Trigger Finger Treatment

[00:00:07.640] When patients come to see me about trigger finger, [00:00:09.920] the first thing I try to explain to them is what the basic anatomy is [00:00:12.720] and help them gather an understanding for why this has happened. [00:00:16.840] When I talk to patients, [00:00:17.760] basically what I describe to them is there are two tendons in your finger [00:00:21.240] and those two tendons run through a tunnel which extends [00:00:24.120] from the distal palm to this last crease in your finger. [00:00:27.400] The whole mechanism, obviously, is lined with a membrane, [00:00:30.920] what we call the tenosynovium, [00:00:32.560] which lubricates and nourishes the tendon as it runs through the tunnel. [00:00:36.400] Now, when you have a problem, [00:00:38.240] what happens is that first, the lining starts to get inflamed, [00:00:41.440] and when it gets inflamed, [00:00:42.720] it starts to rub as you move the finger on this first ring or pulley, [00:00:46.880] and as time goes on, that rubbing leads not only to pain, [00:00:50.760] but then you feel some clicking where that lining has gotten thickened. [00:00:54.280] But when it starts to trigger, and that's where the name comes from, [00:00:57.880] is that the triggering of the finger, they feel like getting caught. [00:01:01.800] That's when you start actually to get a nodular thickening in the tendon. [00:01:06.000] Not only is the lining thick, but the tendon gets thick. [00:01:09.280] As the tendon nodule increases in size, [00:01:12.520] even though your powerful flexors can pull it through the tunnel, [00:01:15.920] the extensors are at a mechanical disadvantage, [00:01:18.920] so it takes a little more effort to get it to go, [00:01:21.680] so people start to notice their finger gets stuck. [00:01:24.160] So in the case of trigger finger, [00:01:25.600] we might start with splinting and anti-inflammatories by mouth, [00:01:29.120] so medication orally, and that's in the milder stages. [00:01:33.280] In the next more severe stages, [00:01:35.280] we'll talk about splinting and an injection of steroid, [00:01:38.080] which is a steroid anti-inflammatory to try to reduce the inflammation. [00:01:41.560] In the case of the trigger finger like we talked about, [00:01:43.480] what you're trying to do is shrink the swelling around the nodule [00:01:45.720] and you're hopeful [00:01:46.280] that the nodule hasn't gotten so big that mechanically, [00:01:48.840] it's going to be a problem, despite the swelling being produced. [00:01:52.520] If they're in the later stages, and really, [00:01:55.360] you know that the nodules is too big, [00:01:57.200] then mechanically, surgery is going to be more appropriate. [00:01:59.920] And then we talk about two options. [00:02:01.600] We have different venues where we can do that type of surgery, [00:02:04.840] and that's where our in-office procedures come in. [00:02:07.120] And so we talk to them [00:02:08.200] about the fact that it's done under a straight local anesthetic. [00:02:11.400] We do that here in the office. [00:02:13.040] We prep and drape the patient out [00:02:14.480] just like we normally do in any other facility, [00:02:16.800] but they're awake just like they are at the dentist. [00:02:19.800] The nice humorous part of it is, [00:02:22.240] we tell them that we can talk to them and they can talk to us, [00:02:24.760] and we don't have our hands in their mouths, [00:02:26.240] so it's a lot easier than in the dentist. [00:02:28.200] And then, of course, afterwards, [00:02:29.520] they drive themselves home. [00:02:30.640] They're in a light supportive dressing, [00:02:32.400] and we give them their post-op instructions and care.