Release of trigger finger

Primary trigger finger is commonly seen in healthy middle-aged women with a frequency two times that of men.
Commonly affected sites are the thumb and middle and ring fingers.
Secondary trigger finger is often seen in patients with diabetes, rheumatoid arthritis (RA), chronic kidney disease, and other metabolic or autoimmune diseases. These patients may be less responsive to nonoperative treatment compared with patients with primary trigger finger.

Indications

Trigger finger release is recommended for patients who do not respond to one or two steroid injections.
An indication is demonstrable catching with a fixed flexion contracture of the proximal interphalangeal (PIP) joint.
Another indication involves children with persistent congenital trigger thumb/finger. See Chapter 105 for the treatment of pediatric trigger digits.

The phenomenon of trigger finger is a mechanical impingement of the often-enlarged flexor tendons as they pass through a stenotic pulley at the level of the metacarpophalangeal (MCP) joint.
The patient often complains of tenderness and a palpable nodule over the A1 pulley.
The PIP joint may also become sore as the central slip strains to extend the finger against the triggering flexor tendon.
The patient sometimes experiences a locked finger/thumb as symptoms become worse. This should be distinguished, however, from MCP joint locking from collateral ligament injury or sesamoid or osteophyte entrapment, which are less common than trigger finger.
Patients with RA may have snapping phenomenon, which can be confused with trigger digits, and is often related to flexor tendon synovial inflammation at the carpal tunnel or early swan-neck deformity as the hyperextended PIP joint pops when reduced in flexion.

Radiographs are rarely necessary.
Ultrasound examination is rarely needed but may be useful to estimate the degree of tendon/pulley thickness or to guide injection within the tendon sheath.

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