WHAT IS A TRIGGER FINGER?
Trigger finger is a common condition in patients who do repetitive gripping or flexing of their fingers and hand. The tendons that flex the fingers run under a ligament, the A1 pulley, which keeps the tendons in place. In some cases, the tendons can get swollen from inflammation and develop a nodule that starts catching and popping under the ligament. In severe cases, the tendon can get so swollen that it will get stuck and will not bend the finger anymore.
WHAT ARE CONSERVATIVE TREATMENTS FOR A TRIGGER FINGER?
Frequently, the patient is offered a course of hand therapy to try to restore the full range of motion of the finger. In addition, anti-inflammatory medications and a steroid injection may be offered to treat the pain and inflammation. Finger splints may also be offered to allow the tendon to rest.
IS THERE A “PERMANENT FIX” OR A SURGICAL OPTION FOR A TRIGGER FINGER?
For many years, the “permanent fix” was surgery through an open incision followed by a release of the A1 pulley so it would heal in a stretched position and take the pressure of from the finger, allowing the finger to bend again without getting stuck. However, an open release requires wound care, removing stitches a week after the procedure, risk of infection, and prolonged return to work due to the wound healing, up to 4 weeks for full gripping. There is also potential for complications from the surgical healing, including pain and thick scar tissue formation.
Now, there is a minimally invasive technique to do the same release that does not require a surgical incision. It is called a Percutaneous Trigger Finger Release Under Ultrasound Guidance. This procedure consists of injecting lidocaine locally to numb the area and releasing the A1 pulley with a needle under live ultrasound imaging. There is no incision with a scalpel so the recovery is much quicker with a much lower risk of infection. The patient can immediately bend the finger again afterwards. The patient will keep a band aid over the area for only 24 hours and does not have to worry about getting stitches removed.
In 3 days, the patient can resume light gripping, and can return to full gripping as soon as in ten days. Pain and scar tissue formation are minimal since the skin is not cut open. In addition, this procedure is cheaper than open surgery since it is done in the office and does not require paying for surgery center fees.
Ricardo E. Colberg, MD
Non-Surgical Sports Medicine & Orthopaedic Physician
Ricardo E. Colberg, MD is a non-surgical sports medicine and orthopedic physician at Andrews Sports Medicine & Orthopaedic Center.
He is a Diplomate of the American Board of Physical Medicine & Rehabilitation and Registered Musculoskeletal Sonographer. He treats patients out of our Birmingham and Pelham clinic locations.
Dr. Colberg has a strong commitment to providing evidenced-based medical care through a patient-centered and holistic approach. When defining the best treatment plan for each patient, he takes into consideration all the components related to the injury, including the underlying biomechanics of the injury, the patient's needs and expectations, as well as the short and long-term implications that the injury will have on the patient.
He works closely with physical therapists and other health-related disciplines in order to assist patients in their recovery process from injuries and help them reach their ultimate goal of returning to their everyday activities and sports at their optimal potential.
Dr. Colberg has a special interest in treating acute and chronic musculoskeletal injuries, including bone, joint, ligament, muscle and tendon injuries. He performs various treatment modalities in the clinic that assist the patient in their recovery from the injury, among them diagnostic musculoskeletal sonography, ultrasound-guided injections, regenerative medicine injections, and advanced ultrasound-guided procedures such as the percutaneous trigger finger release and De Quervain release.
His areas of expertise also include non-surgical management of fractures and dislocations, peripheral nerve injuries (e.g. carpal tunnel syndrome), sport-related spine injuries, pediatric sports injuries, biomechanical evaluation of the injured athlete, implementing sports injury prevention protocols, management of osteoarthritis and screening for cases that may have a better outcome by undergoing a surgical procedure.
Dr. Colberg serves as attending physician for the American Sports Medicine Institute (ASMI) Primary Care Sports Medicine Fellowship Program. He is the Course Director for the ASMI Musculoskeletal Ultrasound Course and Cadaver Workshop, and is faculty for many other ultrasound and regenerative medicine courses around the nation.
He has extensive clinical research experience, including co-leading a national multi-center study on platelet-rich plasma injection and publishing protocols for performing ultrasound-guided trigger finger release and De Quervain release using the Nokor needle. He has published dozens of articles in multiple journals and authored chapters in academic textbooks.
Dr. Colberg is the head team physician for Helena High School, Indian Springs School, and Montevallo High School. He has served as medical director for Jacksonville State University Gamecocks, and team physician for the U.S.A. Paralympic Team, the Alabama Soccer Association's Olympic Development Program, the University of Alabama at Tuscaloosa, Birmingham Barons, Alabama Ballet, and University of West Alabama.
Dr. Colberg is an avid tennis player who competes with local USTA teams in Birmingham. He earned the certification of Elite Professional from the United States Professional Tennis Association. He enjoys spending time with his wife and family doing outdoor sports such as wakeboarding, wake-surfing and snowboarding. Their favorite pastime is visiting their native island of Puerto Rico, where they like to go surfing, sailing and scuba diving. In addition, he enjoys mountain biking and is a member of the International Bicycling Association (IMBA, BUMP). He is fully fluent in Spanish and English.
