What are preoperative considerations for trigger finger (TF)?

Updated: Apr 26, 2021
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
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Answer

Preoperative considerations include the following:

  • Only digits that actively trigger must be considered for operative release
  • Neither PIP contracture nor thumb triggering is suitable for percutaneous release, and the A1 pulley always is transected under direct vision
  • Patients with PIP joint contractures undergo a period of hand therapy and splinting prior to the procedure
  • A tourniquet always is used to obtain a clean operative field
  • Approximately 4-5 mL of 1% lignocaine is used to infiltrate the skin overlying the A1 pulley, with injection performed deeper to the tendon sheath
  • The transverse incision is marked with a skin marker corresponding to the digit to be surgically treated (see the image below)
  • The proximal edge of the A1 pulley coincides almost exactly with the distal palmar crease in the fourth and fifth rays, with the proximal palmar crease in the index and with the halfway point between the two creases in the middle finger
Incision marked out in distal palmar crease for su Incision marked out in distal palmar crease for surgical division of A1 pulley.

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