“Trigger finger caused by ulnar/median nerve surgery? ”
I had ulnar & median nerve surgery back in July, with documented clawing of my 4th & 5th digits prior. After surgery the clawing has somewhat gotten worse and I’m unable to physically open my fingers at all. They will move down towards my palm at the bottom joint, but neither joint on my finger moves. It looks to me like there is significant atrophy and the skin on my fingers has shortened & wrinkles as if it’s being pulled. My surgeon said he’s never had an outcome like this & said it’s possibly permanent nerve damage. My regular Dr says I just need to go to another surgeon and get some shots to loosen the tendons. Is this trigger finger cause by tightening tendons or nerve damage?
Female | 40 years old
Complaint duration: 6 months
Medications: N/a
Conditions: Cubital tunnel @ elbow & wrist, carpal tunnel
1 Answer
Hello, I am sorry that your condition has worsened. This must be a very distressing situation for you.
There are a couple of reasons that people develop clawing of their ring and small fingers and it is sometimes challenging to determine the exact underlying cause. Clawing of the ring and small finger can definitely be because of ulnar nerve dysfunction - either from a compressive neuropathy like cubital tunnel syndrome at the elbow or ulnar tunnel syndrome at the wrist. It can also be from nerve root compression in the cervical spine or from a traumatic injury of the ulnar nerve anywhere from the neck to the wrist. Occasionally the nerve can also be dysfunctional from a tumor within the nerve or compressing it externally. The exact location and cause of the dysfunction is usually made by a combination of physical exam, EMG and Nerve Conduction Study and sometimes an MRI. Hopefully you had a thorough exam prior to surgery to confirm the site of ulnar nerve dysfunction and to confirm that the flexion contracture of your fingers was in fact from ulnar nerve dysfunction or “clawing” and not from another process.
Dupuytren’s Disease can also cause flexion contracture if the digits which can be mistake for clawing and can sometimes also exist at the same time as ulnar clawing. Dupuytren’s causes abnormal scarring of the palm fascia which leads to chord formation that tethers your fingers in the flexed position. Dupuytren’s is sometimes worsened after surgery in the hand or trauma.
Trigger fingers do occasionally become locked but usually patients have a history of triggering or popping of the fingers on flexion and extension prior to becoming locked. There is also usually a tender nodule in the hand just below where the finger meets the hand in the flexor tendon at the A-1 pulley level.
You are quite you g to be suffering from Dupuytren’s as well as severe ulnar nerve dysfunction unless you have had a traumatic injury of your neck or upper extremity.
I would recommend getting a second opinion from another hand surgeon and ensuring that you have a complete physical exam and work up to look at all of the possible causes for your worsening symptoms.
There are a couple of reasons that people develop clawing of their ring and small fingers and it is sometimes challenging to determine the exact underlying cause. Clawing of the ring and small finger can definitely be because of ulnar nerve dysfunction - either from a compressive neuropathy like cubital tunnel syndrome at the elbow or ulnar tunnel syndrome at the wrist. It can also be from nerve root compression in the cervical spine or from a traumatic injury of the ulnar nerve anywhere from the neck to the wrist. Occasionally the nerve can also be dysfunctional from a tumor within the nerve or compressing it externally. The exact location and cause of the dysfunction is usually made by a combination of physical exam, EMG and Nerve Conduction Study and sometimes an MRI. Hopefully you had a thorough exam prior to surgery to confirm the site of ulnar nerve dysfunction and to confirm that the flexion contracture of your fingers was in fact from ulnar nerve dysfunction or “clawing” and not from another process.
Dupuytren’s Disease can also cause flexion contracture if the digits which can be mistake for clawing and can sometimes also exist at the same time as ulnar clawing. Dupuytren’s causes abnormal scarring of the palm fascia which leads to chord formation that tethers your fingers in the flexed position. Dupuytren’s is sometimes worsened after surgery in the hand or trauma.
Trigger fingers do occasionally become locked but usually patients have a history of triggering or popping of the fingers on flexion and extension prior to becoming locked. There is also usually a tender nodule in the hand just below where the finger meets the hand in the flexor tendon at the A-1 pulley level.
You are quite you g to be suffering from Dupuytren’s as well as severe ulnar nerve dysfunction unless you have had a traumatic injury of your neck or upper extremity.
I would recommend getting a second opinion from another hand surgeon and ensuring that you have a complete physical exam and work up to look at all of the possible causes for your worsening symptoms.
