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The recovery for something in trigger finger depends on what treatments you had. Typically, treatments like splinting take a couple of weeks to really improve. Oral anti-inflammatories usually take a couple of weeks as well. Treatments like a cortisone injection in the hand typically only take 24 to 48 hours before a patient’s symptoms really start to improve. With surgery and release of the trigger finger, typically patients get better almost immediately. Patients, even in the recovery room at the hospital typically note no more triggering of their finger as they move it. Some surgeons will even wake the patient up during the operation to ensure that there is no triggering. Typically the recovery then just involves the healing of the skin, which is 10 to 14 days after surgery. This can become a hardship to patients that use their hands to do their job. For example, trigger finger in a manual laborer may impair his hand enough that he could not complete his job and may impose financial difficulties on him and his family. If that’s the case, typically surgical intervention is recommended for a more speedy recovery.
My name is Christopher Stevens, and I’m an orthopedic surgeon, in upper extremity specialist at the Tucson Orthopedic Institute in Tucson, Arizona. I did my undergraduate training at the University of Arizona in Microbiology and I spent four years in medical school at the University of Arizona here in Tucson as well. I did my orthopedic Surgery Training at the University of Florida in Gainesville, Florida, and then spending an additional year after that specializing in upper extremity surgery, followed by an additional year after that, specializing in sports medicine and more specifically conditions that affect the upper extremity in sports medicine.
Today we’re going to talk about trigger finger. Trigger finger is known in the medical world as a condition known as stenosing tenosynovitis, which essentially means that your finger gets stuck as you bring it down into your palm. Trigger fingers is one of the most common diagnosis that a hand specialist sees. It tends to be more common in certain disease states and even overuse injuries. Patients that typically have trigger finger complain of pain and clicking and popping in their hand. The cause of the trigger finger is really that the muscles that move your fingers come from all the way up in your forearm. In your forearm, these muscles transition to a tendon and the tendon attaches out to the bone, which helps you move your finger up and down. In order to make the fingers move more efficiently, the tendons are actually attached to the bone via something called a pulley system, which starts at about the mid palm. In that pulley system, sometimes the tendon can be swollen and when it swells up, it has a tough time going through the tunnel. When it does that, it can cause snapping and catching and even locking it into the palm.
Some of the symptoms of trigger finger: patients typically complain of catching and popping in their finger. So typically they’ll wake up in the morning and the patient will say, my finger was stuck down in the morning and when I started to move it, I felt a pop and it would snap out. That’s because the tenant is being released from that tunnel or the pulley system. Typically they complain of pain right in the palm, right where the tendon starts to go through that tunnel. So right across the mid portion of the palm patients will notice pain and swelling and that’s typically a where you’ll feel a little knot also, if this is longstanding, a lot of time the finger will become more swollen and sometimes it will even cause the knuckle joint to be a little bit contracted or bent down. Pain is usually the reason that patients come to a doctor for evaluation. Typically this can be pretty painful, especially when it snaps. Sometimes the condition can be so severe that the finger is locked down in the palm and can’t be released. Whether the patient tries to pull it out or tries to manually snap it out, it’s stuck there and that’s a more serious condition.
Typically the non-operative treatments for this kind of condition would involve oral anti-inflammatory medications like Motrin or Advil or Aleve, Ibuprofen. Those help decrease the inflammation in the tendon and in the pulley system and actually can sometimes help the condition be much more tolerable. Other things that we can do are to splint the finger as well. Typically splitting it straight, it makes the finger not as functional, but it does help decrease the symptoms should these things not seem to be helping with the condition, a lot of times patients are given the choice for a corticosteroid injection of Cortisone, for example, into the area of the tendon. This helps shrink down the tendon and it helps open up the tunnel so that it doesn’t trigger and catch. Typically in patients without diabetes, this is a pretty effective treatment.
