Doing My Own Carpal Tunnel Surgery (Dr Henry David Nava Dimaano, FPOA)
been doing for our new house. I've been having this numbness -- thumb, index finger, long finger, & the thumb-side half of my ring finger ...
Trigger Finger
Trigger digits are caused by a disproportion in size between the flexor tendons and their retinacular pulley at the level of the metacarpal head (A1 pulley). Flexion of the proximal phalanx at the metacarpophalangeal joint, particularly wit power grip, causes high angular loads at the distal edge of the A1 pulley. Remodelling takes place at this edge leading to hypertrophy, fibrocartilaginous metaplasia and narrowing. Changes in the tendon itself are reactive and not causative and are not addressed in current treatment strategies. Treatment is highly successful unless the patient has underlying problems such as diabetes or rheumatoid diseases. Single trigger digits of less than six months duration in non diabetic patients are treated by steroid injections with a more than seventy percent success rate. The injection technique is demanding and care has to be taken to inject into the sheath and not the tendon. Splinting may be a useful adjunct to steroid injections. Recurrence of symptoms after two injections some weeks apart may be taken as evidence of failure of this strategy. Operative treatment by open division of the A1 pulley under direct vision is close to hundred percent successful, but carries a non zero risk of complications. Injury to the digital nerves is the most feared but probably rarest complication, whereas scar tenderness may be the most frequent and at the same time most recalcitrant. A peculiar variety of trigger finger is congenital trigger thumb, which requires operative release in all instances regardless of the age at diagnosis.