Upper Extremity Tendinopathies (trigger digits, deQuervains, Lateral epicondylitis)-Hand Surgery Update IV: Trigger Thumb

Video Transcription

The treatment of trigger thumb, or stenosyntenosynovitis of the flexor pollicis longus, in this case a transverse incision is made at the base of the thumb MCP joint flexion crease.  The radial digital nerve is identified and protected as this is very close to the skin incision.  You can see here the ragnell retractor now protects this, and the ulnar nerve vascular bundle is identified as well and protected.  The A1 pulley is then first initially released with a 15 blade, and then the remainder of the pulley is released up to the limits of the oblique pulley with tenotomy scissors.  The pulley is not resected, but tension on the flexor pollicis longus identifies that it's been completely released and that there is no longer any triggering.  In this case the patient did not have full extension and this was obtained after surgery.

Video Summary

In this video, the treatment of trigger thumb, also known as stenosing tenosynovitis of the flexor pollicis longus, is demonstrated. The procedure involves making a transverse incision at the base of the thumb MCP joint flexion crease while ensuring the protection of the radial digital nerve. The use of a ragnell retractor safeguards the nerves and the ulnar nerve vascular bundle. The A1 pulley is then released using a 15 blade and tenotomy scissors, up to the limits of the oblique pulley. By assessing the tension on the flexor pollicis longus, it is confirmed that the pulley has been completely released, resulting in the elimination of triggering. The surgery also helped the patient achieve full extension. No credits were granted.

Keywords

trigger thumb

stenosing tenosynovitis

flexor pollicis longus

transverse incision

A1 pulley release