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Trigger Finger

What is Trigger Finger?

Bending the fingers of the hand occurs via the flexor tendons and muscles of the forearm. The long, thin, flexor tendons of the hand connect the bones of the fingers to the forearm muscles, and are kept in place along the way by a series of tunnels known as the tendon sheaths. When the forearm muscles contract, the tendons are pulled through these sheathes, and the fingers bend.

Trigger finger, or flexor tenosynovitis, occurs when the tendon no longer moves freely within its tendon sheath. The flexor tendon becomes stuck, limiting the motion of the fingers. Trigger finger can occur in any finger, including the thumb. It usually involves the tendon sheath at the metacarpal phalangeal joint, where the base of the finger attaches to the hand’s palmar surface. The finger may feel stuck when trying to bend or extend. Discomfort, tenderness, or pain at the base of the finger are common complaints. Some may notice a painful bump in this location. Popping and snapping of the fingers as the tendon gets stuck and released commonly causes patients to seek help.


What Causes Trigger Finger?

Trigger finger can be the result of a problem with the tendon or a problem with the tendon sheath or both. In normal function the flexor tendon glides effortlessly through the tendon sheath. This tunnel is, however, a confined space, and anything that encroaches on that space can be an issue. The tendon may thicken as a result of inflammation caused by overuse or repetitive movements of the hand. Nodules may form on the tendon sheath for the same reason. The tendon sheath may itself become inflamed and thickened. All of these can impede the gliding motion necessary for the tendon to pass through the sheath and hinder normal finger motion.

The exact cause of trigger finger is not known, but it is associated with middle age, female sex, and inflammatory joint diseases such as Rheumatoid Arthritis and Gout. Diabetes can be a confounding factor as well.


How is Trigger Finger Diagnosed?

Trigger finger is diagnosed based on a careful history and thorough physical examination. Lab tests and imaging studies are usually not needed.


How is Trigger Finger Treated?

Trigger finger can be treated non-surgically or surgically, depending on the severity of the symptoms.

Non surgical:

In very mild cases of trigger finger, all that may be needed is rest. Immobilization of the finger through splinting or taping the affected finger to an adjacent normal finger may suffice. Oral anti-inflammatory medications may be prescribed to decrease inflammation and pain while the finger is immobilized. For moderate cases, steroid injections to the flexor tendon sheath may be utilized along with splinting, which may result in complete relief.

Surgical:

If symptoms are not alleviated with conservative methods and repeated steroid injections have not brought relief, surgery may be needed to rectify trigger finger. Trigger finger release surgery involves cutting open the affected tendon sheath to relieve pressure and pain associated with movement of the finger.

Surgery is done under IV sedation with local anesthetic administered to the affected hand. An incision approximately one centimeter long is made on the palm to expose the affected tendon sheath. The sheath is divided, or cut, and the wound is closed. Return to motion is immediate and checked during the procedure. Full movement of the fingers is present within a few days, and return to full activity occurs within a few weeks. There may be mild pain and tenderness at the incision site for up to six weeks following surgery. Hand physical therapy may be prescribed for the few in which hand stiffness occurs.


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.


Videos

To see Dr. Knight answer common questions regarding Trigger Finger treatment options, click on video below.

For more information on Trigger finger, click on video below.




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