Midsota Hand Center

04/23/2026

Trigger Finger (Stenosing Flexor Tenosynovitis)

Trigger finger is a common condition where a finger or thumb becomes "stuck" in a flexed position, or snaps/clicks when attempting to straighten. It is caused by a size mismatch between the flexor tendon and its surrounding pulley system.

1. Anatomy & Pathogenesis
The flexor tendons run through a series of "pulleys" that hold the tendons close to the bone, preventing "bow-stringing."

The A1 Pulley: Located at the level of the Metacarpophalangeal Joint (MCPJ) on the palmar side. This is the most common site of pathology.

The Mechanism: Damage or inflammation leads to localized swelling (a nodule) on the flexor tendon. As the finger flexes, the nodule passes through the inelastic A1 pulley; as it tries to extend, the nodule jams against the pulley's entrance, causing a painful "click" or "trigger.

2. Clinical Presentation
Symptoms:

Audible or palpable clicking during finger movement.

Pain localized over the palmar aspect of the MCPJ.

A tender nodule felt in the region of the A1 pulley.

In severe cases, the finger may be locked in flexion, requiring the other hand to pull it straight.

Risk Factors: Increased incidence in patients with Diabetes Mellitus, Rheumatoid Arthritis, or other connective tissue disorders.

3. Physical Examination
Inspection: Look for a finger held in a flexed position.

Palpation: Place your thumb over the patient's A1 pulley (at the distal palmar crease) while they flex and extend their finger. You will likely feel the nodule "snap" under your thumb.

Differential Diagnosis: Rule out Dupuytren’s disease (which presents with fixed palmar nodules and cords but typically no snapping).

4. Treatment Options
Conservative Management
Splinting: Night splints holding the finger in extension can allow the inflammation to subside.

Corticosteroid Injection: A highly effective first-line treatment (up to 90% success).

Technique: The needle is aimed at the A1 pulley, 1 cm proximal to the MCPJ crease. Avoid injecting directly into the tendon (feel for resistance).

Surgical Intervention
Indicated if conservative measures fail or the finger is chronically locked.

Trigger Finger Release: Usually performed under local anesthesia.

Procedure: A small longitudinal incision is made over the A1 pulley, and the pulley is incised (divided) to allow the tendon and its nodule to glide freely. The patient is often asked to move their finger during the surgery to confirm the "triggering" is gone.

Clinical Pearl
"In your clinic, remember that the A1 pulley is the culprit, but the A2 and A4 pulleys are the most functionally important for preventing bow-stringing. When performing or observing a release, surgeons are careful only to cut the A1. For diabetic patients, be aware that they are more likely to have multiple fingers involved and may have a lower success rate with a single steroid injection compared to non-diabetics."

04/08/2026

"Don't quit until you get the result you want." We say that nearly every day, multiple times a day at the Midsota Hand Center!

What we are talking about is following through with your home exercise program! Bouncing back from a hand injury can be a lengthy process. Everyone heals at different rates, every injury is different.

Different mechanisms of injury such as table saw, snow blower, lawn mower, box cutter, steak knife, broken glass offer different challenges combined with different structures that were injured-bone, tendon, ligaments, skin-they all heal at different lev
How our body responds to an injury and how it heals itself also happens at different levels and times. Everyone forms scar tissue at different levels, swells at different levels.

Work as a team with your hand surgeon, therapist and family and you will succeed. It may take a month, six months or a year. Just don't give up until you "get the result you want."

10/06/2025

To all our friends having difficulty eating their spaghetti...😁

04/01/2025

It's a team effort when you come to the Hand Center! Making a splint, fixing a shoe with velcro! Whatever it takes for our patients!

03/21/2025

Hand injuries no matter what level can be devastating. Working with our friends at Arm Dynamics function can be restored.

Dennis Roberts’ right thumb was amputated during a rocket explosion. He wears a positional prosthetic thumb and enjoys martial arts and golf.

03/04/2025

Our goal is to help our clients regain function after a hand injury.
One of the first goals is to make a fist as this allows a return to grasping utensils to eat, managing clothing fasteners to dress and grip a pencil to write.
Sometimes we have to make a splint to provide a slow, prolonged stretch to a stiff hand.
This is a static progressive splint.
It is a custom molded splint with individual finger slings that help in stretching a stiff joint.

01/07/2025

“Necessity is the mother of invention”, as the saying goes! We hope this will come in HANDy” for those stuck in a cast on a cold day!

11/13/2024

This Thanksgiving Activity Packet is a low to no prep bundle that includes over 120 pages to encourage children to practice fine motor, visual motor, bilateral hand coordination, and handwriting skills all with a Thanksgiving theme.

Created by an experienced Occupational Therapist, this will surely entertain and challenge your student’s skills!

11/13/2024

🍂 Thanksgiving-themed worksheets for fine motor and gross motor fun! Develop essential skills with festive flair! 🍁✍️

11/13/2024

Second MD in the WORLD! Way to go team!

🎉 Congratulations to James Drinane, DO, and the entire hand surgery team at CentraCare – Midsota Plastic Surgery! Dr. Drinane was the SECOND surgeon in the WORLD 🌍 to use nerve tape as part of a nerve graft.

Nerve tape is a novel nerve connection device that allows for a rapid, suture-less, nerve repair. For patients, this means a faster operative time and a stronger, more consistent repair with less scarring.

Pictured are Courtney Minadakis, PA-C, and Dr. Drinane

08/16/2024

James Drinane, DO, shares his motivation for performing hand surgeries, along with the range of surgeries he provides at CentraCare - Midsota Plastic Surgery...

06/07/2024