Introduction:
It is one of the most common painful condition in hand. Usually middle age population (40-60years) suffers. Ring finger and thumb are most commonly involved digits. The condition can present in both hands & may involve any or multiple digits.
Why does it happen?
The exact cause of this disease is not known but the incidence is more in people who have diabetes, hypertension, thyroid disorder or rheumatoid arthritis. Now a day, due to continuous use of electronic gadgets like laptops, mobile phones etc., trigger finger is also seen in younger generation.
What exactly is the problem?
Fig 1: Image showing tendon thickening.
At the junction of finger and palm in hand, there is one pulley named A1 pulley. The function of this pulley is to cover cables (tendons) which are responsible for bending of the finger. Because of above mentioned medical issues, the pulley gets thickened and it causes restriction of free gliding of cables underneath the pulley. Therefore, every time, a person flexes or bends the finger, it gets locked and gives severe pain while attempting straightening or extension. In terminal stages, it can get locked and movement of the fingers may get hampered.
Is there any test to prove it?
Mainly the diagnosis is very obvious and purely based on clinical judgement.
Ultrasonography: It gives fair idea about confirmation of diagnosis, diameter or thickness of the pulley
Is it curable or treatable?
Fortunately, if solved in time, it is always curable. Medical management have very little role in treating trigger finger.
Steroid injection in the A1 pulley area of affected digit in some selected patients can give relief without much side effects. In some patients, it may relieve symptoms but it may show recurrence. Local steroid does not spread in the body therefore side effects of steroid are not seen.
Splintage and steroid injection therapy may work in pregnant females or post pregnancy.
If symptoms affect activities of daily living then ultimately surgery to release the pulley and making tendons gliding free has to be considered.
Surgery is done as day care procedure. It has excellent success rate if done in time. Person can use operated hand after the surgery within a week or ten days’ time. As it is mostly done under local anaesthesia, surgery is very safe.
Surgery to release the pulley under local anaesthesia has been very much gratifying and successful. Usually it is a day care procedure and patient can start using hand immediately after the surgery.
The control of medical problem is very much essential to avoid recurrence or involvement of other digits.
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