OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Dr. J.Clinton Merrick, MD

Trigger Finger or Thumb

By Clinton Merrick, MD
Hand Surgery
Rucker & Merrick, Plastic Surgery Clinic
Eau Claire

Our hands are our interface with the world. We demand incredible things from these two instruments. They protect us from danger, help prepare food and shelter, and connect us with friends and family. These instruments are called on for their strength and flexibility when we work, play or create. To accomplish such intricate functions, thousands of specialized elements are incorporated in a small, elegant package called the human hand.

Equally impressive is our body’s ability to mend itself and protect against invasion from the outside world. Ordinarily, some swelling due to injury in a leg or shoulder does not detract from function except to remind us of the injury until healing is completed. Swelling due to injury in the hand, however, almost always affects function. This is especially true when it comes to the tendons of the hand.


Early evaluation and injection treatment may decrease need for surgery

With the exception of some small muscles, our hands, fingers and thumbs are powered by strong muscles in our forearms, connected to the fingers by tendons. (Tendons are made from collagen and connect muscle to bone. Ligaments connect bone to other bone.) The flexor tendons travel through a series of tunnels that keep the tendon running along the finger bones. This anatomic arrangement keeps the tendon from tightening from the muscle directly to the finger tip. It is within these tunnels that problems can develop.

Trigger finger is one of the most common causes of hand pain and disability. Initially, the patient may experience a dull-aching pain in the palm of the hand at the base of the involved finger. The pain may also be on the back of the hand. This progresses to painful clicking or popping of the finger when flexing and extending. Eventually, the finger may lock when flexed, requiring assistance from the other hand to straighten. Finally, prolonged flexing of the digit can result in irreversible changes in the joints.

The cause of trigger finger is debated, but it does seem to be related to other inflammatory conditions of the lining of the joints, such as carpal tunnel, epicondylitis, de Quervain’s disease and rheumatoid arthritis. Trigger finger is more common in women and occurs most frequently in people in their 60’s. Although trauma has been implicated, the lack of significant incidence in the young male population suggests that it is one of many factors. Finally, diabetes appears to increase the number of affected digits and the severity.

The treatment of trigger finger depends on the severity of the disease, the duration of symptoms, and other underlying medical conditions. The first line of treatment involves injection of a local anesthetic and a small amount of steroid into the tendon sheath. Care must be taken to avoid the nerves and blood vessels to the digit. Splinting of the digits may also be helpful in treating trigger finger. If injection fails (failure is more common in long standing triggers, diabetics and rheumatoid patients), surgery may be required. The procedure involves carefully manipulating the tendon through a small (1cm) incision in the palm. Patients are encouraged to begin moving their fingers immediately after the surgery and return to the office in two weeks for suture removal.

Trigger finger is a common cause of pain in the hand. Early evaluation by a hand surgeon and injection are important. They may decrease the need for surgical intervention and allow one to avoid long term complications.

For more information, or to schedule an appointment with Dr. Clinton Merrick» 715.833.2116/800.456.8222, RuckerMD, Plastic Surgery Clinic or visit www.ruckermd.com

For more information, or to schedule an appointment with Dr. Clinton Merrick » 715.835.6548 715.833.2116/800.456.8222, RuckerMD, Plastic Surgery Clinic or visit www.ruckermd.com