Definition

This is a conflict between the flexor tendon and one of its pulleys (notably the pulley at the base of the finger called «A1») – which form a tunnel that holds the tendon against the bone. An inflammatory thickening of the tendon and/or the A1 pulley prevents the tendon from gliding smoothly, eventually causing it to block either partially or totally.

What are the causes?

Most of the time, no cause is found and the origin is described as «idiopathic». Sometimes, its origin may be secondary to conditions such as diabetes, amyloidosis, inflammatory rheumatic diseases, etc.

What are the symptoms?

It manifests as a blocking of the finger either in the closed position (in flexion, in most cases), or in the extended position (in extension - more rare), requiring «unblocking» with the opposite hand. In milder forms, a simple feeling of «catching» of the finger during flexion-extension movements may be felt. This is very often accompanied by pain on the palmar side of the finger, at its base. A small nodule can usually be palpated at this level.

What tests may be requested?

An ultrasound may be requested to confirm the diagnosis.

How is this condition treated?

Spontaneous healing in mild forms can occur in 50% of cases over 6 to 8 months.

Corticosteroid injection is generally offered as it allows symptom regression in 70% of cases.

If recurrence occurs despite 2 injections, a surgical procedure will be offered. It consists of opening the A1 pulley to release the conflict between it and the tendon, through a small incision in the natural crease of the palm. In the most severe cases with stiffness of the finger joint, resection of half of one of the flexor tendons of the finger may be performed.

The procedure is performed on an outpatient basis. Afterwards, a dressing is kept in place for 10 days. The finger can be mobilized immediately, no splint is required. The scar may remain sensitive for a few weeks. Physiotherapy and self-rehabilitation are only rarely necessary (in severe cases).

What are the risks of the procedure?

They are rare:

• Risks inherent to any surgery (<1% of cases):

  • complex regional pain syndrome (formerly known as «algoneurodystrophic syndrome»): the hand becomes red, warm, swollen, and painful with persistent «electric» pain. This syndrome can last several months.

  • infection (phlegmon of the flexor tendon sheath)

  • wound dehiscence.

• Finger stiffness: in case of inadequate finger mobilization postoperatively or in severe forms. Rehabilitation sessions will then be offered.