Trigger Finger

Trigger finger is a condition in which one of the fingers or thumb catches in a bent position. The finger or thumb may straighten with a snap — like a trigger being pulled and released. If trigger finger is severe, the finger may become locked in a bent position. This condition can affect any finger as well as the thumb.

In most cases, trigger finger is a nuisance rather than a serious condition. However, if it isn’t treated, the affected finger or thumb may become permanently stuck in a bent position or, less commonly, in a straightened position. This can make carrying out everyday tasks difficult.

Cause

Tendons connect muscles to bones. When a muscle is tightened, it pulls on the tendon, and this causes the bone to move.

The tendons that move the finger slide through a tendon sheath (tunnel) as the finger is bent.

  • If the tunnel swells, or the tendon has a bump on it, the tendon cannot slide smoothly through the tunnel.
  • When it cannot slide smoothly, the tendon may become stuck when you patient tries to straighten finger.

Trigger finger can occur in both children and adults. It is more common in people who:

  • Are over 45 years old
  • Are female
  • Have diabetes, rheumatoid arthritis, or gout
  • Do work or activities that require repeated gripping of their hands

Signs & Symptoms

If a patient has trigger finger:

  • The finger is stiff or it locks in a bent position.
  • There is painful snapping or popping when finger is bent and straightened.
  • Symptoms are worse in the morning.
  • There is a tender bump on the palm side of the hand at the base of the finger.

Diagnosis

Trigger finger is diagnosed by medical history and a physical examination. Trigger finger usually does not require x-rays or lab tests.

Treatment

Treatment of trigger finger, also known as stenosing tenosynovitis, varies depending on the severity.

Non-Surgical Treatment

In mild cases, the goal is to decrease swelling in the tunnel.

Self-care management mainly includes:

  • Allowing the tendon to rest. A splint may be required. Or, taping of the affected finger to one of the other fingers (called buddy taping).
  • Applying heat and ice and stretching may also be helpful.

A shot of cortisone may also be given. The shot goes into the tunnel that the tendon goes through. This can help reduce swelling. A second shot may be done if the first one does not work.

Surgical Treatment

Surgery may be recommended if the above treatments don’t work or are unsuitable. The surgeon will cut through the affected section of the tendon sheath so that the tendon can move freely again.

Whether surgery is recommended will depend on considerations such as the level of pain, whether it’s associated with other medical problems, such as rheumatoid arthritis, and how much it’s affecting the patient’s life.

Surgery for trigger finger is effective and it’s rare for the problem to return in the treated finger or thumb.

The surgery is an outpatient procedure. It is usually carried out under local anaesthesia, so the patient will be awake but unable to feel any pain in the hand.

The two types of surgery for trigger finger are:

  • open trigger finger release surgery
  • percutaneous trigger finger release surgery

If the patient has rheumatoid arthritis, these types of surgery may not be recommended because they can cause the finger to drift sideways. Instead, a procedure known as a tenosynovectomy may be necessary. This involves removing part of the tendon sheath to allow the tendon to move again.

Open trigger finger release surgery:
The surgeon will inject local anaesthetic into the palm of the hand. A small incision will be made in the palm of the hand along one of the natural creases, which may mean the scar will be less noticeable. The surgeon will carefully cut through the tendon sheath to make it wider. The wound will then be closed with stitches and covered with a light bandage.

Percutaneous trigger finger release surgery:
Percutaneous means ‘through the skin’. As with open surgery, the surgeon will inject the hand with a local anaesthetic. However, instead of making an incision in the palm, a needle will be inserted into the base of the affected finger and used to slice through the ligament to get to the tendon.

As percutaneous surgery doesn’t involve making an incision, there won’t be a wound or scar. However, the procedure is slightly more risky than open surgery and may be less effective at resolving the problem. Important nerves and arteries are very close to the tendon sheath and can easily be damaged. For this reason, open surgery is usually the preferred method.

Recovering from surgery:
After the procedure, should be able to move the finger straight away. The dressings can usually be removed after a few days to make movement easier, and full movement should return within a week or two.

For open surgery, the palm may feel sore immediately after the procedure, but any discomfort should pass within two weeks.

Sports can be done after around two or three weeks, once the wound has healed and the patient can grip again.

A return to work will depend on the job. If it’s a desk job or a role that involves light manual duties, the patient may not need any time off work. If the job involves manual labour, the patient may need up to four weeks off.

If the surgery was on more than one finger, recovery period may be longer.

For percutaneous surgery rather than open trigger finger release surgery, recovery period may be shorter because there won’t be a wound on the palm.

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