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Flashcards in Trigger finger Deck (25):
1

What is trigger finger?

  • Stenosing tensosynovitis caused by inflammation of  the flexor sheath

2

What is the aetiology of trigger finger?

  • Entrapment of the flexor tendon at the level of the A1 pulley
  • Fibrocartilage metaplasia of the tendon and pulley

3

What is the epidemiology of trigger finger?

  • more common in diabetics
  • Ring finger most commonly affected

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4

What are the conditions associated with trigger finger?

  • Diabetes Mellitis
  • Rheumatoid Arthritis
  • Amyloidosis

5

Who Classiifed trigger finger?

  • GREEN
  • nb: green fingers!

6

Can you describe Green's classification of trigger finger?

  • 1- palm pain and tenderness at A1 pulley
  • 2- Catching of digit
  • 3-Locking of digit, passively correctible
  • 4- Fixed, LOCKED digit

7

What are the symptoms of trigger finger?

  •  finger clicking, pain at distal palm nr A1 pulley
  • finger locked in position

8

What do you find on examination with trigger finger?

  • Lump nr A1 pulley
  • Tenderness over A1 pulley
  •  

9

What are the tx options for trigger finger?

Non op

  • night splintage,activity modified nsaid

OPERATIVE

  • Steriod injections-best for fingers not thumb
  • give 1-3 injections in flexor tendon SHEATH

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10

What group of patients are resistant to steroid injections for trigger finger?

  • Diabetics

11

What  operative tx are there for trigger finger?

  • Surgical debridement and release of a1 pulley

12

Describe your surgical technique of debridement and release of A1 pulley?

  • longitudinal/ transverse incision at distal palmar crease- Over mcpj
  • Release A1 pulley
  • in children may have to release 1 or 2 limbs of sublimus tendon and A2/A3 pulley
  • Post op: early passive and active rom qds
  • If no FROM at 1st fu sent to physio

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13

What is your post op instructions?

early passive and active rom 4x a day if pt has not from on 1st visit sent to PT

14

What are the complications of trigger finger?

  • Radial digital nerve injury- crosses operative field over A1 - mus be protected

15

In children what percentage of trigger thumbs resolve ?

  • >60%

16

What 2 type of pulleys exist in the fingers?

  • Annular
  • Cruciate

17

How many annular ones are there and where are they found?

  • A1- over MCPJ
  • A2 on prox phalanxj
  • A3 over PIPJ
  • A4- on middle of middle phalanx
  • A5- over DIPJ

NB ODD over JOINTS!!

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18

How many cruciate ones are there and where are they found?

  • 3
  • C1- on proximal phalanx after A2
  • C2-  after A3 pulley on middle phalanx
  • C3 At distal end of middle phalanx after A4 and before A5( at dipj)

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19

What pulleys should always remain? why?

  • A2 and A4
  • Prevent bowstringing

20

What are the function of the cruciate ligaments?

  • to prevent sheath collapse and expansion during digital motion

21

What pulleys are in the thumb?

  • 3
  • 1 oblique pulley
  • 2 annular A1 and A2

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22

What is the location of the Annular pulleys in the thumb?

  • A1 at MCPJ
  • A2 on the distal half of the proximal phalanx next to IPJ

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23

Where is the location for the oblique pulley? what is it associated with?

  • Proximal half of the proximal phalanx
  • Assoc with the ADDUCTOR POLLICIS MUSCLE

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24

what is the function of the oblique pulley?

  • Facilitates excursion of FPL
  • Prevents FPL bowstringing

25

What does A2 pulley do in the thumb?

Aids arc of movement