands (craftsmen, athletes, musicians, computer jobs) usually need a longer sick leave.

prophylaxis

In order to prevent a flickering thumb, it is important to minimize the risk factors of the clinical picture. Overloading the thumb in particular plays a major role in the development of the disease. For example, the thumb should be spared at the signs of the disease and the progression of the symptoms should be prevented.