Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

Trigger Finger

Trigger Finger is characterised by a finger which is stuck in flexion (as in making a fist) especially when one awakes after a sleep. the finger resists active attempts to straighten it and sometimes needs to be helped to straighten by the other hand. When it straightens, it does so with a "pop" or a "click" which can be painful or at least, uncomfortable.

The condition is brought about by the thickening of a segment of a flexor tendon or a nodule on the tendon. The nodule has to pass under a fibrous "pulley" each time the finger is flexed. Once through the pulley, the nodule gets stuck on the wrist side of the pulley and then requires force to get it back through the pulley. The normal functions of the hand require a strong grip, but less strength in extension (unless you are a professional Marbles or "shuffleboard" player). This is why the finger sometimes needs assistance from the other hand to straighten.

The problem starts with a tiny injury to the flexor tendon, most commonly involving the Middle finger or the Ring finger, but any finger including the Thumb can be affected. A small nodule or thickening develops due to inflammation of the injured area. Continued backward forward passages through the pulley during daily use of the hand then leads to repeated inflammation and fibrosis in both the nodule and the pulley, causing the build-up mentioned above.

Treatment

Initial treatment, if reported in the early stages of the problem is always conservative.

The problem can sometimes be solved by a short period of rest in a splint and oral Non-steroidal anti inflammatory drugs (NSAIDs)

An injection of locally-active steroids into the tendon sheath is the next option

Both of these methods reduce the inflammation that is causing build-up of the nodule and contraction of the pulley.

When the condition is too well established, commonly because of long-term neglect, surgery is required.

Surgical Treatment is aimed at releasing the pulley to allow free passage of the nodule.

In the past, we usually operated on the hand and split the pulley by cutting it,

but more recently we have found that

a large number of patients can benefit significantly from simple division of the pulley by using the tip of a needle.