Help For Trigger Finger

SAN ANTONIO - Texting, typing on small devices, even holding onto a steering wheel can be impossible for those who suffer from a painful hand condition which causes their finger to lock and stiffen. However a simple outpatient procedure is finally giving them a reason to high five.

Keeping tabs on the weather or simply making a fist were almost impossible for 69 year old Tom Gates, until recently.

Tom Gates told Ivanhoe, “Initially it was kind of funny, look at this little trick finger and then it got worse and worse and it wasn’t funny.”

The retired Air Force lieutenant colonel was suffering from tenosynovitis, or trigger finger. It is an inflammation of tissue inside a finger or thumb.

Christian Woodbury, MD, hand and upper extremity surgeon for the San Antonio Orthopedic Group, told Ivanhoe, “What they’ll notice is catching and locking of the fingers, particularly waking up in the morning with a finger stuck down and it’s painful to pop them out.”

To get relief, Tom opted for a simple procedure that could be done in the office. It’s called percutaneous trigger release. No sedation is required, just a little numbing medication and a tiny blade.

Woodbury said, “We can actually release some of the tissue that the tendon is getting caught on in the office with no stitches and it’s done in about 3 minutes.”

It’s a quick procedure with immediate results.

“In less than 20 minutes I was in, out, I was bending my hand,” Gates told Ivanhoe.

Now the forecast isn’t so bad after all.

Gates told Ivanhoe, “I’m on cloud 9, it’s great, it is absolutely great.”

Although Tom is not a diabetic, Woodbury says people with diabetes are more prone to develop “trigger finger.”  It is also more common among people who must repeatedly grip an item, like a work tool, or musical instrument, for example.

BACKGROUND: Trigger finger is the common name given to a condition known as stenosing tenosynovitis which causes one of your fingers to get stuck in awkwardly bent position then straightens with a snap, like the quick reflex of a trigger being pulled. It’s caused by an inflammation of tissue and if the condition is severe, the finger may become locked into the bent position for an extended period of time. People that suffer from trigger finger usually have jobs or hobbies that require a lot of gripping actions. Trigger finger can cause a lot of pain and discomfort and can prevent the operation of simple daily tasks like typing or texting. (Source: http://www.mayoclinic.org/diseases-conditions/trigger-finger/basics/definition/CON-20043819)


TREATMENTS: 
For mild cases of trigger finger, rest may be all that’s required. Doctors may even recommend putting the finger in a splint in order to keep it in a stationary position. Medications and steroid injections may also be used to clear up any minor cases. For more severe conditions, surgery can become an option. Surgery on trigger finger is done to widen the opening of the tunnel in the finger so that the tendon can slide through it more easily. A small incision is cut in the palm and the tendon sheath tunnel is cut in order to widen and loosen it up. Possible complications from surgery include infection, bowstringing and persistent triggering. (Source: http://orthoinfo.aaos.org/topic.cfm?topic=a00024)

NEW TECHNOLOGY: There is now a relief for more severe trigger finger conditions that doesn’t require surgery. The new procedure is called percutaneous trigger release. Instead of making an incision in the palm of the hand as with traditional trigger finger surgery, the percutaneous procedure inserts a needle into the base of the finger and slices through the ligament. The procedure is a bit risky because important nerves and arteries are near the tendon sheath and they could become damaged. On the other hand, the procedure is a breakthrough in that it can be done quickly and with immediate results. (Source: http://www.nhs.uk/Conditions/Trigger-finger/Pages/Theprocedure.aspx)

FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Jen Gonzalez
San Antonio Orthopedic Group
210-804-5508 / 210-269-9587

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

Christian Woodbury, MD, Hand and Upper Extremity Surgeon, Orthopaedic Surgeon. The San Antonio Orthopedic Group.  

So tell me about trigger finger.

Dr. Woodbury:  Well trigger finger is a pretty common condition that occurs when people get inflammation along their tendons that help them flex the fingers. What they’ll notice is their fingers will be sore and sometimes stick and lock, particularly in the morning. What happens is a knot forms on the tendon of the finger and that knot gets caught as it tries to move back and forth through this piece of tissue or this pulley that the tendon travels through.  What we can do is release that pulley with the knife blade so that the knot can travel back and forth.  Once that happens, the swelling goes down and the pain goes away, but by releasing that pulley, patients immediately get motion and no triggering instantaneously.   It’s more common with people who are doing repetitive motion type activities like texting, typing, using power tools and is a little more common in diabetics as well.

So, why is it a problem if your finger locks and you can eventually unlock it?

Dr. Woodbury:  Well functionally, it can be a real problem not being able to open your hand like you need to and of course it is very painful.  People describe a significant amount of pain whenever they have to pop their finger back out in position.

So you come in and you’re doing something that’s fairly new for this type of injury?  

Dr. Woodbury:  Percutaneous trigger release allows us to actually release some of the tissue that the tendon is getting caught on in the office with no stitches and is done in about 3 minutes. It’s very effective and essentially cures the problem.

Immediately?

Dr. Woodbury:  Yes, traditionally the treatments have been steroid injections and if that doesn’t work, operative treatment which obviously requires a lot more work might have been needed, but now this can be done immediately in the office with really good results.

So one of the pros is no sedation?

Dr. Woodbury:  No stitches, no sedation, just some local numbing medication that lasts for a couple of hours.  There is a loose bandage that goes on the hand for about two days. You can immediately use your hands for light activities like writing, typing, lifting a glass of water and even heavier lifting.  It’s a little sore for a couple of days, but that’s it and the locking goes away immediately.

What is the chance of it coming back? 

Dr. Woodbury:  Well essentially, I’ve never had one come back myself.  So the odds are very low. Essentially it’s a cure.

Have you seen more and more cases with people kind of using their fingers maybe a little more than they used to? Have you seen more cases?  

Dr. Woodbury:  It is definitely becoming more common and I can’t really say for sure why, but there are definitely people that are using more small devices for texting, typing and that kind of thing.

Can you show us the small device?

Dr. Woodbury:  This shows the kind of the general device and how it works. There’s no stitches and again, takes three minutes to do, and that’s it.  That’s the device.

So you just make that an incision?

Dr. Woodbury:  We can actually enter the skin directly with the tip of that blade and it goes back and forth to release a tunnel that the tendon travels through.  So as soon as you make one swipe with this, inside the finger, the problem is solved.

What about scarring? 

Dr. Woodbury:  Scarring is minimal to none.  I mean, only as wide as that little blade is there.  So essentially no visible scarring and no stitches.  The reason we always used to do it open is because there are some structures, arteries and nerves that go in this area that are very close, but we found through research that this procedure can be done effectively with no increased risk to any of those structures.  I think it’s just a situation where people have been hesitant to try something and it’s just advanced to a more minimally invasive procedure and more recently people have accepted this as a procedure that can be commonly done. 


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