Definition & Overview

Trigger finger, or stenosing tenosynovitis, is a condition wherein the fingers lock in place when they are bent, which can cause pain and limit the movement of the affected fingers. This occurs when the tendons in the fingers become swollen, which prevents them from gliding easily through the sheath, which is the tissue that covers them. When the fingers are bent, the inflamed tendons are pulled through the narrowed sheath, causing a popping sound accompanied with pain. While many people suffer from this condition, not all of them seek medical care for it, which means they have to live in pain.

Cause of Condition

There are many possible causes of trigger finger or the inflamed tendon leading to it. These include:

• Strain due to repeated movement
• Force applied to fingers or thumb
• Underlying condition, such as rheumatoid arthritis, diabetes, or gout
• Firmly gripping an object for an extended period
• Trauma localized to the palm or the base of the affected finger

These possible causes also show that certain people have a higher risk of developing this condition. These include those whose line of work involves heavy use of the fingers or repetitive gripping, such as farmers and musicians. Studies also show that it is more common among women and people between 40 and 60 years of age. It also more commonly affects the thumb, the middle finger, or the ring finger, and can also occur in different fingers at the same time, sometimes affecting one finger in each hand.

Key Symptoms

The earliest symptom of a trigger finger is some unexplained soreness at the base of the finger or thumb. Since such soreness can be attributed to several possible reasons or simply to strain, trigger finger can be difficult to diagnose at first. As the inflammation gets worse, however, the pain will start to intensify and other symptoms start to manifest themselves.

Some of the commonly reported symptoms include:

• Stiffness that is usually worse in the morning
• Bump or nodule at the base of the affected finger
• Pain when straightening the finger
• Pain when grasping something

Its most telltale symptom is a clicking or snapping sound when the affected finger is bent or straightened, also accompanied by a sharp and sudden pain. Some patients also experience having their fingers locked in a certain position, such as straight or bent; if it locks in a bent position, the finger is usually unable to return to a straight position, in which case it has to be straightened gently using the other hand.

Who to See & Types of Treatments Available

Since trigger finger is a condition involving the tendons, it is treated by an orthopaedist, a medical professional specializing in the diagnosis and treatment of conditions affecting the skeletal system, including the bones, muscles, and joints. Orthopaedic specialists diagnose trigger finger by conducting a physical exam of the hand and fingers, which usually shows some sign of the condition, such as an inflamed bump or an abnormal position. Thus, there is no need to undergo an x-ray or any laboratory test.

Once diagnosed, the orthopaedic specialist will set out the treatment plan based on the severity of the condition.

Mild cases. Mild cases of trigger finger are treated with a splint, which is worn over the finger for up to six weeks. The splint keeps the finger in an extended position for the duration of the treatment, which means hand movement will be slightly limited. The goal is to promote a rest period during which the affected joint can heal and the inflammation can subside. It can also keep the fingers from curling when the patient is unaware, such as during sleep. Wearing a splint also helps reduce the pain caused by trigger finger, especially in the mornings when the pain is worst. Once the inflammation has healed, the physician will recommend some finger exercises to help the affected joint regain full mobility. However mild the situation is, the patient is also advised to refrain from repetitive gripping over the next three to four weeks.

During treatment, patients may also be given anti-inflammatory drugs such as naproxen or ibuprofen to speed up the healing of the swollen tendon.

Some patients also report an improvement after applying ice over the affected area or after soaking the hand in warm water first thing in the morning.

The total length of time it takes to treat trigger finger depends heavily on the severity of the condition.

Severe cases. In severe cases of trigger finger, the patient has three treatment options: steroid injections, a percutaneous release, and surgery. Steroid medications are used by injecting them directly into the affected tendon sheath to reduce inflammation in the area. This is the most commonly used treatment as it is simple and causes minimal pain. This is, however, only advisable for patients who are not suffering from diabetes. For those with diabetes, the success rate of 90% goes down to just 50%. Sometimes, the patient is given a second injection to achieve the desired results.

In some cases, patients may need a percutaneous trigger finger release, a procedure where a needle is used to cause the locked finger to release. The percutaneous release is most effective when the index, middle, and ring fingers are the ones affected.

In other severe cases, surgery may also be required, although such situations are rare. Surgery, however, is only used as a last resort when the locked finger does not respond to other releasing techniques. To surgically treat trigger finger, an incision is made at the base of the affected finger, and through the incision, the orthopedic surgeon cuts the constricted part of the sheath to allow the tendons to slide easily through again. This procedure has to be performed in an operating room with the patient under local anesthesia, but it can be done on an outpatient basis.

Trigger finger may be a painful condition, but it does not have to be a permanent one. Existing techniques for treating trigger finger helps ensure that patients will not have to continuously live in pain and that the fingers’ normal movement is restored.

References:

• Akhtar S, Bradley M, Burke F. “Management and referral for trigger finger/thumb.” British Medical Journal.
• Al Hasan Makkouk, Oetgen M, Dodds S. “Trigger finger: etiology, evaluation, and treatment.”
• Sato E., Gomes dos Santos J., Joao B., et al. (2011). “Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release, and open surgery.” Rheumatology, Oxford Journals.