Trigger Finger Treatment

Description

Trigger finger occurs when two tendons in a finger are obstructed due to the surrounding membrane becoming inflamed. Dr. Brian Tobias says nonsurgical trigger finger treatments like anti-inflammatory meds are explored first. He can provide surgery if oral medication is ineffective.

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[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.

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The Hand to Shoulder Center

At The Hand to Shoulder Center in Fort Worth, TX, our team of fellowship-trained hand, elbow, and shoulder surgeons treat any and all conditions from the shoulder to the fingertip. Our surgeons perform both elective and reconstructive procedures, including:

  • Joint Replacement
  • Traumatic Injury Surgery
  • Arthroscopic Surgery
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  • Wide Awake Local Anesthesia Only Surgery

Our physicians are associated with the American Society for Surgery of the Hand and the American Board of Orthopaedic Surgery. For more information or to schedule an appointment, please contact us online or call (817) 420-9238.

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