Ultrasound Guided Trigger Finger Release

Trigger finger occurs when fingers become stuck or locked when bending or straightening, often accompanied by pain. The condition is the result of thickening tendon sheath and/or nodule in the palm at the base of affected finger,  which becomes painful when being pressed (see photo below).

Causes
It results from overuse or persistent pressure over the area, such as gripping a golf club or broom. It is common in the elderly, especially in those with diabetes.

Treatment
The treatment modalities depend on the duration and severity of symptoms.

• In mild cases, if the catching sensation is occasional and limited to the morning, minimize the use of your fingers, or wear a finger splint for 3-4 weeks.
• In severe cases with a catching sensation or locking on every flexion or extension of your fingers or you cannot fully clench your fist (see photo below).

There are 2 treatment modalities for severe cases.

• Steroid injection into the tendon sheath should be performed by an orthopedic hand and microsurgery physician because this is a delicate procedure. The steroid must not be injected into the tendon itself, which can become weakened or damaged. This treatment can improve symptoms but cannot prevent recurrence.
• Surgery to cut the constrictive tendon sheath. This procedure is safe because it affords a direct vision of the tendon sheath. However, the downsides are that it must be done in an operating room; the operating time is 30-45 minutes, and suture removal is required afterward, You must avoid wetting the wound for 12-14 days.

At present there is a modality known as Ultrasound-Guided Trigger Finger Release which can break apart the constriction with no skin incision. Your doctor will numb your palm and use a needle to prick and open the constricted tendon sheath by looking at the video monitor.

The advantages of ultrasound guided trigger finger release

• It is performed on an outpatient basis.
• Local anesthesia will be given.
• It is safe for the tendon and nerves because the needle and tendon are visible on the video monitor of the ultrasound machine.
• It is a quick 5-minute procedure.
• The locked fingers are released immediately after treatment.
• No incision is required. No scar; only a needle mark.
• Water exposure is possible within 24-48 hours after the procedure.

Preparing for your appointment
Make a list of the medications and dietary supplements you are taking as well as a list of questions you would like to ask.
Samples of questions are:

• What are the causes of symptoms?
• Are the symptoms temporary and permanent?
• What treatment do you suggest?
• Are there any complications? If yes, what are they?

Samples of questions you may want to ask your doctor:

• What are the symptoms you experience?
• How long have you had the symptoms?
• Are the symptoms temporary or permanent?
• What helps relieve the symptoms?
• What aggravates the symptoms?
• Do your symptoms worsen at any particular time, such as in the morning?
• Does your work or hobby require you to use your hands frequently?
• Have you had any previous hand injuries?
• Are you taking blood thinners such as Aspirin?