One of the best treatment options available for people with trigger finger is something called a corticosteroid injection. This is known by many patients as a cortisone injection. Cortisone is probably the strongest anti-inflammatory medication we have and the good thing about an injection is that if you take a pill, it goes to your whole body. Whereas an injection is focused right on the area where you’re having a problem. A corticosteroid injection can typically be performed in the office. It is usually a mixture of a local anesthetic like Lidocaine or Novocaine that numbs the area and also the corticosteroid, which is the anti-inflammatory medication. Typically it takes about 24 hours for most cortisone injections to take effect. The local anesthetic on the other hand works immediately and typically lasts between two and six hours. I usually tell patients when they leave my office, they feel pretty good because the local anesthetic is working, but usually four to six hours later when it wears off, they’d become symptomatic again. Usually about 24 hours after though, the cortisone will kick in and really help decrease that inflammation and the pain. It is normal for some patients to have a flare of the cortisone afterwards. This is because the hand is pretty shallow and any kind of foreign medication injected into it can cause the body to have some kind of reaction. This typically lasts a day or two and in the end usually benefits the patient a great deal once the anti-inflammatory kicks in.
Patients that fail conservative treatments typically are candidates for surgical intervention. Surgery is outpatient and usually can be done under a local anesthetic. The goal of the surgery is to widen the tunnel so that the tendon doesn’t get caught as it moves the finger. This is done through an incision that’s about a centimeter long right in the mid palm, so the incision is actually very small. The surgery typically takes between five and 15 minutes, and usually it’s very safe. Because of the anatomy of the hand, surgery is usually pretty straightforward. The thumb poses a little bit different anatomy, and so the thumb takes a little bit longer as far as the surgery goes. Most patients are kept without general anesthesia during the procedure, and they’re given just some light sedation. The skin is closed with two or three sutures, which can be taken out in about 10 to 14 days.
The surgery for trigger finger is highly successful. Because of this, there hasn’t been a lot of research focused on making it better than it already is. Some of the latest research involves making the surgery more minimally invasive. This is typically done by studying the anatomy of the tendons and the pulley system a little bit better. We use different anatomic landmarks, for example, such as the crease in the distal part portion of the palm to really localize where the tendons begin, and this allows us to focus our incisions so that we can do this through a more minimally invasive approach. Some of the newer things that people have been trying are to do this endoscopically. This is done with a small camera, but unfortunately the incisions still amount to about a centimeter in length.
During the surgery for trigger finger patients usually have a tourniquet placed on their arm. The reason for this is to limit the blood flow down into the surgical area. This helps the surgeon see because there are small vessels and nerves that are in proximity to where the surgery is done. The tourniquet is typically left up for about 10 minutes during the surgery, and this is usually the main reason that patients need some sedation. Local anesthetic such as Lidocaine or Novocaine is used during the surgery and the incision typically is about one centimeter in length. This is typically located right in the mid palm, where the triggering occurs. The surgery itself just involves releasing the proximal portion or beginning of the tunnel, so that every time the tenant tries to get caught as it goes through the tunnel, now the tunnel is much wider and released so that it can be caught. This typically does not have any effect on a patient’s motion or strength. Typically, all these return to normal postoperatively. During the surgery, the patient is typically awake or lightly sedated, depending on their pain tolerance with the tourniquet.
When you see the orthopedic specialist to be examined for trigger finger, typically all that’s needed is a physical exam. X-Rays typically don’t give us a lot of insight into any more of the pathology. On a physical exam, patients will typically note that pain right over the start where the tendon goes through its tunnel. That’s usually in the mid palm. A lot of times if it’s been going on for quite some time, the patient can reproduce the clicking and popping that occurs with triggering. Many times, also, you will feel a knot in the palm right where the tendon is swollen. The diagnosis is confirmed based on physical exam. Reproduction of pain at the start of the tunnel is probably the most common symptom that patients have. In other cases where the tendon has actually stuck the finger down into the palm, the diagnosis is fairly straightforward.
Some of the risk factors that are involved in trigger finger are patients that have other medical problems. The most common one that typically occurs is diabetes. Patients with diabetes have a much higher incidence of having trigger finger in their hands. Rheumatoid arthritis patients, and even patients with thyroid problems, whether their thyroid is just too low or too high, can also be affected.
