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One of the most common causes of hand problems in normal healthy individuals.
Characterized by painful or painless triggering, snapping, uneven or limitation of movement, locking or deformed fingers.
Lesions: the disproportion of A 1 pulley and the flexor tendon sheath at the metacarpal head level , thickening of A 1 pulley or tendon sheath or even nodule in flexor digitorum superficialis tendon.
Types:
Primary: normal healthy individuals
Secondary: associated with systematic diseases such as D.M., R.A., CTS, de quer vain diseases or post trauma.
Primary types are found much more than secondary types
Causes : repeatative and forceful griding movements of hands,overuse or abuse of hands movements cause microtrauma and fibrotic adhesion of tendon sheath .
Repetitive and excessive manual activities: such as carrying plastic bags. Twisting clothes, gardening activities ,digging ,pruning ,driving golf ,chopping meat or bones, cutting meat, pulling lope, screwing with screw-diver etc.
Tools of risks: scissors pliers, tongs, pincers spade ,knife screwdriver, hammer etc.
Sex incidence: females 4-5 times more incidence than men.
Grading/ Severity
Grade1 : painful tenderness at base of the finger.
Grade2 : uneven finger movements, triggering , unlock by self.
Grade3 : locking finger ,unlock by outside force.
Grade4 : with deformity ,fixed flexion or extend ,bowing, overriding.
Treatments of choice.
Grade1... rest, physical therapy .
Grade2... +Nsaids.(non steroid anti inflammatory drugs)
+/- local steroid injection.
Grade3... +Surgery.
Grade4... only surgery is curative.
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