By Cris Villalonga-Vivoni
Trigger finger, a simple yet painfully debilitating condition, is among the top three most common hand problems treated by Dr. Jacob Jabbour, the hand surgeon at the Hospital of Central Connecticut in New Britain.
Although several treatment options are available, the Hospital of Central Connecticut is now offering patients a minimally invasive surgery providing instant and permanent relief. Created by Sonex Health, the UltraGuideTFR is an ultrasound device that helps Jabbour perform a trigger finger release surgery.
Jabbour has performed more than two dozen UltraGuideTFR procedures since the device became available in January.
"There have been people who have done similar things historically. It's just there hasn't been a device that's been made and designed for [trigger finger] so that [surgery] can be done consistently in a safe way," Jabbour said.
What is it?
Trigger finger is a form of tendinitis that affects the flexor tendons in the fingers and thumb, said Dr. Anthony Parrino, the hand, wrist and elbow surgeon with UCONN Health.
According to the American Academy of Orthopaedic Surgeons, flexor tendons are tight cord-like structures that connect forearm muscles to the bones of the finger, which allows the latter to bend. Each tendon passes through a sheath, a separate tubular structure at the end of each finger. A trigger finger occurs when the bands of tissues along the sheath, called pulleys, become inflamed. As a result, the swelling makes it hard for the flexor tendon to glide smoothly as the finger bends.
The most common pulley involved in trigger finger is the A1 pulley located at the palm-side base on each finger.
Over time, a small nodule can develop on the surface of the flexor tendon, which could also become inflamed. As a result, a painful catching or popping sensation occurs whenever the finger moves. In more severe cases, a person's finger may "lock" into a bent position and needs to be forcefully opened.
"Most people wake up in the morning and their fingers are stuck bent down. It's very painful to open it back up," Parrino said. "Sometimes when they go to grab an object to pick it up and they're bringing their fingers into their palm to do that, the finger will get stuck. That's painful."
The primary cause of trigger finger is unknown, but Parrino said that some chronic conditions, such as diabetes and arthritis, may make someone more prone to trigger finger. He added that many of the patients he treats are older or individuals who overuse their hands, such as weightlifters and gardeners.
Parrino said one to two cortisone injections to the affected finger's tendon sheath is typically the first treatment steps suggested to provide a potentially permanent solution.
He explained that since cortisone is an anti-inflammatory, the injection "basically gets the tendon swelling in the tunnel to come down, which allows the tendon to pass more easily."
The doctor may recommend a trigger finger release surgery if the injections don't reduce the swelling. Parrino said that the hand surgeon makes a small incision on the palm side by the fingers to cut the A1 pulley to release the pressure.
Parrino added that the surgery is performed with local anesthesia, giving the patient a few stitches. Afterward, he asked his patients to move their fingers to ensure no triggering or catching.
According to the American Academy of Orthopedic Surgeons, the surgery doesn't impact the other pulleys in the hand.
"We go down and release that one place. We just opened it up," Parrino said. "It's taking the covering of the roof off of that part of the tunnel so you can't get stuck anymore."
The stitches come out a week later and the scar heals within four to six weeks. There may be typical post-surgery soreness and swelling. Throughout recovery, the patients perform small hand exercises to build strength, such as opening and closing their fists.
"Most patients can just do some home exercises and get back into a normal routine without having to go actually see a hand therapist for dedicated therapy," Parrino said.
Jabbour said he is currently the only hand surgeon offering UltraGuide TRL in Connecticut.
He explained that the device uses ultrasound to locate the tendon, nerves, vessels, pulleys and bones. He said it allows him to visualize better where he's cutting the A1 pulley.
In addition, Jabbour said the procedure takes 10 to 20 minutes per finger and is performed with no general anesthesia.
"With that ultrasound machine, I'm able to see where I'm placing the device, I'm putting it in a safe position and I cut the pulley," he said.
The UltraGuideTFR significantly reduces the size of the incision, Jabbour said. He explained that a traditional trigger finger release requires a half to two-inch incision and stitches to cut the A1 pulley safely. On the other hand, the UltraGuideTFR makes a two to three-millimeter incision, which only needs surgical glue and a bandaid to mend.
Jabbour added that his patients recover faster by making the incision smaller. He explained that most patients could freely move their fingers and grip objects the day after surgery.
For example, one of Jabbour's patients received a traditional trigger-release surgery on their right hand five months ago and reports still feeling pain. Meanwhile, his left hand, which used the UltraGuide TFR, felt significantly better than his other hand in just two weeks.
"My surgery might sound scary, but it is a good solution and it is very safe, " Jabbour said.