What is trigger finger?
- Stenosing tensosynovitis caused by inflammation of the flexor sheath
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
What is the epidemiology of trigger finger?
- more common in diabetics
Ring finger most commonly affected
What are the conditions associated with trigger finger?
- Diabetes Mellitis
- Rheumatoid Arthritis
Who Classiifed trigger finger?
- nb: green fingers!
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
What are the symptoms of trigger finger?
- finger clicking, pain at distal palm nr A1 pulley
- finger locked in position
What do you find on examination with trigger finger?
- Lump nr A1 pulley
- Tenderness over A1 pulley
What are the tx options for trigger finger?
- night splintage,activity modified nsaid
- Steriod injections-best for fingers not thumb
- give 1-3 injections in flexor tendon SHEATH
What group of patients are resistant to steroid injections for trigger finger?
What operative tx are there for trigger finger?
- Surgical debridement and release of a1 pulley
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
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
What are the complications of trigger finger?
Radial digital nerve injury- crosses operative field over A1 - mus be protected
In children what percentage of trigger thumbs resolve ?
What 2 type of pulleys exist in the fingers?
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!!
How many cruciate ones are there and where are they found?
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)
What pulleys should always remain? why?
- A2 and A4
- Prevent bowstringing
What are the function of the cruciate ligaments?
- to prevent sheath collapse and expansion during digital motion
What pulleys are in the thumb?
- 1 oblique pulley
- 2 annular A1 and A2
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
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
what is the function of the oblique pulley?
- Facilitates excursion of FPL
- Prevents FPL bowstringing
What does A2 pulley do in the thumb?
Aids arc of movement