Sagittal band repair

[Stone]

Hello all,

I've been put down to have this surgery now so I thought I'd start a thread to share what happens in case it helps someone later on

The sagittal bands are ligament attachments that run across the back of your hand between the knuckles - their purpose is to keep the extensor tendons centred over the knuckle so you get the leverage when bringing your finger from curled up (flexion) to straight (extension). If one of them stretches then the matching one on the other side of the affected tendon doesn't have anything to pull against, so the tendon 'falls off' the knuckle when you bend the finger, and hopefully comes back to the centre when you extend it again. If it tears completely then once it's fallen off the knuckle it won't go back to its correct position of its own accord, so you don't get the leverage and you're unable to straighten your finger again - you have to use your other hand to push it straight again once you've bent it.

I strained one of these ligament a couple of weeks back doing some DIY - it hurt at the time (sharp pain behind knuckle) and didn't get much better so I rang my hand therapist who panicked a bit I didn't think it was that bad as my GP seemed pretty unconcerned (he sent me away with some ibuprofen gel to rub on it) but having seen an orthopaedic surgeon after being referred by the OT, apparently it's a bit more serious - once it's stretched then it won't heal on its own so they prefer to repair them before they rupture fully.

There's some diagrams and videos (fair warning - surgery videos not good if you're squeamish!) online - the video page shows the problem in a not-gory way so that might be handy if my description wasn't any good!

The basic idea of the surgery is that they use a cut a sliver off the extensor tendon and wrap it around a neighbouring ligament to give the right amount of tension before reattaching it - in theory at least that then restores the pull on the stretched side and brings the tendon back central again. The surgeon is one of the UCHL ones (I was seen as an extra on the fracture clinic) and was really nice - good at explaining and receptive to me asking nicely to make sure I'm sutured carefully (apparently she's going to use a mattress suture, which holds the wound edges together more tightly than normal). I have issues both with GA and local anaesthetic so I'm going to have a review with the anaesthetist before they do it - then they'll decide which to go for as the surgeon didn't mind. She did say if I had it done under local I'd be allowed to watch Apparently the normal healing time is three weeks with no activity and then three with only gentle exercising so it hopefully won't take too long to sort out. In the meantime I have a splint to immobilise my affected MCP which is driving me barmy 'cos I can't use most of my hand!

I'll keep updating as I go along and hopefully it'll be useful to someone

Stone

[Harvest]

I am very interested in this because my sagittal bands are damaged on all my knuckles

[Stone]

I just wrote a long reply and lost ıt ın a power cut Roughly:

It's horrıble, ısn't ıt. Sınce I've been splıntıng the worst fınger someof the others have got bad too - my lıttle fınger ıs trıggerıng so I guess that one ıs already ruptured; the fırst two fıngers' tendons are startıng to sublux more regularly too. I guess I'll need both hands doıng soon then...wıll start to thınk harder about that ıPad. Work ıs tryıng to gıve me a lead engıneerıng role at the moment too so ıt won't do my career any good ıf I keep needıng work done

Sorry about the dots beıng mıssıng from my i's, thıs keyboard ıs not only flat and knackered but Turkısh and I can't fıx my muscle memory

Stone
(öçşğüıİ )

[dragondee]

As a 'watcher of the most gruesome surgery' i found the video very interesting.
Hope it's not something I might need in the future.
Stone, my thoughts and prayers are with you on this one.
Dragondee

[Spireite]

Thanks for the video Stone. I've not had the misfortune of needing to know much about hand anatomy yet (!) so I didn't fully understand what a sagittal band is, but now I do. Very interesting as to what they can do surgically. I shall be interested to read how it goes for you in practice.

[Shadowlady]

Aye, thanks for info, most interesting. I was a bit worried when I saw how quickly the surgeon was going to do the surgery, but the vid was cut

Any news on a date for the surgery? Hopefully it'll be sooner rather than later considering the other issues that are developing. Best of luck for it all hun x

Just for the record, you can get trigger fingers from tendonitis too, the tendon swells inside it's sheath then doesn't glide properly anymore. I used to get that when I worked full time, but it went away when I stopped working f/t.

Take it easy,
S

[Stone]

Any news on a date for the surgery? Hopefully it'll be sooner rather than later considering the other issues that are developing. Best of luck for it all hun x

Yep, 28th June. I guess I get to choose which hand to do first

Just for the record, you can get trigger fingers from tendonitis too, the tendon swells inside it's sheath then doesn't glide properly anymore. I used to get that when I worked full time, but it went away when I stopped working f/t.

I have quite thin hand-skin so you can see pretty clearly what's going on - it's pretty obvious when it's falling off the bone.

Might have totally missed something but I thought you only had tendon sheaths on the flexors? I don't really see where it would happen in the fingers unless it was in the bit on the other side from the carpal tunnel - also I'm guessing it shouldn't move at all on the head of the metacarpal so any amount is bad. It doesn't help that my background levels of codeine stop me feeling when I strain them! I assume the tendons are stronger than the small ligament so hopefully it won't just stretch straight back - perhaps they could do something with synthetics but then it all goes a bit extreme...

