Ultrasound-Guided Tendon Release for Stenosing Ligamentitis (Trigger Finger)
Stenosing ligamentitis, also known as trigger finger, is a disorder affecting the movement of a finger tendon. As the finger bends or straightens, it may click, catch or lock in a flexed position. This occurs when the flexor tendon has difficulty gliding through a narrowed annular pulley, most commonly the A1 pulley, at the base of the finger. As the condition progresses, pain, stiffness and restricted finger movement may develop, making it more difficult to grip objects, work and perform everyday activities.
If conservative treatment has not provided sufficient improvement, one treatment option is minimally invasive tendon release under ultrasound guidance. During the procedure, the narrowed A1 pulley is released so that the flexor tendon can glide more freely.
What is stenosing ligamentitis or trigger finger?
Stenosing ligamentitis, also called trigger finger, is a condition in which the free movement of the finger flexor tendon is impaired. The flexor tendons of the fingers run within tendon sheaths, and annular pulleys help keep them in position.
One of these is the A1 annular pulley, located on the palmar side at the base of the finger.
If this pulley becomes thickened or the tendon increases in volume, a mechanical obstruction to tendon gliding may develop. During finger movement, the tendon may catch, producing a characteristic click or sudden straightening of the finger.
Trigger finger may affect any finger, including the thumb, and in some cases several fingers may be affected at the same time.
What are the symptoms of trigger finger?
Symptoms of stenosing ligamentitis may develop gradually. Initially, there may be mild discomfort, but more pronounced movement problems may develop over time.
The most common symptoms include:
clicking of the finger when bending or straightening;
catching or locking of the finger in a flexed position;
pain at the base of the finger on the palm side;
tenderness or mild swelling in the tendon area;
a palpable thickening or nodule at the base of the finger;
finger stiffness, particularly in the morning;
difficulty fully straightening or bending the finger;
discomfort when gripping or holding objects.
In more severe cases, the finger may only be straightened with the help of the other hand. If the condition persists for a long time, permanent restriction of movement may also develop.
What causes trigger finger?
It is not always possible to identify one specific cause of stenosing ligamentitis. The condition may be associated with thickening of the tendon and A1 pulley, repetitive mechanical strain and certain health conditions.
Trigger finger is more common:
in people who regularly perform repetitive gripping movements;
in people whose work or hobbies involve intensive use of the hands;
in patients with diabetes;
in people with rheumatoid arthritis or other inflammatory joint diseases;
in women;
in middle-aged and older adults.
Trigger finger may also develop without an obvious cause, so repetitive hand strain should not be regarded as the sole cause of the condition.
How is stenosing ligamentitis diagnosed?
The physician usually makes the diagnosis by assessing the patient’s symptoms and performing a clinical examination of the hand and fingers.
The physician assesses:
finger flexion and extension;
clicking or catching during movement;
tenderness at the base of the finger;
possible thickening in the tendon area;
hand and finger function.
If necessary, a musculoskeletal ultrasound examination is performed.
Ultrasound can be used to assess:
the structure of the finger flexor tendons;
thickening of the A1 annular pulley;
the condition of the tendon and tendon sheath;
fluid or signs of inflammation around the tendon;
tendon gliding during movement;
surrounding nerves and blood vessels.
Ultrasound is particularly important when planning a minimally invasive procedure because it allows the physician to accurately identify the treatment area and monitor the position of the instrument.
At the Diagnostikas centrs branch of Veselības centrs 4, a 17LH7 Hockey Stick ultrasound probe, particularly suitable for examining small anatomical structures, is available. It allows detailed visualisation of small and superficially located structures of the hand and fingers, including tendons and ligaments.
How is trigger finger treated?
Treatment of stenosing ligamentitis depends on the severity and duration of symptoms, the degree of movement restriction and previous treatment.
In milder cases, conservative treatment may be sufficient. If symptoms persist or finger function is significantly impaired, the physician may recommend release of the A1 annular pulley.
Conservative treatment
Depending on the patient’s condition, the physician may recommend:
limiting repetitive and forceful gripping movements;
adjusting workload and workplace ergonomics;
using a finger orthosis or splint;
anti-inflammatory treatment, if appropriate for the patient;
occupational therapy or individually tailored exercises;
corticosteroid injection into the tendon sheath area.
A corticosteroid injection may help reduce symptoms, although its effectiveness varies from patient to patient. In some cases, symptoms may recur.
If conservative treatment is not sufficiently effective, minimally invasive treatment may be considered.
