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Trigger Finger

What is Trigger Finger?

"Trigger finger" or "Trigger thumb" is the common term for Stenosing Tenosynovitis which involves the pulleys and tendons in the hand, which bend the fingers. The tendons work like long ropes connecting the muscles of your forearm with the bones of your fingers and thumb. The pulleys in the finger are a series of rings that form a tunnel through which the tendons must glide.  These are much like the guides on a fishing rod through which the line (or tendon) must pass. These pulleys hold the tendons close against the bone. The tendons and the tunnel have a slick lining that allows easy gliding of the tendon through the pulleys.

 

Trigger finger/thumb occurs when the pulley at the base of the finger becomes too thick and constricting around the tendon, making it hard for the tendon to move freely through the pulley. Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the increased resistance to the gliding of the tendon through the pulley, you may feel pain, popping, or a catching feeling in your finger or thumb. When the tendon catches, it produces inflammation and more swelling. This causes a vicious cycle of triggering inflammation and swelling. Sometimes the finger becomes "stuck" or "locked" and is hard to straighten or bend.

 

What Causes Trigger Finger?

 

The causes for this condition are not always clear. Some trigger fingers are associated with medical conditions, such as:

 

  • Rheumatoid Arthritis

  • Gout

  • Diabetes

 

Local trauma to the palm/base of the finger may also be a factor on occasion, but in most cases there is not a clear cause.

 

Signs and Symptoms of Trigger Finger

 

Trigger finger/thumb may start with discomfort felt at the base of the finger or thumb, where they join the palm. This area is often tender to local pressure. Sometimes a nodule may be found in this area. When the finger begins to trigger or lock, many people assume the problem is at the middle knuckle of the finger or the tip knuckle of the thumb, since the tendon that is sticking is the one that moves these joints.

 

Trigger Finger Treatment

 

Eliminating the catching or locking to allow full movement of the finger or thumb without discomfort, is the goal of treatment in trigger finger/thumb. Swelling around the flexor tendon and tendon sheath must be reduced to allow smooth gliding of the tendon. Your doctor may advise you to wear a splint or take an oral anti-inflammatory medication, which may sometimes help. Treatment may also include changing your activities to reduce swelling.

 

Often effective in relieving the trigger finger/thumb, is an injection of steroid into the area around the tendon and pulley. If non-surgical forms of treatment do not relieve the symptoms, surgery may be recommended. This kind of surgery is performed as an outpatient, usually with simple, local anesthesia. The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. Active motion of the finger generally begins immediately after surgery. Normal use of the hand can usually be resumed once comfort permits. Some patients may feel tenderness, discomfort, and swelling around the area of their surgery longer than others. Occasionally, hand therapy is required after surgery to regain better use.

 

For more information about simple, safe, and effective treatments for "Trigger Finger" or any other conditions of the hands or upper extremities, schedule an appointment with Dr. Sagini by calling 239-337-2003.