Trigger Finger

Trigger finger, also known as stenosing tenosynovitis or stenosing tenovaginosis is a condition that affects one or more of the hand’s tendons, making it difficult to bend the affected finger or thumb, causing pain and discomfort.  Each finger has two tendons — the flexor digitorum profundus and the flexor digitorum superficialis. If one of these tendons or the tunnel a tendon runs through (called the tendon sheath) becomes swollen and inflamed, the tendon gets irritated and can “catch” in the tendon sheath. This can make it difficult to move the affected finger or thumb and can result in a clicking sensation.

Trigger finger can affect any finger, most commonly the middle finger, ring finger, and thumb. One or more fingers can be affected and the problem may develop in both hands. This condition occurs when the A1 pulley, a tunnel at the base of the finger, thickens, or when the flexor tendon develops a nodule. This narrowing or friction causes the tendon to catch or get stuck as it moves through the tendon sheath, resulting in a snapping or locking sensation as the finger straightens or bends. This issue is often linked to repetitive hand use, certain medical conditions, and can lead to pain, stiffness, and an inability to fully extend the finger.

While the causes of trigger finger are not well known, several factors may increase your risk for developing the condition. These include:

• Medical conditions: Trigger finger is more common in people with certain medical conditions, such as rheumatoid arthritis, diabetes, hypertension, and thyroid disorders.
• Forceful hand activities: Activities that involve repetitive or forceful gripping, squeezing, or lifting can increase risk. This includes jobs using tools or playing sports that involve a strong grip.
• Age: Trigger finger is more common in women aged 40 to 60.

The most common symptoms of trigger finger include:

• A snapping or popping feeling when you move your fingers or thumb. It might feel like your affected digits are “catching” or getting stuck as they move.
• Pain and stiffness when flexing your fingers or thumb in toward your palm.
• Soreness in your palm near the base of your fingers or thumb. This pain is usually worse when you’re gripping or grasping something.
• Swelling or a tender lump in the palm of your hand.
• Your fingers or thumb locking (sticking) in a flexed position. You might need to use your other hand to gently push your fingers to straighten out.

Trigger finger symptoms (especially stiffness and locked positions) are usually worse first thing in the morning. Stiffness usually gets a little better as you start using your fingers and thumb.

The doctor will typically be able to diagnose a trigger finger by talking with you about your symptoms and examining your hand. Typically, X-rays or other tests are not absolutely necessary to make the diagnosis.

During the exam, your doctor will look for:

• Tenderness over the flexor tendon sheath in the palm of your hand
• Thickening or swelling of the tendon sheath at the base of your finger or thumb
• A clicking or catching sensation when you bend and straighten your finger or thumb

It is crucial to visit a specialized orthopedic surgeon with appropriate training and experience as it ensures an accurate diagnosis and the development of a personalized treatment plan tailored to your specific case, leading to better outcomes and a more positive patient experience.

Conservative (Nonsurgical) Treatment

Initial treatment for a trigger finger is usually conservative (nonsurgical).

• Resting your hand and avoiding activities that make it worse may help to resolve the problem.
• Splinting: Wearing a splint at night to keep the affected finger or thumb in a straight position while you sleep may be helpful.
• Physiotherapy (Exercises): Gentle stretching exercises can help decrease stiffness and improve range of motion in the involved digit.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs)can help relieve pain and inflammation.
• Steroid injections: Steroid injections use corticosteroids to reduce inflammation and can resolve conditions like trigger finger by being injected into the tendon sheath at the base of the digit. While typically effective, if symptoms persist or return, a second injection may be considered, but surgery is usually recommended if two injections are unsuccessful. For patients with diabetes, these injections may be less effective and can cause a temporary increase in blood sugar, requiring careful monitoring.

Surgical Treatment

If your trigger finger does not get better with nonsurgical treatment, you may wish to consider surgery. The decision to have surgery is based typically on how much pain or loss of function you have in your digit. The surgical procedure for trigger finger is usually trigger finger release.

It is a minimally invasive, outpatient surgical procedure that is performed under local anesthesia, allowing for a quick return to normal activities with no overnight hospital stay.  A surgeon makes a small incision, typically 1.5 cm, in the palm at the base of the affected finger.

This incision allows the surgeon to cut the tight A1 tendon sheath.  The surgery itself is quick, usually lasting around 15-20 minutes.

Trigger finger release surgery is a safe and common outpatient procedure with high success rates, often exceeding 90%, for relieving trigger finger symptoms. However, choosing an experienced orthopedic or hand surgeon is important because his expertise significantly impacts procedure success, the likelihood of full recovery, and the minimization of potential complications. The surgeon’s ability to properly assess your individual situation and effectively restore full finger movement is crucial for a positive outcome.

As mentioned above, trigger finger release is a generally safe and effective surgical procedure with a high success rate, although some pain, swelling, and numbness are normal post-operative symptoms. Most patients experience immediate improvement, with full recovery taking a few weeks, but it’s essential to follow your surgeon’s specific instructions for wound care, activity, and exercises to ensure the best outcome.