Conservative treatment

A quick finger does not necessarily have to be treated surgically. There are various treatment concepts that allow conservative treatment. It is important, however, that the symptoms are not too far advanced and that the finger is still in its early stages.

Then, for example, water baths can be performed. To do this, the hand is placed in warm water five times in succession for about five minutes. In doing so, the hand should be relaxed and protected.

Slight movements of the hand should be done instead of strength exercises. The water can easily be moved back and forth a little. Soap or fragrances complement the hand bath, and also provide a pleasant smell.

If the water baths do not help, a cortisone injection can be given. This is applied into the ring band of the thumb. One of the remedies of choice is betamethasone, which takes effect after 2 to 5 days.

The injection is administered by means of a commercial syringe: First, the area above the ring band is disinfected. Then 1ml solution is usually applied into the ring band with a syringe. The whole procedure is of course carried out under local anesthesia, since the cortisone syringe has a rather large volume and can therefore cause pain.

The anesthesia is done with a local anesthetic, takes effect after about 5 minutes, and subsides after a good quarter of an hour. During this time window, the injection can be made with cortisone. During this time, the doctor checks whether the injection has really landed in the ring ligament and not in the adjacent tendon.

Cortisone has an anti-inflammatory effect, in higher doses also immunosuppressive. An immunosuppressive – i.e. suppressing the immune system – effect does not have to be assumed with such small doses. If there is no improvement within the next six weeks, a new application can be made.

This is carried out in the same way. In case this application again shows no success, a third application should be avoided. In this case, it is advisable to consider a surgical approach of the quick finger.

However, the success rate of a cortisone injection for the fasting finger is in the range of 85%. Since hardly any side effects are to be expected and the procedure only takes a few minutes, this form of conservative treatment can be regarded as an alternative before surgery is actually performed. The cost of a cortisone injection varies greatly, and depends on the doctor and the region of the body.

A finger injection, including application, normally costs less than 50€. If there is no success after a conservative treatment, the “ultima ratio” – the last step – is still surgery. An operation of the quick finger is not a very big operation, and can be performed microsurgically and on an outpatient basis.

This means that the patient can go home immediately after the operation. However, it should be noted that the finger is bandaged, numb, and may hurt slightly. If the patient has arrived by car, a driver should be arranged for after the operation.

In any case, emotional support can make an operation more bearable, even if the operation is usually only performed with local anesthesia: After the anaesthetic has been injected into the nerve tract of the finger, a short wait is made until the feeling disappears from the finger. Then a small incision is made from the inside of the hand – medically from “palmar” – at the level of the ring band. The ring band is in a way the guide for the finger tendon.

Anyone who has ever laid an electric cable in a room knows the small cable clamps with which the cable can be neatly fastened to the wall. Similarly, the tendon runs along the bone, the cable clamps in this case being the ring bands. During surgery, the ring ligament is now split.

This means that the tendon has more play and no longer gets caught on the ring band. Of course, this cannot be done with several ring bands on one finger, as the tendon would otherwise detach completely from the bone. However, splitting a single ring ligament will relatively reliably eliminate the discomfort caused by a fast finger.

Surgeons even speak of a freedom from symptoms in the range of 100% – i.e. another 14% more than with conservative therapy. After the ring band has been split, the skin is closed again at the operated area and sutured.The skin incision is only 1-2 cm small, but in such exposed areas as the hand, care is taken to ensure a particularly good cosmetic result. For this reason, the suture is usually sewn with 3-4 stitches, i.e. it is particularly tight.

After the operation, the finger must be protected and is provided with a splint and a bandage. The initial swelling can still cause pain in the first days after the operation, but this will disappear within the first week. After about 10 days the stitches can be removed.

This can also be done by the family doctor, and does not necessarily have to be done in hospital. However, many surgeons insist on wound control of “their own” surgery. The pain usually goes away together with the swelling within a week.

Unnecessarily, many patients are afraid of pulling the stitches: If the patient is involved in a conversation and pulls the stitches on the side, he or she often does not even notice. Only when the stitches have grown in, which can be the case after more than two weeks, can pain occur. But even then there are ways to take away the pain.