Trigger finger is a condition where the patient is unable to stretch (extend) or bend (flex) the digit. It
starts with difficulty bending the finger freely, gradually becoming more difficult and painful to make a fist until finally the digit is frozen in a position of flexion, the joint bent at an angle. The patient can only stretch the finger passively using the other hand. It may take several months or a year before he or she gets to that point, but the progress is tender and the use of the hand and dexterity is impaired. The cause is a stenosis or narrowing of the synovial sheath . There is a fibrous ring that holds the tendon in position; if it becomes narrow or tight on the tendon it cannot glide back and forth. This may be caused by an inflammatory process (like rheumatoid arthritis) or may be due to excessive forceful repetitive motion.
- Rest and therapy can improve the situation but if the patient returns to similar activity, the
- Injection with cortisone is also effective by decreasing the inflammatory responses and swelling provided the finger is kept splinted with rest.
- Surgical release, cutting the tightening around the tendon is usually the quickest and most permanent way to correct the problem. In the procedure the tendon is not cut or weakened, it is only released. The procedure is done under sedation with local anesthesia in an outpatient setting.
The surgical procedure is done under sedation to keep the patient comfortable with local anesthesia of the hand. After release of the tightened tissue the incision is closed and the hand is dressed with a very small splint to reduce extreme range of motion. The patient should be able to perform self care, in 1-2 days, combing their hair, getting dressed, etc. The patient is discharged to his or her caretaker the same day. The patient is seen in 7-10 days for a follow up appointment. The patient is usually discharged from the physicians care in 2-3 weeks. Results are good because the intervention is minimal.
The process is initiated with a consultation with Dr. Nosti. Not only the hand problem but also
associated medical conditions need to be discussed freely; diabetes, high blood pressure.
The different treatment options will be mentioned. If the problem is due to repetitive use of the hand and there are no other problems are present there is no need for extensive workup. Questions
- How long does it take to do the procedure? Usually 30 minutes and add plus pre op
- How much pain? Pain is limited once the compression is released, the incision itself is tender but tolerable with or without analgesics.
- How soon use of the hand? Depending on the level of activity, office work may be started after
one day. Heavier duty such as lifting, carrying heavy objects may take longer.
Post Operative Care
There will be moderate pain for 2 to 3 days gradually the motion is recovered with proper exercises. The strength of the hand grip may be reduced temporarily. Heavy lifting or repetitive motion should be avoided for three weeks.