Minimally Invasive Tendon Release for Trigger Finger Under Ultrasound Guidance
Ultrasound-guided tendon release for stenosing ligamentitis is a minimally invasive procedure in which the narrowed A1 annular pulley is divided to restore freer gliding of the finger flexor tendon.
More precisely, the tendon itself is not released; instead, the pulley restricting its movement is released.
Ultrasound allows the physician to visualise the tendon, A1 pulley, nerves and blood vessels in real time, helping to accurately control the position of the instrument during the procedure.
What is ultrasound-guided tendon release?
It is a minimally invasive surgical procedure in which the A1 annular pulley is released using a specialised instrument.
During the procedure, ultrasound can be used to visualise:
the finger flexor tendons;
the A1 annular pulley;
the tendon sheath;
digital nerves;
surrounding blood vessels;
the position of the instrument in relation to anatomical structures.
After the pulley has been released, the tendon should no longer catch at the narrowed site, and finger movement may become freer.
How is the procedure performed?
The procedure is usually performed under local anaesthesia on an outpatient basis.
The physician:
Assesses the flexor tendon, A1 pulley and surrounding structures using ultrasound.
Determines the safest point of entry for the instrument.
Administers local anaesthesia to the treatment area.
Introduces a specialised instrument under ultrasound guidance.
Releases the narrowed A1 annular pulley without damaging the tendon itself.
Checks tendon gliding and finger movement.
During the procedure, ultrasound helps monitor the position of the instrument and reduce the risk of injury to surrounding tissues.
What are the advantages of an ultrasound-guided procedure?
Compared with a more extensive open surgical approach, a minimally invasive ultrasound-guided procedure may offer several advantages:
a very small access point to the treatment area;
precise visualisation of anatomical structures;
the procedure is performed under local anaesthesia;
less soft-tissue trauma;
sutures are usually not required;
a small scar or puncture site;
potentially faster return to everyday activities.
However, recovery time and treatment outcome may vary from patient to patient.
Who may be suitable for the procedure?
Ultrasound-guided release of the A1 annular pulley may be considered in patients who:
have been diagnosed with stenosing ligamentitis or trigger finger;
regularly experience clicking or catching of the finger during movement;
have persistent pain at the base of the finger;
have restricted finger movement that interferes with everyday activities;
have not achieved sufficient improvement with conservative treatment;
require release of the pulley and whose anatomy allows a minimally invasive approach.
A physician’s consultation and individual assessment are required before the procedure.
Is ultrasound-guided tendon release an operation?
It is a minimally invasive procedure in which the A1 annular pulley restricting the free movement of the finger flexor tendon is divided.
Unlike conventional open surgery, the ultrasound-guided approach allows the procedure to be performed through a very small access point while important anatomical structures are visualised in real time.
Recovery after the procedure
After tendon release for trigger finger, the treated area may have:
mild swelling;
tenderness;
bruising;
discomfort with certain finger movements;
temporary finger stiffness.
Return to light everyday activities depends on the patient’s condition and the physician’s recommendations.
Finger movement is usually resumed according to the specialist’s instructions, while forceful gripping and heavy lifting may need to be restricted temporarily.
If finger movement had been restricted for a long time before the procedure, full recovery of function may take longer.
Possible risks
As with any invasive procedure, ultrasound-guided A1 pulley release may involve risks such as bleeding or bruising, pain or tenderness at the treatment site, persistence or recurrence of symptoms, scar tissue formation or prolonged stiffness, among others.
Ultrasound guidance helps to identify the location of anatomical structures more accurately, but it cannot completely eliminate the possibility of complications.
When should you see a physician?
A specialist consultation is recommended if:
the finger regularly clicks or catches;
it is difficult to fully straighten the finger;
the finger locks in a flexed position;
there is pain or swelling at the base of the finger;
symptoms interfere with gripping, work or everyday activities;
previous treatment has not provided sufficient improvement.
Timely diagnosis helps to select the most appropriate treatment method and reduce the risk of long-term movement restriction.
Tendon Release for Trigger Finger in Riga
Minimally invasive ultrasound-guided tendon release for stenosing ligamentitis or trigger finger is available at the Veselības centrs 4 Diagnostikas centrs, Grebenščikova iela 1, Riga.
The procedure is performed by Dr Matīss Mežals – Algologist, Physical and Rehabilitation Medicine Physician, Ultrasound Specialist.
A physician’s consultation is required before the procedure to confirm the diagnosis and assess the most appropriate treatment method.
