Ultrasound-Guided Cortisone Injections for Trigger Finger/Thumb

 At Alton Pain Clinic, we understand the challenges posed by Trigger Finger and Trigger Thumb. These conditions can impact your ability to perform daily tasks, causing discomfort and limiting hand mobility. This detailed blog explores the condition, from its introduction and underlying causes to the potential benefits of ultrasound-guided cortisone injections as a management option.

Introduction to Trigger Finger and Trigger Thumb

Trigger Finger, medically termed stenosing tenosynovitis, and Trigger Thumb occur when a finger or thumb becomes stuck in a bent position and may snap straight suddenly, like pulling a trigger. This condition results from inflammation in the tendon sheaths, which hinders smooth tendon movement.

Although the condition can affect any finger, the thumb, middle finger, and ring finger are most commonly impacted. Trigger Finger is especially prevalent among individuals who perform repetitive gripping motions, those with certain health conditions such as diabetes or rheumatoid arthritis, and those in their 40s to 60s.

Anatomy of the Fingers and Thumb

To understand Trigger Finger and Thumb, it is essential to grasp the anatomy of the fingers and their associated tendons:

Tendons and Pulley System

  • Flexor Tendons: These cord-like structures connect the muscles of the forearm to the bones of the fingers and thumb, enabling bending movements.
  • Pulley System: A series of fibrous sheaths called pulleys hold the tendons close to the bones. This arrangement minimises bowstringing and allows smooth, controlled finger movement.
  • A1 Pulley: Located at the base of each finger and thumb, the A1 pulley is the most commonly affected site in Trigger Finger/Thumb.

Pathology of Trigger Finger and Thumb

The condition develops due to the following processes:

  1. Inflammation: Repetitive motion or underlying conditions can cause irritation and swelling in the tendon sheath.
  2. Nodule Formation: Persistent inflammation may lead to the development of a small lump or nodule on the tendon, further restricting smooth movement.
  3. Stenosis: Narrowing of the tendon sheath results in difficulty as the tendon attempts to pass through the constricted area.
  4. Locking and Catching: As the tendon struggles to glide smoothly, fingers or thumbs may become locked in a bent position before snapping back into place.

Symptoms of Trigger Finger and Thumb

Common symptoms include:

  • Pain and tenderness at the base of the affected finger or thumb.
  • A clicking or snapping sensation when attempting to move the finger.
  • Finger stiffness, especially in the morning.
  • A visible lump near the affected joint.
  • Locking of the finger or thumb in a bent or straight position.

Causes and Risk Factors

While the precise cause of Trigger Finger is not always identifiable, the condition is often associated with:

  • Repetitive Use: Activities involving repeated gripping, such as gardening or typing, can strain the tendon.
  • Medical Conditions: Diabetes, gout, and rheumatoid arthritis are linked to increased susceptibility.
  • Gender and Age: Women and individuals aged 40 to 60 are at higher risk.

Diagnosis of Trigger Finger and Thumb

Diagnosis typically involves:

  • Medical History: A thorough review of symptoms and risk factors.
  • Physical Examination: Palpation of the affected area may reveal tenderness, swelling, or a nodule.
  • Dynamic Testing: Observation of finger movement to identify clicking, locking, or snapping.

Ultrasound imaging may also be used to assess tendon and pulley abnormalities in detail.

Management of Trigger Finger and Thumb

Management strategies depend on the severity of the condition:

Non-Surgical Options

  1. Rest and Activity Modification: Reducing repetitive motions may alleviate symptoms.
  2. Splinting: Immobilising the finger or thumb can minimise strain on the tendon.
  3. Physiotherapy: Strengthening and stretching exercises may improve mobility.

Medical Interventions

  • Cortisone Injections: Administered under ultrasound guidance, cortisone injections aim to reduce inflammation within the tendon sheath.
  • Pain Relief: Non-steroidal anti-inflammatory drugs (NSAIDs) may offer temporary relief.

Surgical Intervention

In severe cases, a surgical procedure to release the A1 pulley may be considered.

Ultrasound-Guided Cortisone Injections

At Alton Pain Clinic, we utilise advanced ultrasound technology to ensure precise delivery of cortisone injections for Trigger Finger and Thumb. This approach offers enhanced accuracy compared to blind injections.

Benefits of Ultrasound-Guided Cortisone Injections

  • Improved Precision: Ultrasound guidance allows the clinician to target the exact site of inflammation.
  • Minimised Risk: Reduces the likelihood of complications by avoiding surrounding structures.
  • Non-Invasive: Provides an effective alternative to surgery in many cases.

Mechanism of Action of Cortisone

Cortisone is a corticosteroid that works by:

  1. Reducing Inflammation: Inhibits the release of inflammatory mediators within the tendon sheath.
  2. Decreasing Swelling: Alleviates the pressure within the pulley system, allowing smoother tendon movement.
  3. Relieving Pain: Interrupts the inflammatory process, reducing discomfort.

The effects of cortisone injections are typically noticeable within a few days to a week and may last several weeks or months.

Why Choose Alton Pain Clinic?

At Alton Pain Clinic, we prioritise patient care and precision. Our specialists employ state-of-the-art ultrasound technology to deliver tailored treatments. With a commitment to excellence, we aim to provide a seamless experience from consultation to recovery.

Conclusion

Trigger Finger and Thumb can significantly affect hand function and quality of life. Ultrasound-guided cortisone injections offer a precise, minimally invasive management option tailored to individual needs. At Alton Pain Clinic, we combine expertise with advanced technology to ensure optimal care. For those seeking relief from Trigger Finger or Thumb, consider booking a consultation with us.

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