Trigger Finger


Introduction

Tendons are soft tissue strings, which main function is to connect muscles to bones, transmitting the impulse of muscular contraction that produces movement. Therefore, any damage or harm to them can cause some limitations or inability in the fingers movement.

This may be the case of swelling of flexor tendons in the hand fingers, known as trigger fingers.

The trigger finger is the result of a chronic inflammation of the flexor tendons in one or more fingers of the hand. The long-evolution tendonitis is responsible for a thickening of the affected tendon (tendon nodule), which makes its way difficult through the pulley.

The pulley is a fibrous membrane that connects tendon to bone through a “tunnel-like” sheath.

If a section of the tendon widens as a result of an inflammatory process, it does not glide smoothly through the tunnel made by pulleys, and sometimes it “locks” at the same tunnel, causing a bent finger or “trigger finger”.



When the finger tries to extend, the tendon keeps blocked at the entrance of the pulley. By increasing the strenght to complete the movement, the tendon overcomes the obstacle, but causes some discomfort at the fingertip.

The repeated movement of the tendon sliding through the pulley causes the tendon to swell and therefore a progressive increase of its volume, creating a vicious circle that maintains the swelling process.

At the beginning, tendons glide with difficulty and cause only pain, but as time goes by, they lead to a lock of the finger, commonly called “trigger finger”.

The trigger finger occurs spontaneously, with no apparent reason.

Sometimes it may be secondary to a hand traumatism or may appear as a result of a disease such as diabetes, gout, Dupuytren’s contracture, rheumatoid arthritis or primary arthritis of the hand.

The most affected group of age  is between 40 and 60 years old.


Symptoms

The trigger finger mostly affects the thumb, middle and ring fingers, but sometimes the index and little fingers as well.

In the initial phases patients complaint about pain only when they move the finger, although sometimes it is possible to realize the typical mechanical lock of the disease. The patient usually refers a “click” at the fingertip, although the problem lies further down.

The “click” is usually more common in the mornings. When the patient is getting up, one or more fingers are bent and he/she has to make an effort to extend them. Sometimes it is necessary to use the other hand to extend the finger/fingers. This symptom decreases gradually during the day and working hours and it shows again the following morning.

Palm palpation often reveals a nodule that moves when the finger moves.


Traditional surgical treatment

The purpose of surgery is to release flexors after cutting and opening the pulley at the base of the finger; increasing the room for the tendon to move, so that the flexor tendon can glide more easily through the tunnel. This surgery is carried out through an incision of about 2 centimetres made in the palm of the hand for each affected finger.

      

After surgery, it is necessary a resting period and the hand may move freely but avoiding manual tasks and efforts.

It will be also necessary to start moving and extending the finger from the first day after surgery in order to avoid the growth of adhesions and rigidity, which is sometimes more uncomfortable than the pathology itself.





Percutaneous surgical treatment

For many years, the only surgical solution for trigger finger has been the open surgery. Although this kind of surgery is very effective and is still presented to patients, at Clinica Planas we offer another surgical possibility much less invasive and that allows a quick recovery.



Open surgery requires a daily wound care, to remove stitches a week later, and has a higher risk of infection. Also, recovery will be longer as well as time to return to work.

Percutaneous surgery allows, by using a special needle and ultrasound live images, to release flexor tendons and therefore, to correct the problem without surgical incisions. This procedure is carried out in about 10 minutes on an outpatient basis under local anaesthesia.



As there is no incision, there are no wounds, which provide the patient with a quick recovery, a lower risk of infection and a lower possibility of having painful keloids.
Recovery is faster and pain is nearly nonexistent.

The patient will be able to move the finger immediately and will not have to worry about any medical care or stitches removal.
On the third day, the patient can return to light gripping activities and ten days later to strong gripping ones.



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