Ultrasound-guided percutaneous trigger finger release

Trigger finger, or stenosing tenosynovitis, is a common disorder affecting one’s fingers in particular.

It is caused by the inflammation and swelling of the tendon sheath, i.e. the protective covering of finger flexor tendons.

Sheaths, made of connective tissue, contain a lubricating liquid that allows the tendons to slide.

What are the causes of this condition and what are its accompanying symptoms?

Excessive use is the sole cause of this condition, which results in pain and reduces functionality significantly.

Initially, pain occurs only during movement.

Later on, however, it is also experienced while resting.

The area may be swollen and sensitive to pressure.

Sometimes, painful inflammation causes the tendon sheath tissue to bond at a certain point, thus making it harder for the tendon to slide, and therefore to move, in the sheath.

The symptoms sometimes include a sense of squeaking and sometimes cause finger stiffness or finger catching or locking in a bent position (trigger finger).

More specifically, the tendons on the side of the palm are held in position by arching ligaments, known as annular ligaments.

In a patient with trigger finger, the tendon sheath and/or the tendon are/is swollen, thus forming a small mass (nodule).

When the finger is bent, this nodule slides under an annular ligament.

To get the finger back to its original position a higher amount of force is needed to pull the mass back to the tendon.

This usually happens abruptly, i.e. the finger is straightened with a snap.

Who may develop this condition?

It has been estimated that approximately one third of those suffering from a trigger finger also suffer from carpal tunnel syndrome at the same time.

Tendon sheath inflammation can irritate nearby nerves and thus cause such problems as loss of sensation.

This condition affects 2-3% of the population.

Those doing repetitive movement in their daily lives, such as those working on a computer or musicians, as well as those suffering from diabetes, rheumatoid arthritis or gout are more susceptible to this condition.

These inflammations are more frequent in pregnant and breastfeeding women.

How to diagnose the condition and choose appropriate treatment?

Clinical examination will often suffice for diagnosis.

In most of the cases, immobilization will suffice to deal with the condition, at least in its initial stages, and prevent reoccurrence.

As a preventive measure, changes have to be made to the activity that has caused the condition.

Physiotherapy can also be helpful.

Anti-inflammatory pain killers and steroid injections can help relieve the pain.

However, these treatments are not always successful and therefore surgery may be the only solution eventually.

“Surgery aims to fully release annular ligament A1, which prevents tendon motion, and partly release annular ligament A2, so that the flexor tendon is able to slide more easily in the sheath.”

Patients undergoing surgery see their functionality improve significantly and are relieved of the pain.

The operation is carried out using either the traditional method or the percutaneous release approach.

There are significant differences between the two methods.

What are the differences between the two methods used to treat the condition?

More specifically, open surgery requires a long incision, which takes weeks to heal.

It may take 4 to 6 months for the swelling and the hand and finger stiffness to disappear.

And the symptoms may persist even after surgery, so that the patient may need physiotherapy.

On the contrary, where percutaneous release is used, patients may get rid of the symptoms and recover in just a few days!

This is so because the operation is carried out using a special release method, which can treat the trigger finger problem in a minimally invasive manner.

What are the advantages of percutaneous release?

The surgeon uses ultrasound to identify the constricted part of the tendon sheath which hinders the movement of the tendon and cut the sheath through a tiny 2 mm long incision.

That is, the incision is made after using ultrasound to identify the defective part of the tendon sheath, thus preventing any damage to other healthy parts which require no surgery.

As opposed to conventional open surgery, which requires a 15-20 mm long incision, this method and the dedicated tool used require 2 mm long incisions which need not even stitching!

The patient will leave the hospital wearing only a bandage on the wound, which will be removed 3 days after the operation.

That is, the incision is almost non-existent, and the patient will recover very quickly and regain his/her movement very soon so that he/she is able to get back to his/her day-to-day activities very shortly.

Generally, the patient will be able to do household tasks, such as kitchen chores, within a few days after the operation.

The advantages of this method also include reduced costs, which are significant if we also take into account that the patient will get back to work very shortly.

No other method has been proved to ensure such outstanding results.

It does have certain limitations though, as it is NOT recommended for the trigger thumb.

Currently, Dr Triantafyllopoulos is the only surgeon carrying out ultrasound guided percutaneous trigger finger release at the Athens Medical Group and in the entire Greece.