What is Trigger Finger

Host: There is a condition called a ‘trigger finger’. First of all we do not use guns, so why do they call it trigger finger? Guest: Trigger finger, is because when the patient bends the finger, the finger clicks into a bent position and then it jumps back into straight position and sometimes it clicks into bent position and the patient cannot straighten it out at all. And sometimes the patients are stuck in that position and cannot use that finger. Host: What causes it? Guest: Trigger finger is caused by inflammation of the tendons. There are many causes of inflammation of the tendon, for example, rheumatoid arthritis or it could be just from repetitive stress syndrome where excessive repetitive use of the fingers would cause it, for example, typing your keyboard, but when the finger tendon become swollen, it has to normally go through a tunnel into the finger. Now, the tunnel remains the same size and the tendon becomes larger, so it clicks in and clicks out of the finger as you bend and straighten the finger. Host: And how do we fix it? Guest: Majority of the patients can be treated conservatively and I would say approximately 80% of the patients could be treated conservatively. Host: And that would do what? Guest: Cortisone injection is approximately 80% successful, but if somebody says I don’t want to have an injection we can treat it with a splint and the splinting is successful in about 67% of the cases that is almost like two-thirds of the patients. Host: Where you say a splint you keep it in the -- Guest: We keep the finger in a straight position with a splint, so it does not bend. Host: How long you should be in a splint? Guest: Six weeks. The splinting works but it takes six weeks. Injection works immediately, but it hurts; that’s the basic difference. Host: If you do these things, does it come back. Guest: In 80%, it does not come back; in 20% it comes back within a year. Host: And if it does keep coming back, is there any surgery you can do for that? Guest: Yes. I have developed a technique called percutaneous trigger finger release; mine was the first article in a large series that was reported in literature and what we did was to anesthetize just the finger area and then take a needle and with the needle we opened up the canal from outside and that is successful in about 95% of the cases and so now patients who do not want to have the cortisone injection, I tell them they can have just the lidocaine injection, the Xylocaine and just release it and so it is successful in about 95% cases. So the other 5% that do not succeed we percutaneous in the office, we do it in -- Host: So, basically conservative therapy is always tried first; the last thing you do is do a surgical -- Guest: That is absolutely correct.