Stone

[Shadowlady]

Hi Stone,

Sorry hun, I certainly didn't mean to imply that you didn't know what was going on in your own hands! Not at all, I just added it as an aside in case anyone searched for 'trigger finger' and this came up. It was something the Doc diagnosed me with ages ago, he explained it to me like that, Looks like it is usually a problem with the flexor tendon. I also had carpal tunnel syndrome at the time too. Thankfully mine just wore off when I quit typing all day. No surgery here thankfully, it's a scary thought for me. Have you ever had surgery before?

Mmm, my extensors wriggle over the knuckles on a couple of fingers too, you think that could be bad? Have done for years without any probs, but they've been getting sore doing that recently. Those fingers have gone very slightly twisty and grumpy. The tendons aren't subluxing at all tho, well, not like in those vids. Very minor issue I thought? Hmm. To show the Doc or not? I've no idea if there's anything he can do or if there's any protective/preventative things I can do? Had any advice for your other fingers at all?

Wow, monday, not long at all to wait. Have you had a chat with the surgeon about the possibility of using something synthetic? The tendon does look quite a lot thicker than the ligament, so I guess it must be stronger? I quite liked the look of the surgery, not that I know anything about these things, but that weaving on the tendon back on itself, it did look... secure, strong, clever and neat. There seemed to be plenty of strong looking tendon left too. Hopefully you will get/have got a decent physio that you get on with to help with your recovery. I really hope it goes well for you, and that you manage to ease your fingers back into behaving themselves again. It's such a big deal, all of this, so important (Yeah, state the obvious, why dontcha?! ). Your work, it's very hands on? What kinds of activities do you do with it?

All the very best,
S

[Stone]

As a 'watcher of the most gruesome surgery' i found the video very interesting.
Hope it's not something I might need in the future.
Stone, my thoughts and prayers are with you on this one.

Aw, thanks

Have you ever had surgery before?

Erm yes, quite a lot I'd be really very phobic if it still bothered me that much! (current count is 4 under general and 3 under local but I might have missed a couple)

Mmm, my extensors wriggle over the knuckles on a couple of fingers too, you think that could be bad? Have done for years without any probs, but they've been getting sore doing that recently. Those fingers have gone very slightly twisty and grumpy. The tendons aren't subluxing at all tho, well, not like in those vids. Very minor issue I thought? Hmm. To show the Doc or not? I've no idea if there's anything he can do or if there's any protective/preventative things I can do? Had any advice for your other fingers at all?

It depends, the message I got was that it's OK if it's been stable for years and isn't painful - if you do get pain it's possibly(!) just overuse if it's not too bad. If it suddenly starts subluxing and previously didn't then it's probably a stretched ligament and may clear up on its own if you're able to rest it enough - if not then she said it'll just eventually rupture and need fixing anyway. By contrast if a flexor tendon ruptures it's a medical emergency! They're under a lot of tension so if they do tear they go ping and disappear halfway up your forearm - quite hard to dig back out, and more difficult surgery/bigger hole in your arm the longer you leave it.

Wow, monday, not long at all to wait.

Nope, it wouldn't be if I actually got the date right It's the 28th July, I was just having one of my moments...

Have you had a chat with the surgeon about the possibility of using something synthetic?

Not yet, was going to see how chatty she was during if she does it under local.

The tendon does look quite a lot thicker than the ligament, so I guess it must be stronger? I quite liked the look of the surgery, not that I know anything about these things, but that weaving on the tendon back on itself, it did look... secure, strong, clever and neat.

Yeah, it's a pretty bright idea. I guess the middle bit of tendon fills in with more tendon once it's healed, not sure if the grafted bit ends up like a tiny normal tendon or is always made out of middle-bit, if that makes sense. I have this mental picture of my tendons being a bit like Cheese Strings

Hopefully you will get/have got a decent physio that you get on with to help with your recovery. I really hope it goes well for you, and that you manage to ease your fingers back into behaving themselves again.[...] Your work, it's very hands on? What kinds of activities do you do with it?

Yeah, hopefully the clinics will work out ok and nice hand therapist lady will be able to sort me Work is a mixture of keyboard/mouse probably 70% of the time and building electronic stuff into racks for the rest, I might have to teach myself into not abusing my flexibility to get stubborn/awkward connectors done up

I'm hoping the triggering little finger is a calloused bit on the flexor tendon so not a problem, looks like I need two right fingers and one left one done so far!

Stone
(sorry if this was a bit disjointed, still have whatever the opposite of jetlag is...)

[Shadowlady]

Hiya Stone,

How are your hands doing?

You know, I could have sworn I'd replied to you here? Weird. Sorry!

Wow, yes, that's quite a bit of surgery experience there!

I decided to ignore my fingers, then it occured to me that the there's only one tendon over the knuckle on those pics and vids, and I seem to have two, one main bit that just wiggles a bit, and one smaller bit that goes off the side of my knuckle. Perhaps that's why my fingers seem a bit wonky, or perhaps I'm imagining it, or it's all normal to look like that! I'll mention it to the GP & probably Prof G when I see him next.

