HISTORY

The trigger finger was first described by Notta in 1850. The first release was performed by Schönborn in 1889. Subsequently, the first annular (A1) pulley release has been described via a transverse, longitudinal, or chevron incision as well as percutaneous techniques.

ETIOLOGY

Triggering of digits occurs secondary to a disproportion of the digital retinacular sheath and contents (flexor tendon and synovial sheath). “Bunching” of tendon fibers is caused by the angular entry of the tendon against the digital retinacular sheath as they enter the A1 pulley; this causes friction and trauma.

INDICATIONS FOR SURGERY

Failure of non-operative treatment, including activity modification, splinting, non-steroidal anti-inflammatory drugs (NSAIDs), and most commonly, corticosteroid injections. Patients may have painful or symptomatic catching, sticking, or triggering of a finger when flexed into the palm, often necessitating release with the contralateral hand. Frequently, a painful mass can be palpated in the palm just proximal to the A1 pulley.

Release of the A1 pulley to relieve symptoms from stenosing tenosynovitis may be done with needle release of the A1 pulley; some clinicians prefer this technique if triggering occurs on command. We prefer an open technique utilizing a small oblique skin incision, which requires minimal anesthesia and has a short postoperative recovery time. Operative equipment is given in Table 31.1.

SURGICAL PREPARATION

1. 
   

   In the preoperative area, identify the correct patient, hand, and finger(s) to be released. Mark the digit or digits to be released with the identifying physician’s initials.

   
   
2. 
   

   Apply cushioned cotton wrap and over this apply an appropriate size upper arm tourniquet to the side to be operated on. Apply a 10/10 drape at the distal skin/tourniquet border.

   
   
3. 
   

   Prep the hand, nails, and forearm with a 5-minute scrub of 2% or 4% chlorhexidine and apply sterile drapes without contamination.

   
   
4. 
   

   Once prepped and draped, again re-identify and confirm the correct patient, hand, and finger(s) to be operated on and confirm with other operating team and operating room staff members.