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Trigger Finger

Trigger Finger Surgery Dallas

Dallas Plastic and Hand Surgeons Dr. David and Solomon Azouz review Trigger Finger: symptoms, surgical, non-surgical treatment, cost, insurance, and recovery.

What is a Trigger Finger or Trigger Thumb?

Trigger finger surgery restores a trigger thumb or known also as Stenosing Tenosynovitis, which is a painful condition that causes pain, stiffness, and a sensation of locking when you move your finger or thumb.

The flexor tendons are long cord-like structures that attach the muscles of the forearm to the bones of the fingers. When the muscles contract, the flexor tendons allow the fingers to bend.

Each of the flexor tendons passes through a tunnel in the palm and fingers that allows it to glide smoothly as the knuckle bends and straightens. This tunnel is called the “tendon sheath.”

Along the tendon sheath, bands of tissue called “pulleys” hold the flexor tendons tightly to the finger bones. The tendons pass through the pulleys as the finger moves. The pulley at the base of the finger is called the first annular pulley or “A1 pulley,”.

Trigger Fingers occur when the tendon becomes inflamed or thickened, which makes it difficult for the flexor tendon to glide through the A1 pulley as the finger bends. When the finger flexes and the nodule passes through the pulley, there is a painful sensation of catching or popping.

In a severe case of a trigger finger, the finger locks and becomes stuck in a bent position. Sometimes the patient must use his or her other hand to straighten the finger.

Causes for Trigger Finger

While the causes of the trigger finger are not well known, several factors may increase your risk of developing the condition. These include:

  • Medical conditions: Trigger finger is more common in people with certain medical conditions, such as diabetes and rheumatoid arthritis.
  • Forceful hand activities: The condition is known to occur after the forceful use of the fingers and thumb.
  • Some patients have a congenital trigger finger or thumb. This means that as a child or infant, they develop a trigger finger.
  • Acute inflammatory conditions: An acute injury such as a work injury or surgery can cause an inflammatory process that leads to scarring or inflammation, causing a trigger finger or thumb.

Trigger Finger Symptoms

Symptoms of the trigger finger often start slowly but can also occur after an injury, surgery or trauma (work injury). They may follow a period of heavy or extensive hand use, particularly pinching and grasping activities.​

Symptoms of trigger finger include:

  • A tender lump at the base of the finger on the palm side of the hand
  • A popping or clicking sensation as you move your finger
  • Hand pain when you bend or straighten the finger
  • Finger stiffness, particularly in the morning
  • Finger catching or locking in a bent position, which suddenly pops straight
  • In a severe case, the involved finger may become locked in a bent position.

Surgical treatment is definitive as it changes the anatomy causing the locking and triggering:

  • Patients are candidates for surgery when they have failed medical management, have locking of the finger, have a mass, or if they are having significant pain and choose to have definitive management with surgery. Surgery is elective and is done on an outpatient basis. The surgical procedure for the trigger finger is called “tenolysis” or “trigger finger release” and is done by releasing the first annular pulley.
  • Releasing the A1 pulley removes the barrier that is blocking tendon movement so the flexor tendon can glide smoothly through the tendon sheath. The first annular pulley is not a required pulley, with the fingers and thumb functioning normally without it. Dr. Azouz places the incision in a crease of the hand with an anesthetic block that numbs the upper extremity. The incision in the palm is small, and many patients report being unable to see the incision line after it heals. Patients are then placed in a specialized splint, and their hand is elevated.

Recovery after trigger finger surgery

Dr. Azouz utilizes multiple methods to minimize pain, swelling, and bruising after a trigger finger release. Dr. Azouz utilizes both local and regional blocks to numb the hand after surgery. The block can last for up to 24 hours after surgery, and while active most patients do not report any pain. The hand is placed in a specialized splint and elevation pillow to minimize bruising and swelling.

Although the incision will heal within a few weeks, some patients will require hand therapy to further assist with swelling and stiffness.

Outcomes after trigger finger release

Patients often report significant improvement in function as well as relief from the pain of a trigger finger. Some patients have concomitant problems such as osteoarthritis, carpal tunnel syndrome, or triggering of other digits. Dr. Azouz usually recommends treating the most painful and motion-limiting problems first, as it is not usually possible to treat multiple hand problems with one surgery. Dr. Azouz can release multiple trigger fingers in one day but does not recommend treating both hands as this can limit self-care in the recovery period.

Trigger Finger Surgery Frequently Asked Questions

How Much Dose Trigger Finger Surgery Cost?

Trigger finger surgery costs can widely vary. Dr. Azouz will determine the cost of surgery through a medical history and physical examination. Insurance companies often consider trigger finger surgery medically necessary. Cash pay prices are often available for patients who do not have insurance.  Worker’s compensation carriers will generally approve surgery when it is medically necessary and compensable with an at work injury.

Dr. David Azouz has patients from throughout the Dallas,Fort Worth area including Plano South Lake, and other surrounding neighborhoods. Patients also fly not only from all over Texas including Midland, Odessa, Houston, Austin, but also all over the world to be cared for by plastic surgeon Dr. David Azouz.

What are the Nonsurgical Options for Trigger Finger?

Medical Management is possible for early cases of trigger finger which include:

​Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve) — may relieve the pain but are unlikely to ease the swelling constricting the tendon sheath or trapping the tendon.

Rest. Avoid activities that require repetitive gripping, repeated grasping, or the prolonged use of vibrating hand-held machinery until your symptoms improve. Certain professions including dentists, oral surgeons and woodworkers are more likely to develop trigger fingers.

Steroid injections may assist in reducing the inflammation from a trigger finger. Steroid injections do pose a risk of tendon rupture when multiple injections are performed. Patients with a palpable mass, locking of the finger or who have had inflammation for a long time are not as likely to benefit from conservative methods such as an injection.

Where does Dr. Azouz Operate?

Dr. Azouz has privileges at a variety of hospitals and emergency rooms throughout the DFW metroplex including Dallas, Fort Worth, Richardson, Plano, Flower Mound, Addison. Patients frequently travel to see Dr. Azouz from Frisco, Allen, Mckinney, Arlington and Rockwall. It is not uncommon for patients to even travel from across Texas including East Texas (Tyler, longview), West Texas (Midland, Odessa) and central Texas (Waco, Austin) to see Dr. Azouz.

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