As we age, the passing years tend to be full of annoying reminders. For some people, trigger finger is one of them. It hurts, and can be a barrier to activities people enjoy. Sometimes it can even end a career early.

Surgery is the standard treatment when trigger finger becomes chronic. This can help prevent the frequent locking of the finger into a cramping trigger position when attempting to grasp small objects. However, traditional surgery cuts through highly touch-sensitive, nerve-dense tissue, which can create a challenge for pain management. After the incision, dissecting tissue, cutting the ligament and finishing with stitches, recovery can take some time. Over one patient in ten will experience complications like infection, scar tissue and chronic pain.

Ricardo Colberg, MD of Andrews Sports Medicine and Orthopaedic Center became interested in finding a simpler approach that could achieve the desired results using techniques that would be easier on the patient.

“As we began to see minimally invasive techniques in other procedures, I read about early attempts to use less invasive palpation-guided techniques to release trigger finger,” Colberg said. “The development of higher resolution ultrasound gave us a real time view inside the finger without the need for a larger incision.

“At Andrews, when we see potential for what may be a better way to help our patients, we believe in doing the research, gathering the data and making decisions based on real-world outcomes. That’s what we did with a series of studies on trigger finger release to determine the advantages of an ultrasound-guided minimally invasive approach.

“Today with this procedure, I help patients achieve relief from these symptoms with less pain, faster recovery, less expense and a lower risk for complications.

“With high resolution ultrasound, I can see nerves, blood vessels and other tissues I want to protect. We can do the procedure in the clinic or at the bedside so patients don’t have to pay extra to book a surgical center. Anesthesia is simpler since instead of a traditional scalpel, I use a Nokor needle similar to those that inject medications. It’s tipped with a tiny 18 gauge blade that I advance while watching the ultrasound images. I cut the ligament that is catching and holding the tendon near the bone, then irrigate and flush, and withdraw the needle and blade. A bandage goes on for three days and I tell patients to limit grip weight for a couple of weeks, then add activity as tolerated.”

Patients can usually go to work the next day, and will likely be healed enough to return to normal activities sooner than they would have been with an open incision.

“We’ve followed outcomes through the years, and patients have been very pleased with results. At 1.3 percent, complications have been only around one-tenth of what is typically seen in open procedures,” Colberg said.

The released ligament tends to stretch out as it heals, so it isn’t likely to start catching again in the same finger. However, patients who have one trigger finger may experience the same problem in other fingers. Colberg has one patient who has flown across the country four times to have the procedure done in different fingers.

“After I had traditional surgery with the first trigger finger, the pain and recovery time were so bad that I didn’t want to go through that again. I found an article about Dr. Colberg and the minimally invasive approach he uses, so I came from California to Birmingham to have it done. It was so much easier that I came back for the other fingers,” the patient said.

Colberg’s patients often include dentists, hygienist and physicians such as interventional cardiologists who spend a lot of time gripping tiny tools and working in tight spaces.

“I also see trigger finger in people like professional violinists and people whose jobs involve repeated gripping, vibration, twisting and heavy lifting. Even recreational activities like crochet and knitting can cause a flare up from overuse. If the tendon becomes irritated and swollen and begins catching under the ligament, when rest and conservative medications are no longer enough, it may be time to get evaluated for a release procedure,” he said.

The primary difficulty for patients who prefer the less invasive approach is finding a physician who has completed the special training required and has experience doing it. Colberg and Andrews Sports Medicine have offered training programs to physicians interested in learning the technique. In time, the choice should become more widely available. Similar techniques might offer new possibilities for treating other conditions in the future.