NOTT’S DISEASE OR CLICKING FINGER: HOW NOT TO “CLICK” THE DISEASE

Click, click, click. Such sounds can often be heard when bending the fingers of yourself or your loved ones. Do not pay attention, this joint clicks, it’s okay, it’s been a long time ago. Many of us have heard such or similar answers in response to the question, what is it that clicks on you?

Do you have to be as careless and does it click on the joint? Let’s figure it out.

The topic of our conversation today is clicking finger or Nott’s disease.

WHAT IS NOTT’S DISEASE?

Knott’s disease is a disease of the flexor tendon of the finger, in other words, it is a disease of the hand, which is characterized by the typical “snapping” of the finger or fingers with maximum flexion into a fist, restriction of movement, pain at the base of the fingers when pressed, morning stiffness of movements in the hand.

This disease was first described by Alfred Knott back in 1850, which is why it got the name – Knott’s disease.

In medical terminology, the name of the disease is also used as stenosing ligamentitis.

And among the people, because of the characteristic sound when bending the finger, this pathology is also called the clicking finger.

STATISTICS

According to statistics, this disease is most common in women over 40 years old, and on average, it occurs in 2 people out of 100. It should be noted that quite often this lesion occurs in children.

As a rule, this disease primarily affects the thumb and ring fingers.

As practice shows, the defeat is most often found on such fingers:

• Ring finger -44%.
• Thumb – 26%
• Middle finger – 20%.
• Little finger – 7%.
• Index finger – in 3% of cases.

Especially often, this disease also occurs in people whose professional activities are associated with squeezing objects in the palm of their hand; screwdrivers, hair dryers, manicure tools, etc. or using machines that apply pressure to the palm. 

These factors provoke inflammation of the palm, and, as a result, the onset of snapping finger disease.

In addition to external factors (unfavorable work, physical labor), an inflammatory process in the body associated with the musculoskeletal system (arthritis, arthrosis, osteoporosis, osteoarthritis) can be a precursor of stenosing ligamentitis.

SIGNS OF DISEASE, SYMPTOMS

In most cases, snap finger disease is asymptomatic. The person may feel a small lump, feel pain in the palm of the hand or mild numbness, or even find a swelling and crunching or clicking sound when bending the finger.

In addition, additional symptoms may also occur that bring discomfort, such as:

• sensation of an obstacle that occurs when the finger is flexed or extended;
• blockage, inability to bend or unbend a finger;
• pain that is localized at the base of the finger.

CAUSES OF OCCURRENCE

Nott’s disease very often occurs against the background of systemic diseases – diabetes mellitus, gout or rheumatoid arthritis.

The patients themselves believe that the joint itself clicks, but this isnot self-deception.

It is important to note that in children from 1 year old, Nott’s disease often appears due to developmental peculiarities. The fact is that the flexor tendon of the finger has annular ligaments. They prevent lateral movement of the tendon, especially when moving.

In young children, it often happens that the tendon grows much faster than the ligament, causing it to crush it.

Accordingly, in this place the tendon becomes significantly denser. When the lump passes through the narrow ligament channel, a clicking sound is produced. Over time, constriction can cause the lump to become larger, preventing the tendon from moving and thus keeping the finger in a flexed position.

The mechanism of development of pathology in adults does not differ, but the root causes of its appearance are completely different. If an adult is diagnosed with Knott’s disease, the reasons, in addition to the above, may be as follows:

• regular loads on the fingers, performing monotonous hand movements (typing, driving a car);
• inflammatory process localized in the hand;
• injury and damage in the area of ​​thickening;
• hereditary predisposition;
• atherosclerosis;
• diseases of the thyroid gland;
• constant squeezing of the ligaments;
• physical labor with stress on the hands.

In most cases, Knott’s disease causes an inflammatory process provoked by constant stress. The risk group includes women, as well as people who, by occupation or hobby, constantly perform the same movements (for example, sew, knit or embroider) or have chronic diseases.

Due to problems in metabolic processes and due to weakened connecting materials, as well as other reasons, stenosing ligamentitis can also develop against the background of the following deviations such as:

• arthrosis;
• spondyloarthrosis,
• spondylosis;
• epicondylitis;
• humeroscapular periarthritis.

