Trigger Finger Trigger finger is a locking of the digit into the palm of the hand making it difficult to bring the finger straight. It is most often noticed in the morning when there is some swelling in the hands or after a period of strenuous activity such as gardening. Some patients have a constant locking, and arthritis can aggravate the situation. This phenomenon involves the tendon that runs from the tip of the finger on the underside into the palm and forearm. A sheath surrounds this tendon. When the tendon becomes swollen or the sheath becomes smaller, the tendon will become locked within the sheath. The swelling and inflammation in the tendon sheath can be relieved by taking oral anti-inflammatory agents or by refraining from activities which cause the hand to swell. By doing so, the locking phenomenon is less noticeable. However, in cases in which these regimens are not successful, patients are advised to have a tenovaginotomy, a release of the tendon sheath. The tenovaginotomy is usually performed under local anesthesia and sedation in the office surgery unit. It can also be done on an outpatient basis in the hospital surgicenter, usually on occasions when other surgeries must be done for the hand. A tenovaginotomy entails a small transverse incision in the distal palm, at the base of the involved finger or fingers. Dissection is carefully done to the level of the tendon sheath. A linear incision is made along the tendon sheath in the direction of the tendon in order to release that portion constricting the tendon as it moves. Occasionally we will also find ganglions in the area of the tendon and tendon sheath, which also lend to the obstruction and tightening of the tendon within the narrow tunnel. In those circumstances we will also remove the ganglion. A ganglion is a cyst containing synovial fluid and is attached to the tendon or originates from the bony joint immediately beneath the cyst. Following surgical intervention, patients will be place into a plaster splint pressure dressing, which can be removed within a matter of days. The patients are subsequently encouraged to go through range of motion therapy and may well be sent to our hand therapist for further follow-up. Patients will, as is customary for most of our surgeries, be placed on prophylactic antibiotics prior to surgery and will be continued on them afterward. Patients will usually be able to return to their normal activities within a month if there is no tendency to fluid collection or there is no history of significant arthritis. The younger the patient the sooner the recovery, but again, patients must be cooperative in terms of their home therapy as well as with the hand therapist. As is true in any surgical procedure, there is the chance of infection and bleeding, as well as some scar formation at the incision site. Since Vitamin E and aspirin products impair blood clotting, patients are to refrain from these medications at least one week prior to their operation. Healing is impaired by nicotine. Therefore, patients should refrain from chewing Nicoret gum and smoking two weeks before and one week after surgery. There is also the possibility of injury to the tendon and digital nerves and vessels in the area of the tendon sheath. Again, this is a seldom seen problem. The possibility of recurrence of triggering has been noted and this is observed to owing to scar formation forming around the tendon sheath incision with subsequent entrapment of the tendon as in the usual trigger finger. These situations often mandate repeat surgical procedures. The fees for trigger finger release are mandated ten working days prior to surgery and the office will process your insurance coverage without charge. Please feel free to ask any of these points raised in this letter of Dr. Kennedy, or any member of our staff.
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