Trigger finger – annular ligament splitting

Overview
Operation: 30-60 minutes
Anesthesia: local anesthesia
Length of stay: outpatient
Suture removal: after 14 days
Healing time: 2 weeks

The so-called trigger finger, also called stenosing tenosynovitis or annular ligament stenosis, is a frequently occurring disease of the hand in which overload and chronic inflammatory processes lead to mechanical tightness of the finger tendons and thus to functional impairment. This narrowing of the tendons manifests itself as an audible click, which can also be painful, and a quick movement of the finger. Those affected not only suffer from the pain, but often cannot even perform simple activities because the finger continues to bend and, in the worst case, remain in this position. There are several ways to conservatively treat a trigger finger, but these are usually not permanent. During an operation, Dr. Matiasek will rid you of your suffering in the long term.

What are the causes of trigger finger?

The exact causes and mechanisms of a trigger finger often remain unknown. Usually it is a combination of chronic overload and genetic predisposition, which favors stenosing tenosynovitis. Basically, the trigger finger is created when the flexor tendon of the affected finger undergoes a thickening. The flexor tendons lie on the knuckles and are connected to the bony structures by the so-called ring ligaments. They can slide underneath these annular ligaments when the fingers move. However, this sliding mechanism is impaired when the tendon structures thicken and the surrounding tissue swells, which leads to symptoms.

It is assumed that either overstressing the fingers or small injuries lead to inflammatory processes on the tendons and then cause them to thicken. People who put a lot of strain on their hands and fingers at work or in everyday life are particularly affected, such as athletes, piano players, craftsmen, but also more and more people who work and type on the computer for several hours a day. The female gender is more likely to be affected, women are around five times more likely to get a trigger finger than men.

What are the symptoms of trigger finger?

The typical symptoms result from the deterioration in the mechanical gliding ability of the tendons through the annular ligaments. The thickened tendon blocks the finger tendon, which means that both flexion and extension are only possible with increased effort or even with the help of the other hand. The tendon then snaps in the desired direction with a jerk, which also gives the expression of the trigger finger or snapping finger. In addition to the typical restriction of movement and the snapping mechanics of the finger, there may be a reduction in the exertion of force, a feeling of tension and typical pain that is triggered by overcoming the blockage. In addition, the constant friction of the tendon causes additional irritation through the narrowed annular ligament canal, which in the long term intensifies the pain and worsens the inflammatory changes in the tendon. Many patients not only find the pain of a trigger finger stressful, but also suffer above all from their somewhat restricted everyday life.

What do I have to consider before treating trigger finger?

Before surgical treatment is undertaken, conservative methods should first be tried to see whether the symptoms improve without surgical intervention. Relieving measures, immobilization, anti-inflammatory and pain-relieving ointments and creams, physiotherapeutic exercises or local injections are used, which promise relief especially in the early stages of the disease. However, if the damaging stress on the finger is continued, the symptoms can still recur.

Before Dr. Matiasek plans a surgical intervention of the so-called annular ligament splitting, he will collect your medical history, exact symptoms and previous treatment attempts in a detailed conversation. First you describe your symptoms, describe the course of your illness and inform Dr. Matiasek on previous attempts at therapy. If there has been no improvement through conservative therapies, surgical splitting of the annular ligament is recommended as soon as possible in order to prevent further worsening of symptoms or serious loss of movement. The decision for a surgical procedure is not made by Dr. Matiasek alone, you create an individual treatment plan together.

During our consultation, you will be informed about all the important aspects and treatment steps involved in splitting the annular ligament. If you have any questions, please ask them during your consultation. It is of great importance to Dr. Matiasek that his patients are optimally prepared for the procedure and fully informed. Since the annular ligament is split under local anesthesia, no special precautionary measures need to be observed with regard to anesthesia. However, since it is still a surgical procedure, you should avoid blood-thinning medication such as aspirin about two weeks before your surgery appointment. If you are taking sleeping pills, please also stop taking them 14 days before the procedure. You should also reduce or completely limit your alcohol and nicotine consumption during this time.

How does annular ligament splitting work?

The annular ligament is a short procedure that is performed under local anesthesia. With a cross-section along the skin folds of the finger joints, the skin is incised and the annular ligament and the thickened tendon are located and exposed in order to get an optimal view of them. The annular ligament is cut and any excess or scarred tissue around the tendon is removed. When the tendon is sufficiently slidable again, the wound is closed and sutured again.

What complications can occur with annular ligament splitting?

The splitting of the annular ligament is basically a low-risk intervention. Nevertheless, general surgical risks such as bleeding, infections or injuries to important surrounding structures such as nerves cannot be completely ruled out. If a nerve is damaged, permanent numbness can result.

What do I have to consider after annular ligament splitting?

Since annular ligament splitting is a relatively short procedure and is performed under local anesthesia, you can go home after a few hours. As soon as the anesthesia has subsided, the fingers can and should be moved again in a targeted and controlled manner. Before discharge, you will be shown movement exercises that train the mobility of the fingers and avoid the formation of adhesions or scarring.

As soon as the anesthesia wears off, you may experience slight pain at the surgical site. For this purpose, adequate pain medication is prescribed before discharge, which can be taken, if necessary, in the first few days after the procedure. Directly after the operation, it is recommended to wear a bandage and to cool the wound regularly. Showering and brief washing of the affected hand with clear water is allowed, but the wound should be kept dry in order to prevent wound healing disorders and delays. The sutures are removed after 14 days, the healing period is usually completed after six to eight weeks, at which point the hand can also be fully loaded again.

What is the prognosis for trigger finger?

The prognosis of an operative treatment of trigger finger by splitting the annular ligament is very good overall, most of the time complete mobility and functionality of the finger can be restored, disturbing symptoms such as the snapping sensation and pain can disappear completely. With conservative treatments, symptoms often recur, which is why patients are usually advised to undergo surgery in order to permanently improve their well-being.
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Trigger finger is a common symptom of chronic overstrain and improper strain on the hands and is associated with an uncomfortable feeling of tension and pain. In many cases, conservative therapeutic approaches and physiotherapy only bring about short-term improvement, so that surgical splitting of the annular ligament is the only effective and permanent solution.

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