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Trigger Finger

Trigger finger (stenosing tenosynovitis) is a condition that causes the finger to be locked when it is bent.

Tendons are bands of tissue that attaches muscles to the bones. When bending and straightening the finger, the tendon slides through the tissue that covers it (sheath).

Due to repetitive and forceful movements, the tendons in the finger may become inflamed. When this happens, it may be stuck in the narrow space of the sheath, causing the finger to be locked in the bent position. Depending on the severity of the condition, treatment options can range from noninvasive options to surgery.

Causes

  • Repetitive movements
  • Forceful movements
  • Gripping performed over long periods
  • Previous injury to the tendons of the finger

Symptoms

Trigger finger often affects the ring finger and the thumb. In some cases, more than one finger can be affected and both hands can become affected. Clear indicators of trigger finger include the following:

  • Morning finger stiffness
  • Finger momentarily stuck in the bent position and suddenly straightening itself
  • Finger locked in bent position and unable to straighten itself
  • Clicking or popping sensation when bending and straightening the finger
  • A painful bump (nodule) at the base of the finger

If there is noticeable stiffness in the finger joint, medical attention is recommended so the doctor can review the symptoms and would be able to perform a physical evaluation. If the finger joint is inflamed or hot, it might be a telltale sign of infection so seeking medical attention is imperative.

Certain factors have been known to put one at risk of developing the condition. Some of these factors include:

Certain health conditions – Individuals suffering from other diseases like rheumatoid arthritis or diabetes are at a higher risk of developing the condition.

Sex – Trigger finger is observed to be more common in women than in men.

Repeated gripping – Hobbies and occupations that entail prolonged gripping and repetitive hand use can increase one’s chances of developing trigger finger.

Diagnosis

Elaborate testing is not necessary when diagnosing trigger finger. In most cases, diagnosis is made based on the physical exam and the patient’s medical history. During the physical examination, patient will be asked to open and close the hand so the doctor can check for evidence of locking, smoothness of motion, and areas of pain.

The doctor will also check if there is a lump present. Lumps that are associated with trigger finger moves as the finger does because it is attached to the tendon.

Prior to seeing a health care provider, it would be wise to prepare a list of questions so you will be able to make the most out of your visit.

Key questions you need to ask should include:

  • Is the condition temporary?
  • What are the likely causes of the symptoms?
  • What are the likely treatment options?
  • Are there possible complications associated with any of the treatment or the condition itself?

As a patient, you should also prepare accurate answers for questions the doctor might ask such as:

  • How long have you experienced the symptoms?
  • Are the symptoms persistent or do they come and go?
  • What are the symptoms you have noticed?
  • Have you had any hand injuries?

Prevention

Avoiding overuse is the key to preventing the trigger finger from developing. If symptoms like swelling and stiffness in the fingers begin to manifest, it is advisable to give the fingers substantial rest. To keep them from becoming inflamed, alternating activities is recommended.

Treatment

For mild cases, the surgeon may simply ask you to rest the finger and also prescribe putting on a splint to allow the affected finger to be immobilised.

Other conventional and noninvasive treatments include:

  • Heat or ice – Some individuals notice an improvement when they ice the palm several times during the day. Others on the other hand find warm-water soaks done first thing in the morning beneficial.
  • Rest – Activities that entail repeated grasping, repetitive gripping, or prolonged use of the hand should be avoided for at least three to four weeks.
  • Stretching exercises – Gentle exercises might be recommended in order to retain finger mobility.
  • Splint – Wearing a splint at night might be required for up to six weeks in order to keep the affected finger in extended position. Apart from helping the tendon rest, splinting will also prevent the fingers from curling.

For moderate cases, the surgeon may prescribe some anti-inflamatory drugs to reduce the swelling and may also give steroidal injection directly into the sheath. However, while nonsteroidal anti-inflammatory drugs like naproxen (Aleve) and ibuprofen (Motrin, Advil) may help alleviate the pain, it will not relieve the swelling brought about by the condition.

Surgery and other procedures

If symptoms are severe or if the condition does not respond to conservative treatments, the following approaches might be suggested:

Percutaneous release – The procedure involves inserting a sturdy needle in the tissue around the affected tendon after the palm is numbed. Moving the finger and the needle will break apart the constriction. This procedure is done under ultrasound control in order for the doctor to see where the tip of the needle is when under the skin. This is necessary so opening the tendon sheath can be facilitated without damaging the tendon or the nerves nearby.

Steroidal injection – A steroid medication injected into the tendon sheath may help lessen inflammation and can cause the tendon to move freely again. This is considered the most common treatment approach. For individuals who do not suffer from diabetes, it is deemed effective in as much as 90 percent of the patients.

Surgery – Surgery is aimed to create more room within the sheath for the tendon to move through it. Basically, this is achieved by cutting the sheath. The conventional method is to cut a small incision near the base of the affected finger and cut the sheath. Another method, which does not involve cutting, uses the sharp end of an injection needle to cut the sheath open.

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