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Trigger Finger

What is trigger finger?

Trigger finger/thumb occurs when one of your fingers or thumbs catches into a bent position. It feels as if your middle joint is popping in and out of place even though you haven’t had an injury to the popping joint. Early in the condition, there may be just pain at the base of the finger without snapping. In advanced cases the digit may even become locked in a flexed/bent position and less commonly an extended/straightened position.

What causes trigger finger?

Tendons that bend or flex the digits attach the forearm muscles to the bones in the finger. The tendons travel through important bands or pulleys much like a rope goes through pulleys to afford the digit the mechanical advantage it has to pull the digit into the palm. Each tendon is lined by tenosynovium a tissue that secretes fluid that lubricates the tendon to smoothly glide through the pulleys. Triggering occurs from a relative narrowing of the sheath or overabundance of tenosynovium restricting the tendon gliding. As the tendon space decreases, it begins to catch which causes increased inflammation. With acceleration of the process, the tendon may develop a nodule which causes the digit to become locked.

Repetitive use of the hand is the most common cause. Other health conditions may also lead to this condition such as diabetes or rheumatoid arthritis. This condition is more common in women.

What are symptoms of trigger finger?

Symptoms begin with soreness in the palm and stiffness of the digit greatest in the morning. Tenderness with a possible nodule develops at the base of the digit. A popping or clicking feeling may develop with finger movement. The digit catches with flexion and then pops into extension. In advanced cases the digit becomes locked in a flexed/bent position. This condition is more common in the middle, ring and thumb. Common to have more than one finger and both hands involved.

How to diagnose trigger finger.

The diagnosis is based on the clinical history and examination. There will usually be tenderness at the palm at the base of the involved digit. In more advanced cases there will be grinding at the base of the digit through normal range of movement. There may be popping of the digit in and out of flexion and extension of the digit. In severe cases the digit may be limited in motion with inability to extend or flex the digit fully.

Treatment Options

Non-surgical treatment of trigger finger.

In mild cases, conservative treatment can be highly effective and consists of rest, avoidance of repetitive activities, splinting, warm water soaks, exercises and massage. Nonsteroidal anti-inflammatory drugs (NSAID’s) are initially prescribed. If no relief with oral medication, at least one steroid injection is safe and may be very effective.

Surgical treatment of trigger finger.

For symptoms unresolved with conservative treatment, a simple surgery is usually curative. Through a small incision in the palm under local anesthesia, the first pulley is released without any functional limitations. There is usually immediate relief of symptoms. This is one of the only surgical procedures that can be performed routinely on both hands. There is usually soreness at the surgical site for several weeks after surgery. Therapy is necessary in severe cases where joint stiffness has developed.

How can Dr. Knight help you with trigger finger?

If you think you have symptoms of trigger finger, a visit to a hand surgeon is recommended. Dr. Knight will expedite your care by making an accurate diagnosis and providing quality and effective care through conservative measures with surgery as a last resort.

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