The condition in which the inflammatory stenosing tenosynovitis of the flexor tendon, due to the constriction of the tendon sheath beneath the special structure (A1 pulley) of the bending (flexor) tendons in the hand, is called Trigger Finger Disease. In the finger that is especially problematic in the mornings when first getting up, the tendon gets caught and locked after the bending movement. Patients usually have to force the bent finger open with their other hand in a painful manner. The constricted A1 pulley tendon can cause the tendon to wear and even tear.
Who Gets Trigger Finger Disease?
Trigger finger disease is more commonly seen in people with diabetes, thyroid diseases, and inflammatory rheumatoid diseases (such as Rheumatoid Arthritis). However, it is often seen in people who do not have any other illnesses. This can also rarely be seen in newborns.
What are the Symptoms of Trigger Finger Disease?
The symptoms of trigger finger are swelling, a sensitive lump in the palm, a feeling of catching in the finger joint during the bending movement of the finger, and pain during the bending or straightening movement of the finger. The diagnosis is usually made through a physical examination. Laboratory tests, imaging methods such as MRI and ultrasound, are not usually necessary.
How is the Treatment of Trigger Finger Disease Done?
Trigger finger problems rarely heal on their own without special treatment. If it does heal, it can usually heal in the first month of its onset. If trigger finger is not treated, it can cause joint stiffness and flexor tendon adhesions. These conditions make treatment more difficult and reduce the chance of successful treatment.
Corticosteroid Injection Under Ultrasound for Trigger Finger Treatment
The treatment of trigger finger aims to relax the constricted pulley (A1 pulley) with a corticosteroid injection. Corticosteroid is applied to the area around the pulley using ultrasound. Injections without ultrasound carry the risk of being made inside the tendon. Corticosteroid injections made inside the tendon can weaken it and cause it to break.
The success of corticosteroid injection in trigger finger disease in the thumb is lower. The success of corticosteroid injection in trigger finger disease in other fingers is between 60-90%.
How is the Trigger Finger Surgery Performed?
If the trigger finger does not improve after a single corticosteroid injection or if it recurs after a certain period of time, surgery is planned.
In trigger finger surgery, the constricted pulley is accessed through a small incision over it and the pulley (A1 pulley) is relaxed and the skin sutured.
What Kind of Anesthesia is Suitable for Trigger Finger Surgery?
General anesthesia or regional anesthesia (entire arm is numbed) is performed. Local anesthesia is not very preferred. This is because the sensory nerves of the finger pass on both sides of the tendon to be relaxed during the surgery. In order to prevent damage to these nerves during the surgery, it is necessary to see the surgical site well. To achieve this, a tourniquet is placed on the upper arm temporarily to cut off blood flow. The tourniquet stops blood flow by creating pressure. In the case of local anesthesia application targeting the surgical site only, the patient does not feel pain at the surgical site but experiences pain at the place where the tourniquet was placed. For this reason, the choice of anesthesia in trigger finger surgery is either general anesthesia or regional anesthesia.
What is the process after Trigger Finger Surgery?
The surgical wound heals within 10-14 days. During this time, water contact should be avoided at the surgical site. After the surgery, finger movement is allowed.
