QT Pathologies (EN)
"Trigger finger" and "trigger thumb", involve the pulleys and tendons in the hand that bend the fingers.
The tendons work like long ropes connecting the muscles of the forearm with the bones of the fingers and thumb. In the finger, the pulleys are a series of rings that form a tunnel through which the tendons must glide, much like the guides on a fishing rod through which the line (or tendon) must pass. These pulleys hold the tendons close against the bone. The tendons and the tunnel have a slick lining that allows easy gliding of the tendon through the pulleys.
Trigger finger/thumb occurs when the pulley at the base of the finger (A1) becomes too thick and constricting around the tendon, making it hard for the tendon to move freely through the pulley. Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the increased resistance to the gliding of the tendon through the pulley, one may feel pain, popping, or a catching feeling in the finger or thumb.
Sometimes the finger becomes stuck or locked, and is hard to straighten or bend.
- Anatomy of pulleys (blue) and flexor tendons Anatomy images courtesy and copyright of Primal Pictures Ltd – www.primalpictures.com
Causes for this condition are not always clear :
- Associated with medical conditions such as rheumatoid arthritis, gout, and diabetes (see Rheumatoid arthritis section)
- Local trauma to the palm/base of the finger
In most cases there is not a clear cause.
Trigger finger/thumb may start with discomfort felt at the base of the finger or thumb (A1 area), where they join the palm. This area is often tender to local pressure. A nodule may sometimes be found in this area.
The medical history and clinical examination of the involved finger are enough to make the diagnosis.
Symptoms may be tenderness, a grinding and more typically a popping in flexion and extension of the finger.
In advanced cases, the motion may be limited with inability to fully extend or flex the finger.
The goal of treatment in trigger finger/thumb is to eliminate the catching or locking and allow full movement of the finger or thumb without discomfort.
Swelling around the flexor tendon and tendon sheath must be reduced to allow smooth gliding of the tendon.
Non-surgical treatment can be efficient and involve the modifications of activities, oral anti-inflammatory medication intake, excercises and massage, wearing of a splint. An injection of steroid into the area around the tendon and pulley is often effective in relieving the trigger finger/thumb.
When conservative treatment failed, the surgical release of the pulley system (A1) is the treatment.
The surgeon widens the tendon tunnel (A1) by slitting its roof while protecting nerves that lie near the tunnel. The wound will require a small dressing for 10-14 days, but light use of the hand is possible from the day of surgery and active use of the digit will aid the recovery of movement. Pain relief is usually rapid without any functional limitations. Recurrence of triggering after surgery is uncommon.
During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.