Trigger Digits .pdf

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TD
PAUL JARRETT
ORTHOPAEDIC SURGEON

Post-operative care
A small bandage is worn for two days.
Upon removal of the bandage the small
sticky plaster is worn for a further 7 days
and then removed. I use absorbable
sutures which do not require removal. The
wound is tender usually for a few weeks
resolving over this period. From 10 days
after your operation you can commence
washing your hand as normal and I would
recommend massaging the wound with
moisturising lotion twice daily. The small
white sutures will fall out by themselves
over a few days and do not require formal
removal by a nurse or doctor.

Hand
Upper Limb
Orthopaedic Trauma

Your Guide to
Trigger Digits

(Stenosing Tenovaginitis)

The fingers can be moved immediately
following the procedure and heavy work
may not be possible until the wound has
healed. The risks of the procedure are low
but include infection (1%), stiffness and
nerve injury (rare).
Best wishes in
your recovery.

PAUL JARRETT
ORTHOPAEDIC AND HAND SURGEON
Murdoch Orthopaedic Clinic
100 Murdoch Drive
Murdoch WA 6150

Phone: 08 9311 4636
Fax: 08 9311 4627
E–mail: admin@pauljarrett.info

Triggering mechanism

pauljarrett.info

TRIGGER FINGER / THUMB

What is happening in my wrist to cause carpal tunnel syndrome?
Symptoms

Who gets triggering

A trigger digit sufferer will experience
a discomfort or pain in the palm of the
hand at the base of the affected digit(s)
and often a clicking feeling when moving the digit especially when bending
and straightening it. The digit may in
fact get caught down in the palm (triggering) and it may be necessary to pull
the digit out straight again with a painful click. In a milder form of this condition the clicking and catching down in
the palm may be absent but the other
symptoms present. Trigger finger or
thumb can come on gradually or occasionally very rapidly and may resolve
spontaneously over time or remain
indefinitely without treatment.

Trigger finger is a very common hand condition
affecting females and males of all ages. Infants
and middle aged females are particularly prone
and there is an association with diabetes.

What causes triggering
The flexor tendons that bend your fingers run
within a tunnel called the fibrous flexor sheath
from the end of your palm into your finger as
shown on the diagram below. The mouth of sheath
(A1 pulley) is narrower than the main part of the
tunnel. In a trigger digit a small swelling develops in the tendon which catches in the mouth
of the sheath as the tendon glides in and out of
the sheath. The clicking feeling represents the
swelling catching in the mouth. The cause of the
majority of swellings causing a trigger digit is not
known, however fortunately effective treatment is
available.
A trained medical practitioner can diagnose
trigger finger by a clinical assessment and it is
rare for any additional tests to be required.

Treatment options
Should a trigger digit be mild and resolving it is
entirely reasonable to let the condition resolve
spontaneously; this can be aided by resting the
hand avoiding repetitive hand work for
approximately a week. For more severe and for
non-resolving triggering the main treatment
options are hand therapy and steroid injections.
Hand therapy involves exercises and treatments
such as ultrasound.

Nodule in Flexor Tendon

Steroid injections involve injecting very small

amounts of steroid into the affected
area. The steroid remains at the injection site and aims to reduce the swollen
area in the tendon. A single injection
resolves a triggering digit over 60% of
cases and if requires a further one or
two injections will result in over 90% of
trigger digits resolving after the steroid
injection treatment. Steroid injections
may be carried out by your family doctor or surgeon, are usually the first line
treatment for trigger digits and are considered safe. Steroid injection treatment
aims to provide a permanent resolution
of the triggering.
Should injections not work a small operation called trigger release is available. Usually carried out under local
anaesthetic through a small wound in
the palm, the mouth of the sheath in
which the flexor tendon travels is cut to
prevent the triggering and the condition resolves following this procedure.

Steroid injection


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