-------------------------------1089656885
TRIGGER FINGER
Introduction
The tendons that bend your fingers run through a tunnel or sheath. Trigger
finger is caused by a thickening on the tendon catching as it runs in and out
of the sheath. The most common cause is _tenosynovitis_
(http://www.pncl.co.uk/~belcher/tenosyn.htm) . You can often feel this swelling in the palm as you
move the finger. The system is very similar to bicycle brake cable. If the
wire becomes bent or rusty, the brakes work badly. There are two ways of
treating the problem.
(http://www.pncl.co.uk/~belcher/trigger2.html) Click on the video icon to
see a clinical example (440 Kbyte file)
Steroid injection
A small amount of steroid is injected around the tendon. This flattens out
the swelling on the tendon allowing it to glide freely in and out of the sheath
once more. A single injection is all that is needed in 50% of cases. A
further 25% will respond to another injection (i.e. three-quarters of cases can be
successfully treated in this way). The steroid injection does not work
immediately. It causes no general side-effects but occasionally the skin around
the injection-site can be made a little thinner. Therefore two injections are
the maximum.
Surgery
This is needed if the steroid injections do not work. It involves a small
procedure under local anaesthetic. A slit is made in the mouth of the sheath to
prevent the tendon catching at this point.
The condition can occur in any finger and therefore the triggering may return
in the affected or other fingers. This is, however, very unusual if you have
had surgery.
Post-operative care
Local anaesthetic will be injected around the site of operation and therefore
this area and the nearby fingers will remain numb for up to ten hours after
surgery. As this effect wears off, it may well be worth taking some pain
killers.
Hand elevation is important to prevent swelling and stiffness of the fingers.
Please remember not to walk with your hand dangling, or to sit with your
hand held in your lap. Hand movement should be continued and you should perform
normal light activities after the operation.
You will be discharged with a bulky dressing, consisting of gauze, wool and a
crepe bandage. Please remove the entire dressing after 72 hours and inspect
the wound. There obviously will be some swelling and bruising. Look out for
any redness or tenderness in the area around the wound which might indicate an
infection. Do not apply antiseptic. Please contact my secretary if you have
any worries.
At this stage it is safe to get the hand wet in a bath or shower. The wound
and the surrounding skin often become very dry and will be more comfortable if
a moisturizer is applied, including the wound itself (eg. E45 and Diprobase
Creams).
You can drive a car after 1 week as long as you are comfortable and have
regained full finger movements. Your stitches will be removed about 2 weeks
after the operation. Timing of your return to work is variable according to your
occupation and you should discuss this.
Complications
* Infection Any operation can be followed by infection and this would
be treated with antibiotics.
* Scar You will have a scar on the palm. This will be somewhat firm to
touch and tender for 6-8 weeks. This can be helped by massaging the area
firmly with the moisturizing cream.
* Stiffness About 5% (1 in 20) of people are sensitive to hand surgery
and their hand may become swollen, painful and stiff after any operation
(algodystrophy). This problem cannot be predicted but will be watched for
afterwards and treated with physiotherapy.
* Nerve The nerves running to the fingers can be damaged during the
surgery and cause numbness in part of the finger. This complication is very
rare and the nerve would be repaired immediately.
(http://www.pncl.co.uk/~belcher/operations/Trigger%20finger.pdf) Operative
series
-------------------------------1089656885
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<DIV>
<H2>
<CENTER>TRIGGER FINGER</CENTER></H2>
<H3>Introduction</H3>
<P>The tendons that bend your fingers run through a tunnel or sheath. Trigge=
r=20
finger is caused by a thickening on the tendon catching as it runs in and ou=
t of=20
the sheath. The most common cause is <A=20
href=3D"http://www.pncl.co.uk/~belcher/tenosyn.htm">tenosynovitis</A>. You c=
an=20
often feel this swelling in the palm as you move the finger. The system is v=
ery=20
similar to bicycle brake cable. If the wire becomes bent or rusty, the brake=
s=20
work badly. There are two ways of treating the problem.</P>
<P>
<CENTER><IMG height=3D175 src=3D"http://www.pncl.co.uk/~belcher/images/trigg=
ery.gif"=20
