Houston Methodist. Leading Medicine

Hand FAQ


I am on active duty in Iraq. I have a very tender wrist nodule that is causing a trigger finger. The trigger finger is aggravated by almost everything I do with my hands. They are going to ship me out to have surgery. How soon can I get back with my unit after this type of operation?


Trigger finger is a catching or popping of the tendons as they move the fingers. Usually this problem occurs as the finger is moved toward the palm of the hand. This movement is called flexion. The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone. To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the tendons to glide through the tunnel formed by the pulleys as the hand is closed to grasp objects. Triggering makes it difficult to fully flex the finger. And if the soft tissues get stuck, then you may not be able to relax the hand and open up the fingers. Triggering is usually the result of a thickening in the tendon. Constant irritation from the tendon repeatedly sliding through the pulley causes the tendon to swell in this area. A nodule or knob forms. The pulley ligament may thicken as well. The nodule catches on the pulley causing a popping or catching sensation. Sometimes, a thickening in the band of connective tissue across the back of the wrist is the cause of the problem. This area is called the extensor retinaculum. Even minor changes in the tendon can cause catching of tendon as it tries to glide under the retinaculum. Surgery is usually done using regional anesthesia, which means only the arm is put to sleep. But the surgery can also be done under a general anesthesia in which you go to sleep. This type of surgery could be done in a field hospital such as a mobile army surgical hospital (MASH) unit. But the U.S. Army decommissioned the last MASH unit in 2006. MASH units have now been replaced by U.S. Army's Combat Support Hospitals. It's likely that you will be transferred to this type of facility for the procedure. With any surgery (no matter how simple), there are some risks. There is a slight risk of infection. Decreased motion, instability, and nerve or blood vessel damage can occur. Any of these (or other) complications can delay recovery. However, if everything goes well and there are no complications, you will be able to move your fingers and wrist soon after surgery. Stitches are removed after two weeks. A physical therapist may see you to make sure you can move your wrist normally and perform all of your required duties. This is important to the safety of all the soldiers within your unit. Michael Khazzam, MD, et al. Extensor Tendon Triggering by Impingement on the Extensor Retinaculum: A Report of 5 Cases. In The Journal of Hand Surgery. October 2008. Vol. 33-A. No. 8. Pp. 1397-1400.

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