28th July eh, could be worse... Could be better!

Is it not a bit late to chat about alternatives as you're having the surgery?! For your other fingers though I suppose. She sounds friendly, maybe she wouldn't mind a call?

Heh heh, cheese string tendons. I've definitely written this post before, serious deja vu. I made a really rubbish joke about tasty fingers but now I don't remember it. Probably for the best.

Have you tried that software that types for you as you speak? Ah ha - I remember I went to look, and yes you have tried it and about a gazillion different fancy keyboards too!

Hmm. Have you tried finger splits or taping to reduce accidental hypermobility abuse? I should imagine so as you have an OT though eh?

If the triggering little finger is because of a lumpy bit on the flexor tendon like I used to get, I found that with my fingers, gently rubbing the pad at the base of the finger (to and fro in the direction of the finger) would ease it up and usually get it to gently release itself. Felt nice too. Once I'd got it released I'd open and close my hands several times to get them moving right and then it'd be ok for a while before getting grumpy again. Apart from sometimes when they just triggered every time, then I'd get annoyed and squish them flat on the desk with my fist! RAH!

Take care,
S

[Stone]

Yep, you just described my fingers - the little bit off to the side of the tendon is the overstretched ligament (sagittal band) being dragged where it shouldn't go

Speech-to-text wouldn't work for me - not only do I talk much slower than I think (and randomly get my words in a muddle too!) but I'm in a busy open-plan office so there's a fair bit of background noise. I think it typing what it thought I said rather than what I did say would drive me potty too!

I have lots of different splints so I pick and choose day-to-day. At the mo I have two ring splints and a thumb-MCP splint on my right hand, and my MCP-extension splint on the left - I used to have another ring splint for my right index finger but it wasn't quite the right size and fell off somewhere! My thumb is still a bit sore after I subluxed it yesterday - I have very poor range of motion at its CMC joint and compensate by hyperextending the MCP, so it's vulnerable to damage if I stretch it too far backwards by mistake. It probably didn't help I was showing off to the nice new physio, he was a bit boggled and said he'd never seen a more hypermobile shoulder Taping's probably the only thing I haven't tried, not sure how good it would be as I have really sweaty hands (autonomic thing) and the skin peels away where it rubs and is damp. I have to mix and match a bit though, I've had the thumb splint on all day and it's squashing my pisiform out of place now!

My triggering finger is a true triggery one (I can always extend and flex it, it just briefly gets stuck midway) so I dunno what its problem is. I'll ask when I next see the nice hand therapy lady (27th).

I got a letter from the surgeon today (copy of one she sent to my GP) which basically says 'diagnosis of radial sagittal band rupture on left middle finger against a background of hypermobility, I plan to reconstruct it under a block' so it sounds like I am having a local anaesthetic after all!

All fun and games...!

Stone

[Stone]

Saw the pre-admission people yesterday - the anaesthetist on duty said it was being done under a general and I was booked in overnight, so I guess it changed again Hopefully I'll be OK to get the train back home afterwards.

The anaesthetist said he had someone with EDS in for tooth extraction last week and the local worked fine on them so he was a bit blasé about it but I guess it won't matter if I'm under a general anyway. They said they'd stick some local in it just before they finished so hopefully it will be fairly comfortable afterwards. I asked if I should taper off my normal medication / painkillers before admission - he said it was fine as they'd prefer to give everyone painkillers before their ops but don't have time Fingers crossed it's not too sore.

Not long now!

Stone

[Shadowlady]

Hi,

Yup, ok, I'll be talking to the Docs. Do you get odd whole finger pain, like with Raynaud's but painful instead of cold? I do, cue weird zombie finger attack dreams.

Heh heh, I did wonder whether that software would just massively wind you up instead of being helpful!

I've not tried splints; I didn't think they'd help as my fingers tend to twist and lean over rather than bend backwards much. I like taping them when they play up though, reducing twisty leaning and pain. The tape I use (stretchy joint support tape from the chemist) doesn't stick well to skin, only to itself, and it doesn't like being wet as it then starts overstretching and eventually just falls off. So it may not work for long at all on sweaty hands? Depends how sweaty they are I suppose. Worth a try though I should think as it's cheap enough? I'll spare you my taping explations unless you're fascinated enough to ask, as I completely made up how I do it!

I guess you won't be chatting with the surgeon as she's working then! I've decided that I don't like that anaesthetist.

Not long now... Hope the travelling goes ok and it's not too painful - got my fingers crossed for you!

Take it easy,
S

[Stone]

Big day tomorrow, I'm off to bed in a minute! (0430 start, ick! )

Nice hand therapist lady said this morning I'll probably have a cast for the first week or so then swap for bandage + splint - it'll be similar to my night resting splints but with the thumb free and with lots of space for swelling. Hopefully it'll all go to plan Gory pictures in due course.

Stone

[Spireite]

Good luck. I'm looking forward to the pictures, gory or otherwise. I'm not sure I could guarantee to get up at 4.30 though! In fact I failed once before and missed a flight - my subconscious prefers to sleep.