The jutting finger

What’s a jutting finger?

Also known as spring finger or stenosing tenosynovitis, this is an irritation of the flexor tendon sheaths of the fingers, of variable origin. The flexor tendons pass along the finger in a channel reinforced by rings called pulleys. To facilitate their sliding in the canal, they are surrounded by a synovial sheath. This sheath can thicken spontaneously, for example in diabetic patients, or through irritation against the thickened walls of the pulley in the palm of the hand.

The nodule in the sheath makes sliding more difficult. If the nodule is too large, it will have difficulty passing over the pulley, causing the finger to lock in flexion. The patient’s efforts to extend the finger may cause a jerk as the nodule passes abruptly through the hen. The thumb and ring finger are the most frequently incriminated fingers.

Initially, morning pain or stiffness may appear on mobilization of the affected finger, then the symptoms disappear with the restarting movements. They become permanent as the conflict intensifies. This is followed by intermittent blockages with characteristic jumps. Eventually, as symptoms progress, the finger may become stuck, requiring the use of the other hand to release it.

What tests are required?

In most cases, the doctor’s description of the complaints and examination of the hand are sufficiently typical to dispense with further investigations. In case of doubt, an ultrasound scan can be used to visualize the flexor tendons and confirm the thickening of their structure. It’s a painless examination lasting about fifteen minutes.

What are the treatment options?

• Non-surgical

In the early stages, cortisone is usually infiltrated into the flexor tendon sheaths of the fingers. This procedure can be performed during the consultation. The aim is to reduce thickening of the tendon sheaths, and can sometimes resolve the problem once and for all. It can take several weeks for the effect to take hold. Note that cortisone infiltration only has a localized effect, not a generalized one as when taken in tablet form. Sometimes, after infiltration, the pain at the injection site may be stronger for two or three days.

• Surgical

If symptoms persist or recur, surgery may be required. The aim is to eliminate the conflict between the flexor tendons and the first pulley of the digital canal by opening the latter. This completely eliminates pain and blockages, without affecting finger function.

The operation takes place on an outpatient basis, usually under local anaesthetic, and lasts just a few minutes. After the operation, a simple padded dressing is applied, leaving the fingers to move as normally as possible. Light activities such as writing or eating are not a problem, but clamping and lifting should be avoided for about a month. The same applies to sports involving the operated hand.

The protrusion disappears immediately after surgery, whereas the mobility limitation, if present before surgery, may take several weeks to disappear. The scar may remain painful to the touch for several weeks, and we recommend massaging it with a moisturizing cream every day. The length of time off work depends on the profession. It usually lasts between two and four weeks. Occupational or physiotherapy is generally not necessary, unless the finger remains stiff.

What are the possible complications?

• Non-surgical treatment

Infiltration can sometimes be complicated by a local infection. In some cases, skin discoloration may occur at the injection site.

• Surgical treatment

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Complications specific to protruding fingers

Incomplete tendon release is rare. Symptoms persist and require further surgery.

Recurrence is rare, and more often seen in patients with diabetes. Further surgery is then indicated.

Limited finger mobility may persist, especially if the disease is at an advanced stage.