TRIGGER FINGER

Stenosing tenosynovitis or trigger finger is a common clinical condition characterized by a painful ‘locking’ or ‘clicking’ of the digit. It can occur in any digit, but most commonly occurs in the thumb (30% to 60%), followed by the index and ring fingers and, occasionally, in the little finger.


Normal anatomy of the flexor tendon of the hand and pulley's


Trigger finger, the tendon has acquired nodule which blocked the normal flexion - extension of the finger.


Pain area

Acquired trigger digit

Trigger digits are commonly divided into acquired and congenital. The acquired trigger digit most commonly occurs in the fifth or successive decades. There is a predilection for females, with a 6:1 female to male incidence.

Adults (acquired triggers) most often presents with snapping or intermittent locking, especially in the morning. The patients often complains of pain over the metacarpophalangeal joint, aggravated with applied pressure on the base of finger while the patient actively flexes and extends the ditits.

The digit may ‘lock’ prohibiting active extension of the finger. Alternatively, the digit may become locked in extension not allowing active flexion. This is not as common, but when it does occur, it is usually in the thumb.

Trigger finger of the 3rd finger

Congenital trigger finger

Congenital trigger finger are usually not noted until the first pediatric visit or later as the child begins to use his or her thumbs. Therefore it is speculated that they are not true congenital triggers but rather acquired in the first week to months.

The frequency of congenital trigger digits ranges from 1 in 2,000 (0,05%) to as high as in 1 in 50 (2%). In contrast to adults, children have an equal distribution by sex and present with a locked digit.

The thumb is the most common in either group, but much more so in children, especially bilateral trigger thumbs that occurs about 25% of the time.

CONSERVATIVE TREATMENT
THERAPY: 

CONSERVATIVE TREATMENT

Nonoperative treatment modalities include:
 

  • activity modification
  • anti-inflammatory drugs
  • local steroid injection into the flexor tendon sheath
  • splinting


Corticosteroids local injection to relief the edema


Metacarpal-phalangeal splint

OPERATIVE TREATMENT
THERAPY: 

OPERATIVE TREATMENT

Surgical treatment reliably relieves the problems for most patients. The decision to have surgery is a personal one, based on how severe the symptoms are and whether nonsurgical options have failed. In addition, if the finger is stuck in a bent position, the doctor may recommend surgery to prevent permanent stiffness.

Surgical Procedure

The goal of surgery is to widen the opening of the tunnel so that the tendon can slide through it more easily. This is usually done on an outpatient basis, meaning you will not need to stay overnight at the hospital.
Most people are given an injection of local anaesthesia to numb the hand for the procedure.

The surgery is performed through a small incision in the palm or sometimes with the tip of a needle. The tendon sheath tunnel is cut. When it heals back together, the sheath is looser and the tendon has more room to move through it.


Sheath release.

Local anesthaesia.

Scin incision, indentifying the tendon and the sheath.

Tendon sheath release.

REHABILITATION: 

The patient is able to move his or her finger immediately after surgery. The compression dressing is removed after 48 hours. Recovery is usually complete within 2-3 weeks.