Dr. Ebraheim’s educational animated video describes the conditions of trigger finger and trigger thumb.
Trigger finger is a condition where the involved finger will catch as it bends.
The finger is straightened with a pop or a snap. The flexor tendon becomes thick and irritated as it slides through the tendon pulley causing a thickened nodule and triggering of the tendon. The discrepancy between the diameter of the tendon and the size of the pulley opening causes the triggering.
Symptoms
•Pain may be located in the palm at the base of the finger.
•Tenderness at the A1 pulley.
Causes
•Occurs more in women •More in diabetics •Rheumatoid arthritis
•Repetitive injuries •Occupational.
Locking can occur when the tendon is unable to pass through the sheath. As the tendon becomes inflammaed, it gets caught.
Treatment
•Rest •Splinting •Injection into the sheath not the tendon •Injections can be repeated •Surgical release of A1 pulley.
When releasing the A1 pulley, the release should be done at the level of the MP joint.
The A2 and A4 pulleys are important and should not be touched, excised or released.
A1 pulley is cut and the flexor tendon is released.
Technique of injection
•Injection into the flexor sheath may provide relief for triggering of the finger.
•After the site is marked, use a 25gauge needle.
•Advance the needle through the midline down to the bone.
•Pull the needle back slightly and inject the medication freely.
How do you surgically release the A1 pulley?
•The incision is marked on the MP flexion crease.
•The incision is marked out in the palmar crease for surgical division of the A1 pulley.
•The A1 pulley is exposed and released.
•The tendon is released.
•Patient is asked to move the fingers to confirm the success of the operation.
•Incision for trigger thumb release placed in MP flexion crease.
•When releasing the flexor pollicis longus tendon, watch out for the digital radial nerve in the field of surgery.
Sagittal view ultrasound showing the flexor tendon going through the A1 pulley of the finger.
Transverse view ultrasound showing the flexor tendon going through the A1 pulley of the finger.

0:00 Introduction
0:09 TRIGGER FINGER
0:56 Symptoms
3:25 TREATMENT
5:00 TECHNIQUE OF INJECTION
6:45 SURGICAL RELEASE