It is very important for the patient to realize that the main danger of the disease is that, if untreated, the finger can be fixed in a bent state, and it will be almost impossible to straighten it without the intervention of a doctor.

As a rule, with a very advanced stage of Nott’s disease, limitation of mobility appears.

But you should not get upset ahead of time, since this pathology is being successfully treated today, so if you have such a problem, in no case should you postpone your visit to the doctor for a long time.

In the medical center “Ladisten Clinic” you can get qualified advice from experienced orthopedists who will carry out complex diagnostics and prescribe treatment for you depending on the stage of the disease. The diagnosis by an orthopedist, as a rule, occurs on the basis of interviewing the patient, palpation and obtaining a complete clinical picture using radiography.

VARIETIES OF THIS PATHOLOGY

Depending on which ligaments of the patient were affected in medical practice, the following classification is distinguished:

1. Nott’s disease. The primary signs of the onset of pathology are painful clicking of the finger when it moves back and forth. Secondary symptoms of the disease are already becoming a serious problem in which the hand, with the existing deformed joint, begins to function with difficulty.
2. De Quervain’s disease. Stenosing vanginitis is a problem with the abductor muscle that swells. This leads to the effect of friction of the inflamed tendons on the bone-fibrous canals, while the pathological process provokes significant pain at the base of the movable limb of the hand.
3. Syndrome of the carpal canal (tunnel syndrome). In this area, the patient sometimes compresses the median nerve, which is responsible for the sensing and motor skills of the hand.

STAGES OF THE DISEASE

Knott’s disease has several stages, such as:

1. The initial stage, after which pain is noticeable during palpation of the palm in the area of ​​the base of the finger, there may also be irregular difficulties with extension and / or flexion of the affected finger, which is especially pronounced in the morning.
2. The second stage, in which constant clicking brings severe discomfort to the patient. The blocking of the finger becomes more noticeable, and the natural overcoming of it is more difficult – often a person has to bend and unbend the finger with the other hand. Unpleasant sensations persist after snapping, probing the thickening at the base of the finger also causes pain.
3. The third stage is characterized by an increase in limited mobility, in which a persistent contracture is already forming. The change of position of the finger is achieved only with the help of the second hand. After the affected finger clicks, the patient feels prolonged pain that is felt throughout the palm, forearm and even shoulder.

METHODS FOR TREATMENT OF NOTT’S DISEASE

Depending on the degree of the disease, various methods of treating the clicking finger are used in medical practice.

When diagnosing a grade 1-2 of the disease, a blockade is usually performed using hormonal anti-inflammatory drugs, and physiotherapy is additionally prescribed.

In the early stages, Knott’s disease can also be cured using conservative methods, such as:

• reduction of physical exertion on the hand;
• drug treatment with anti-inflammatory drugs;
• the use of physiotherapeutic procedures (electrophoresis, magnetic therapy).

With the ineffectiveness of conservative methods and the blockade, as well as at stage 3 of the disease, doctors recommend surgery – dissection of the A1 ligament at the base of the finger.

SURGERY FOR NOTT’S DISEASE

With Nott’s disease, the operation can be performed in two ways:

1. open method, in which a small skin incision is made with sutures and further dressings. With this method, under local anesthesia, an orthopedic surgeon dissects the annular ligament, which limits the movement of the tendon.
2. minimally invasive method called needling, in which only small punctures of the skin are made with a needle, without stitches and dressings.                  

FORECAST                                      

For this pathology, orthopedists give a favorable prognosis. As a prophylaxis for stenosing ligamentitis, doctors, as a rule, recommend changing the main type of activity and reducing the load on the hand in ordinary life. Also, the patient is taught the correct position of the hands, self-massage and other effective independent influences on the problematic part.

At the Ladisten Clinic medical center, the treatment of stenosing ligamentitis is carried out at the highest level, after which you or your loved ones will forget about the problem of clicking finger forever.

We are always glad to see you!

Your Ladisten Clinic.