Today we’re going to talk about trigger finger. And trigger finger is known in the medical world as a condition known as stenosing tenosynovitis, which essentially means that your finger gets stuck as you bring it down into your palm. Trigger finger is one of the most common diagnosis that a hand specialist sees. It tends to be more common in certain disease states and even overuse injuries. Patients that typically have trigger finger complain of pain and clicking and popping in their hand. The cause of the trigger finger is really that the muscles that move your fingers come from all the way up in your forearm. in your forearm, these muscles transitioned to a tendon and the tendon attaches out to the bone, which helps you move your finger up and down. in order to make the fingers move more efficiently, the tendons are actually attached to the bone via something called a pulley system, which starts at about the mid-palm. In that pulley system, sometimes the tendon can be swollen and when it swells up, it has a tough time going through the tunnel. When it does that, it can cause snapping and catching and even locking it into the palm.
One analogy that I like to use when I tell patients about trigger finger is that it can be similar to having a knot and you’re fishing line. So if you have a knot in your fishing line and you’re reeling it in, when that knot hits their line, it will get stuck. And if you use enough force, you can stop that knot right through the line, but not without that force. And typically what it does, it’s a violent action. That’s the same thing that occurs in trigger finger, where the tendon snaps through the pulley in the mid palm.
With regards to trigger finger, this could be a broad spectrum of how it affects someone’s daily life. Some patients have mild symptoms where they only notice some pain in the palm when they grip something like a golf club. Some patients have their fingers stuck down in the palm where it essentially renders the hand on functional. The more severe the case is, and the more you rely on your hands to do your normal activities or to do your job, the more severe it can have an effect on your life.
There are several online websites that can help patients and provide more education regarding trigger finger. One is the American Society for Surgery of the Hand or www.assh.org. The other is the American Academy of Orthopedic Surgeons, and this is www.aaos.org as well. These have further educational materials for patients that are put in layman’s terms and go through the whole spectrum of the condition.
Some of the conditions that occur commonly in conjunction with trigger finger are things like carpal tunnel syndrome and even arthritis of the thumb joint. Typically, patients with trigger fingers have these other issues as well. in patients with certain medical conditions that are higher prevalence than trigger finger are typically also affected in these conditions. What I mean by that is a patient who has diabetes typically has trigger finger and carpal tunnel in the same hand.
One of the most important things you can do before your appointment with the orthopedic specialist is to really pay attention to your symptoms. When I say that, I mean pay attention. Is it worse in the morning? Or is it at night? Does it wake you up from sleep? What has helped it? Has resting it helped it? Has taking something like oral anti-inflammatories like Ibuprofen helped it. These things are very important along with the duration of symptoms. Has it’s been going on for months, weeks, or just days? All these affect the decision making process and the treatment that we align for each patient.
Typically with trigger finger, some of the things that you can do to limit the pain, in the interim where you’re trying to get to see someone to diagnose the condition is to rest it. Typically a popsicle stick or tongue depressor may help hold the fingers straight, which will limit it getting caught in the palm. Other things like different tiger balms or different balms and in the mid palm as a massage would also help decrease some of the symptoms.
Some of the non-operative treatments that are available for trigger finger involve things like splinting, oral, anti inflammatories, and even injections into the hand. With splinting. The finger is typically immobilized straight. That helps prevent the finger from getting stuck in the palm. As with splinting, any extremity, it is a little bit difficult and patient compliance is not always the best. From my standpoint, I completely understand because when your finger can’t bend, it renders it nonfunctional. And although you’re helping your trigger finger, you’re limiting the use of the hand and the hand is what makes us human and most of us need that to do our activities of daily living and even work.
While you’re waiting to see the doctor for your trigger finger, some of the things that you can do to limit your pain and decrease some of the symptoms are to do things like limit the use of your head. So heavy manual labor, even repetitive activities should be avoided, especially if they’re painful. One of the things you can do after surgery to prevent any kind of complication, is really to keep your dressing in place and keep it dry. Typically, dressings are placed in the operating room and are sterile. Usually patients keep those in place for a couple of days before they’re allowed to remove them. And it’s important to keep the dressing and the surgical incision site dry. Moisture is typically the enemy of healing. So even if patient showers, they’re instructed to make sure that it’s dry afterwards. While there’s still sutures in your skin, we usually advise patients not submerge them. So things like doing dishes, things like swimming in a pool or a lake are typically not advised until the skin has completely healed.
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