Trigger Finger

The ability to bend the fingers is governed by supportive tendons that connect muscles to the bones of the fingers. The tendons run along the length of the bone and are kept in place at intervals by tunnels of ligaments called pulleys. When the fingers bend or are straightened, a slippery coating called tenosynovium helps the tendons to smoothly glide through the ligaments with reduced friction.

Inflammation in the tenosynovium leads to a condition called trigger finger, also known as stenosing tenosynovitis or flexor tendonitis, where one of the fingers or thumb of the hand is caught in a bent position. The affected digit may straighten with a quick snap, similar to pulling and releasing the trigger on a gun; hence, the name trigger finger.

Causes

Trigger finger is caused by inflammation of the tenosynovium. Inflammation forms a nodule and makes it difficult for the tendon to glide smoothly within its sheath, causing “catching” of the finger in a bent position and then suddenly releasing the finger straight. Other causes of trigger finger may include:

• Repetitive motion: Individuals who perform heavy, repetitive hand and wrist movements with prolonged gripping at work or play are believed to be at a high risk of developing trigger finger.
• Medical conditions: Conditions associated with developing trigger finger include hypothyroidism, rheumatoid arthritis, diabetes and certain infections such as tuberculosis.

Trigger finger is more common in females than males.

Signs and symptoms

Commonly reported symptoms associated with trigger finger include:

• Pain and tenderness over the inflamed tendon nodule
• Bent finger suddenly pops out and straightens
• “Popping” or “clicking” sound, or sensation when the nodule moves through the pulley
• Finger feels stiff and sore
• Finger gets locked with the inability to straighten when the nodule grows large and gets stuck in the pulley
• Symptoms are worse in the morning

Long-term complications of untreated trigger finger can include permanent digit swelling and contracture, as well as tearing of the tendon or rupture.

Diagnosis

Hand and wrist conditions should be evaluated by an orthopaedic hand surgeon for proper diagnosis and treatment. Trigger finger is diagnosed based on your medical history and physical examination, without any special testing required.

Treatment

Your surgeon will recommend conservative treatment options to treat trigger finger symptoms. Treatment options will vary depending on the severity of the condition. Conservative treatment options may include the following:

• Treat any underlying medical condition that may be causing the problem, such as diabetes or arthritis.
• Rest the hand for 2-4 weeks or more by avoiding repetitive gripping actions. Avoid activities that tend to bring on the symptoms.
• Perform strengthening and stretching exercises with the affected finger.
• Occupational therapy may be recommended for massage, heat, ice and exercises.
• Ice over the affected finger may help relieve symptoms. Apply ice over a towel for 5-15 min, 3-4 x daily.
• Non-steroidal anti-inflammatory drugs (NSAIDs) may help to relieve pain and inflammation.
• Steroid injections administered into the affected finger may help reduce the inflammation.

If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more, and your quality of life is adversely affected, your surgeon may recommend a surgical procedure to release the tendon.

Percutaneous trigger finger release surgery is a minimally invasive procedure performed under local anesthesia. Your surgeon makes one small incision on the affected finger area, about an inch long, and releases the tight portion of the flexor tendon sheath.