width=3D250 align=3Dbottom border=3D5 NATURALSIZEFLAG=3D"0"></CENTER>
<P></P>
<P>
<CENTER><A href=3D"http://www.pncl.co.uk/~belcher/trigger2.html"><INPUT type=
=3Dimage=20
height=3D100 width=3D100 src=3D"http://www.pncl.co.uk/~belcher/images/video.=
gif"=20
align=3Dbottom border=3D0 NATURALSIZEFLAG=3D"3"></A></CENTER>
<P></P>
<P>
<CENTER>Click on the video icon to see a clinical example (440 Kbyte=20
file)</CENTER>
<P></P>
<H3>Steroid injection</H3>
<P>A small amount of steroid is injected around the tendon. This flattens ou=
t=20
the swelling on the tendon allowing it to glide freely in and out of the she=
ath=20
once more. A single injection is all that is needed in 50% of cases. A furth=
er=20
25% will respond to another injection (i.e. three-quarters of cases can be=20
successfully treated in this way). The steroid injection does not work=20
immediately. It causes no general side-effects but occasionally the skin aro=
und=20
the injection-site can be made a little thinner. Therefore two injections ar=
e=20
the maximum.</P>
<P>
<CENTER><IMG height=3D175 src=3D"http://www.pncl.co.uk/~belcher/images/stero=
idy.gif"=20
width=3D250 align=3Dbottom border=3D5 NATURALSIZEFLAG=3D"0"></CENTER>
<P></P>
<H3>Surgery</H3>
<P>This is needed if the steroid injections do not work. It involves a small=
=20
procedure under local anaesthetic. A slit is made in the mouth of the sheath=
to=20
prevent the tendon catching at this point.</P>
<P>The condition can occur in any finger and therefore the triggering may re=
turn=20
in the affected or other fingers. This is, however, very unusual if you have=
had=20
surgery.</P>
<P>
<CENTER><IMG height=3D175 src=3D"http://www.pncl.co.uk/~belcher/images/trigs=
urg.gif"=20
width=3D250 align=3Dbottom border=3D5 NATURALSIZEFLAG=3D"0"></CENTER>
<P></P>
<H3>Post-operative care</H3>
<P>Local anaesthetic will be injected around the site of operation and there=
fore=20
this area and the nearby fingers will remain numb for up to ten hours after=20
surgery. As this effect wears off, it may well be worth taking some pain=20
killers.</P>
<P>Hand elevation is important to prevent swelling and stiffness of the fing=
ers.=20
Please remember not to walk with your hand dangling, or to sit with your han=
d=20
held in your lap. Hand movement should be continued and you should perform=20
normal light activities after the operation.</P>
<P>You will be discharged with a bulky dressing, consisting of gauze, wool a=
nd a=20
crepe bandage. Please remove the entire dressing after 72 hours and inspect=20=
the=20
wound. There obviously will be some swelling and bruising. Look out for any=20
redness or tenderness in the area around the wound which might indicate an=20
infection. Do not apply antiseptic. Please contact my secretary if you have=20=
any=20
worries.</P>
<P>At this stage it is safe to get the hand wet in a bath or shower. The wou=
nd=20
and the surrounding skin often become very dry and will be more comfortable=20=
if a=20
moisturizer is applied, including the wound itself (eg. E45 and Diprobase=20
Creams).</P>
<P>You can drive a car after 1 week as long as you are comfortable and have=20
regained full finger movements. Your stitches will be removed about 2 weeks=20
after the operation. Timing of your return to work is variable according to=20=
your=20
occupation and you should discuss this.</P>
<P> </P>
<H3>Complications</H3>
<UL>
<LI><STRONG>Infection</STRONG> Any operation can be followed by infection=20=
and=20
this would be treated with antibiotics.=20
<LI><STRONG>Scar</STRONG> You will have a scar on the palm. This will be=20
somewhat firm to touch and tender for 6-8 weeks. This can be helped by=20
massaging the area firmly with the moisturizing cream.=20
<LI><STRONG>Stiffness</STRONG> About 5% (1 in 20) of people are sensitive=20=
to=20
hand surgery and their hand may become swollen, painful and stiff after an=
y=20
operation (algodystrophy). This problem cannot be predicted but will be=20
watched for afterwards and treated with physiotherapy.=20
<LI><STRONG>Nerve</STRONG> The nerves running to the fingers can be damage=
d=20
during the surgery and cause numbness in part of the finger. This complica=
tion=20
is very rare and the nerve would be repaired immediately. </LI></UL>
<P><A href=3D"http://www.pncl.co.uk/~belcher/operations/Trigger%20finger.pdf=
"><IMG=20
height=3D30 src=3D"http://www.pncl.co.uk/~belcher/buttons/b-acrobat.gif" wid=
th=3D30=20
align=3DabsMiddle border=3D0 NATURALSIZEFLAG=3D"3"></A><B><FONT=20
color=3D#ff0000>Operative series</FONT></B> </P></DIV></FONT></BODY></HTML>
-------------------------------1089656885--
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