New Minimally Invasive Trigger Finger Surgery

Pess and his resident, Michael Dunn, MD, have also developed a minimally invasive surgical technique to treat a syndrome called trigger finger, trigger digit, or, in medical journals, stenosing tenosynovitis. The anatomy behind the condition is as follows: The tendons that move along the fingers are held in place on the bones by a series of ligaments called pulleys. The ligaments form an arch on top of the bone that creates a sort of tunnel through which the tendon glides. The tendons are wrapped in a slippery coating called tenosynovium, which reduces the friction and allows the flexor tendons to glide through the tunnel as the hand is used to grasp objects. Trigger finger is caused when the tendons that move along the fingers thicken to form a nodule. This may also cause a thickening of the pulley ligament as well. This swelling constricts smooth gliding of the pulley tendons, affecting the movement that allows the fingers or thumb to move toward the palm of the hand.

Usually examination of the trigger finger or thumb reveals the condition without tests or radiography. Causes may include rheumatoid arthritis, repetitive use of certain power tools or musical instruments, long hours of grasping a steering wheel, and congenital defects, although frequently the cause is unknown. New Minimally Invasive Trigger Finger Surgery The standard open technique involves making either a longitudinal or transverse incision in the palm, and releasing the pulley that is obstructing the tunnel and preventing the tendon from sliding smoothly.

Using the Pess-Dunn method involves insertion of a small knife, the Trigger Release Tome, which the two surgeons invented, through a small incision (about 3 mm) and releasing the pulley tendon. Another percutaneous technique employs a similar procedure using a needle that is rubbed back and forth until the pulley releases. In a study published in the Journal of Hand Surgery, Pess and Dunn compared their knife to the needle procedure and found that the latter tends to cause tendon damage, while the knife they designed does not. Pess has been using this technique for about 2 years and has performed about 200 operations, he says. Pess and Dunn are currently submitting for publication a clinical study of the success of their knife in the first 200 patients.