David J. Slutsky


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3475 Torrance Blvd., Ste F
Torrance, CA 90503


Appointments: 310.792.1809
Fax: 310.792.1811

Office hours: M-F, 9am – 5 pm

Worker’s compensation, Medicare and most insurance plans accepted.

In September 2008, we will be moving to a beautiful new 4,400 sq ft, state of the art dedicated hand center located at 2808 Columbia Ave in Torrance, CA., which will feature onsite nerve conduction studies, occupational hand therapy and digital x-ray.
 


PROCEDURES

TRIGGER FINGERS

Stenosing tenosynovitis or “triggering” of the thumb or fingers flexor is a common cause of hand pain. As the patient flexes and then attempts to extend the involved digit, painful triggering or snapping occurs. The phenomenon of triggering is due to an acquired constriction of the base of the flexor tendon sheath, which is located at the transverse palmar crease. The most common form of trigger finger is the primary type. Secondary trigger finger can be seen in rheumatoid arthritis, gout, diabetes or other disorders that cause connective tissue changes. Trigger finger often coexists with de Quervain's disease and carpal tunnel syndrome, which are other manifestations of stenosing tenosynovitis in the hand.

Anatomy
The flexor tendon sheath envelops the two finger flexor tendons, starting in the distal palm. The sheath is organized into pulleys or alternating regions of tough annular regions and thin filmy areas crossing the joints. The tendon sheath acts to prevent bowstringing of the flexor tendons during active finger flexion. The edge of the first annular pulley almost exactly coincides with the distal palmar crease in the fourth and fifth rays, which is the transverse crease just before the finger webspace creases, the proximal palmar crease in the index, and halfway between the two creases in the middle finger. The proximal edge of the thumb flexor tendon sheath is directly deep to the metacarpophalangeal joint crease.

Pathophysiology
In triggering, the flexor tendon often develops an adaptive nodule just before the tendon enters the sheath. This nodule has been called Notta's node. It is this node that is responsible for the triggering. Although the flexor tendon sheath is constricted at the metacarpophalangeal (MP) joint i.e. the first knuckle, the patient often localizes the phenomenon incorrectly to the proximal interphalangeal (PIP) joint and misinterprets the problem as a dislocation. This erroneous diagnosis is especially likely to be made by the physician who "reduces" the locked finger by manipulation of the digit into extension. Less common is locking of the digit in extension because the finger or thumb flexor tendon is trapped at a more distant point in the flexor tendon sheath. This may be a reason for recurrence or persistence of the triggering following surgery.

Treatment
Nonoperative treatment such as local injection of steroid into the flexor sheath may cure the condition, especially if the triggering has been present for less than 6 months. Recurrences are frequent, however, and a reliable minor surgical operation will immediately and permanently relieve the condition.
Surgery (link to trigger finger release video)

A 1 cm transverse incision is made in the distal palmar crease in line with the involved finger. The thickened edge of the first annular or A1 pulley, is divided for approximately 5 mm or until the tendon nodule is no longer impinging on the flexor sheath with passive finger extension. Postoperative range of motion exercises are started immediately. Most patients have recovered within 2-4 weeks, at which time a return to usual activities is well tolerated.

Work Considerations
Most people can perform one-handed work activity by the 2nd week followed by light duty including clerical work at 4-6 weeks. Heavy manual labor can often be resumed by 8 -12 weeks.