Go Ahead, Make My Trigger Finger Better
If Clint Eastwood had a trigger digit, his adversaries might have avoided his smoking gun. A trigger digit refers to a finger or thumb joint that gets locked in a bent position. When this occurs, the other hand is needed to reach over, grab it, and unlock and straighten it.

Trigger digits mostly occur where the finger or thumb tendon crosses the palm in front of the main knuckle. When the digit bends, the tendon normally slides easily back and forth through a small sheath, called the tendon pulley. A nodule forms where the tendon or its covering swells. The inflamed nodule goes through the pulley when the digit is bent but gets stuck on the other side, causing the finger or thumb to lock in a bent position.

Doctors may treat the trigger by injecting cortisone into the nodule. By reducing the size of the nodule, the digit can bend and straighten freely. Unfortunately, in two of every three cases, the nodule will return again within one year.

Surgery may be required to release the tendon pulley. This keeps the nodule from getting stuck when the finger or thumb is bent. Surgeons have used an "open" technique with good results. This involves making a large incision just over the tendon pulley. The open method allows doctors to see inside to cut the tendon pulley.

A newer way to release the tendon pulley is to use a percutaneous (across the skin) method. Eastwood (not Clint) first described this technique in 1992. The doctor simply inserts a needle through the skin, just under the tendon pulley. By twisting the needle, the tendon pulley is cut, and the nodule is free to move. The challenge with this surgery is the surgeon is unable to see the tendon pulley. Until now, no studies have compared the results of the open and percutaneous forms of surgery for this condition.

One hundred trigger digits were surgically treated. Just under half (46) were treated with the open method; the others were treated percutaneously. Surgery time was markedly longer using the open method. By comparison, people got quicker results when treated with the percutaneous method. Their pain went away almost twice as fast, and they got back to work within four days, compared to nearly eight in the open group.

Along with its cost effectiveness (the price of a disposable needle), these authors conclude that "when surgery is indicated, the percutaneous method is a quicker procedure with significantly better results in rehabilitation."
E. C. A. M. Gilberts, MD, et al. Prospective Randomized Trial of Open Versus Percutaneous Surgery for Trigger Digits. In The Journal of Hand Surgery. May 2001. Vol. 26A. No. 3. Pp. 497-500.