Trigger Thumb/Trigger Fingers

A trigger thumb for trigger finger he is a condition caused by irritation or inflammation of the flexor tendon to the thumb or finger.  The flexor tendons, which flex the fingers and thumb run on the palm side of the hand in a tunnel called the flexor tendon sheath. along this tunnel, there are fibers bands, called pulleys, which run across the top of the flexor tendon and pulled it down. for each digit there is a tight area where the flexor tendon sheath is somewhat constrictive, called the A1 pulley.  This is located on the palm side of the knuckles.  Any condition that produces inflammation or swelling of the flexor tendons may produce a localized area of swelling on the flexor tendon (nodular flexor tenosynovitis). the swollen area of the tendon to the thumb or finger may then become restricted by the A1 pulley, producing a catching, clicking or actual locking of the thumb or finger.  This is similar to a rope with a knot on it getting caught at the pulley.

Overuse activities such as repetitive gripping may produce a swelling of the flexor tendons and a trigger thumb/finger.  Inflammatory disorders such as rheumatoid arthritis, lupus or gout may also produce a trigger thumb/finger.  Trauma to the hand may cause bleeding in the flexor tendon sheath and also produce this condition.  Recent surgery in the hands/ palm such as carpal tunnel surgery may also  produce swelling and a trigger finger/Palm.

Conservative treatment consists of an injection with Xylocaine and Cortisone in the flexor tendon sheath surrounding the tendon ,, followed by a series of flexor tendon gliding exercises designed to help promote free gliding of the flexor tendons in the flexor tendon sheath.  See figure. when conservative treatment fails , or there is repeated recurrence of a trigger thumb/finger, surgery as indicated.  Surgery consisted of a trigger thumb or trigger finger release. this as an outpatient procedure with local standby or twilight anesthesia.  After administering local anesthesia, a small transverse incision is made on the palm over the A1 pulley of the affected digit.  The A1 pulley is released and cut, the swollen tenosynovium or tissue around the tendon may be trimmed back and the skin is then closed.  A small dressing is applied.  Early finger motion is encouraged immediately.  The patient may use the hand for simple activities such as eating or getting dressed.  There is no heavy lifting or carrying for two weeks after surgery.  The patient is required to keep the dressing and incision dry for two weeks.  After two weeks the sutures are removed and the patient may resume most normal activities.  Possible complications include anesthesia related problems, wound healing problems or infection.