Trigger finger

Question 1

What is trigger finger?

Answer 1

• Stenosing tensosynovitis caused by inflammation of the flexor sheath

Question 2

What is the aetiology of trigger finger?

Answer 2

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

Question 3

What is the epidemiology of trigger finger?

Answer 3

• more common in diabetics
• Ring finger most commonly affected

Question 4

What are the conditions associated with trigger finger?

Answer 4

• Diabetes Mellitis
• Rheumatoid Arthritis
• Amyloidosis

Question 5

Who Classiifed trigger finger?

Answer 5

• GREEN
• nb: green fingers!

Question 6

Can you describe Green’s classification of trigger finger?

Answer 6

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

Question 7

What are the symptoms of trigger finger?

Answer 7

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

Question 8

What do you find on examination with trigger finger?

Answer 8

• Lump nr A1 pulley
• Tenderness over A1 pulley
  *

Question 9

What are the tx options for trigger finger?

Answer 9

Non op

• night splintage,activity modified nsaid

OPERATIVE

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

Question 10

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

Answer 10

• Diabetics

Question 11

What operative tx are there for trigger finger?

Answer 11

• Surgical debridement and release of a1 pulley

Question 12

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

Answer 12

• 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

Question 13

What is your post op instructions?

Answer 13

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

Question 14

What are the complications of trigger finger?

Answer 14

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

Question 15

In children what percentage of trigger thumbs resolve ?

Answer 15

• >60%

Question 16

What 2 type of pulleys exist in the fingers?

Answer 16

• Annular
• Cruciate

Question 17

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

Answer 17

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

NB ODD over JOINTS!!

Question 18

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

Answer 18

• 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)

Question 19

What pulleys should always remain? why?

Answer 19

• A2 and A4
• Prevent bowstringing

Question 20

What are the function of the cruciate ligaments?

Answer 20

• to prevent sheath collapse and expansion during digital motion

Question 21

What pulleys are in the thumb?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

what is the function of the oblique pulley?

Answer 24

• Facilitates excursion of FPL
• Prevents FPL bowstringing

Question 25

What does A2 pulley do in the thumb?

Answer 25

Aids arc of movement