WHAT IS TRIGGER FINGER?

Trigger finger is a very common disorder in which a swelling forms on one of the tendons in the hand. Tendons run in little tubes like tunnels, known as tendon sheaths and that swelling on the tendon can get caught on the entrance to the tunnel, giving rise to the triggering or catching sensation. This is a bit like a tube train getting caught on the entrance to its tunnel. There is a gradual onset with initial catching and it can get so bad that the finger even gets completely stuck down in the bent position. It is always worse in the morning and improves as the day progresses. It can affect tendons of the fingers and thumbs in both hands. It isn’t really known why people get it and it is not more common in manual workers.

TREATMENT

There are two simple treatments for this. The first is a cortisone injection which is injected and need not be very painful. Using a very fine needle the cortisone is injected just through the skin and the cortisone washes down over the tendon. It is not necessary for the needle to be placed in the tendon sheath (which is painful). This has a very high success rate at stopping the triggering although it takes up to 7 days to take effect. The cortisone will usually stop the triggering for around six to nine months. The injection can even be repeated. The Injection does not weaken the tendon. The second treatment is corrective surgery. This is done under local anaesthetic and takes about 20 minutes (a bit like going to the dentist) and this is curative. The surgery opens the tendon sheath making the opening rather like a funnel so that the swelling can slide in and out of the tendon sheath without catching on the entrance.

SURGERY

Surgical release is done under local anaesthetic. Mr Kurer uses a special local anaesthetic mixture which means that no tourniquet has to be applied and in fact any patient who is on Warfarin does not even need to stop the Warfarin. A small transverse incision is made in the palm at the level of the main transverse skin crease. The incision is no more than 1 cm long. It is advantageous having the patient awake because as the tendon sheath is released the patient can check whether that has been sufficient to stop the triggering. Even though the finger is numb, the patient can tell whether it is still catching or not. A hidden absorbable stitch is then placed in the skin and a plaster and bandage applied. The patient then goes home. As this is under local anaesthetic, the patient does not need to starve beforehand.

ACCELERATED REHABILITATION REGIME

Mr Kurer’s regime is that the next day the patient removes the dressings and plaster and washes the hand under the tap, dries it and applies a new plaster and starts to use the hand. The hand may be sore for two to three days but the triggering is gone and the pain from the triggering is gone. Because this does not interfere with function greatly, trigger fingers in both hands can be done simultaneously. The stitch does not need to be removed and is invisible.

COMPLICATIONS

The commonest complication is wound infection which is easily treated with oral antibiotics. Tendonitis or persistent soreness may occur, which only last a few weeks and can be treated with a further cortisone injection. Recurrence of triggering is very rare..

SELF-PAY PACKAGE

Mr Kurer offers a self-pay package including out-patient assessment, surgery and one follow-up appointment including use of the operating theatre, medications and dressings for £995.00 (providing there is operating theatre availability).
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TRIGGER FINGER