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Trigger Finger

Trigger Finger is a painful condition in which one of the fingers or the thumb of the hand gets temporarily stuck in a bent position and may straighten suddenly with a quick snap, similar to pulling and releasing the trigger on a gun, hence the name Trigger Finger. Trigger finger is also called as Stenosing Tenosynovitis or Flexor Tendinitis.

Trigger finger is more common in women than men, and is mostly seen among people between 40 and 60 years of age. People like musicians and industrial workers who routinely grip an item or use highly repetitive movements of the fingers for prolonged period have an increased risk of developing trigger finger. Certain medical conditions such as rheumatoid arthritis, diabetes, or gout increase the risk of developing trigger finger.

Signs and Symptoms
The initial symptoms of trigger finger are pain and stiffness in the finger or thumb. The symptoms worsen after periods of inactivity and loosen with movement. Pain and stiffness are, thus felt more in the morning, especially while firmly grasping an object or straightening your finger. A characteristic popping or clicking sensation may also be felt as you move your finger.

As the condition progresses, a bump may occur over the joint of the affected finger in the palm of the hand. Occasionally, the affected finger or thumb may get temporarily stuck in a bent position. It may suddenly pop out and straighten or you may have to use your other hand to straighten it.

Disease overview
A human hand is made up of wrist, palm, and fingers. The hands enable us to perform many of our daily activities such as driving, writing and cooking etc. The anatomy of the hand is intriguing.

Tendons are the tough, fibrous bands of tissue that attach the muscles of the forearm to your finger and thumb bones. They allow you to bend and extend your fingers and thumb. As you bend or straighten your fingers or thumb these tendon glide smoothly within a fluid-filled protective tendon sheath present next to the finger bones, which is lined by a layer of tissue called tenosynovium.

In trigger finger, tenosynovium lining the tendon sheath gets inflamed, resulting in the thickening and constriction of the tendon sheath. The narrow sheath further irritates the tendon, which also gets inflamed and thickens. The inflamed tendon may also develop nodules on it. All these changes in the tendon make its passage difficult through the already inflamed narrow sheath resulting, in pain and stiffness of the corresponding finger.

Occasionally, when you are trying to straighten your finger, the inflamed tendon may get momentarily stuck at the mouth of the tendon sheath causing the finger to remain stuck in the bent position. It may then suddenly slip through the narrow area and cause the bent finger to pop out and straighten.

Diagnosis
Your doctor diagnoses trigger finger after reviewing your symptoms and medical history. Usually, no special tests are ordered. The doctor will perform physical examination of the affected hand and fingers to look for areas of pain, smoothness of motion and evidence of locking.

Treatment
Treatment of trigger finger varies according to the severity and duration of the condition. If trigger finger is mild, your doctor will first ask you to avoid all activities that may aggravate the condition such as one that require repetitive gripping and grasping. The doctor may also put a splint on the affected finger to restrict movement and give some rest to the joint. The doctor may also suggest mild exercises to perform with the affected finger to maintain mobility.

For a more severe case, your doctor will usually prescribe NSAID’s (non-steroidal anti-inflammatory drugs) to relieve pain and inflammation. The doctor may also administer a steroid injection near or into the inflamed tendon sheath to reduce inflammation.

Surgery
Trigger finger seldom doesn’t respond to any of the above mentioned conservative treatments; in such cases your doctor may suggest surgery to prevent permanent stiffness. The aim of surgery is to enlarge the opening of the tunnel so that the tendon can slide through it more easily.

There are two types of trigger finger surgeries:

  • Open trigger finger release surgery
  • Percutaneous trigger finger release surgery

Open surgery
The surgery is usually done on an outpatient basis and you will be discharged on the same day of the surgery. The surgery is performed under local or regional anesthesia. A small incision is made in the palm and the tendon sheath is cut near the base of the finger to release the tendon. The incision is closed with sutures, and then covered with a sterile dressing.

Percutaneous trigger finger release surgery
Percutaneous trigger finger release surgery is also an outpatient procedure and is performed under local anesthesia. In this procedure, a needle is inserted into the base of the affected finger rather than making an incision in your palm. The needle is then used to cut the tendon sheath and release the tendon. As no cut is made for this procedure, no stitches will be needed and the recovery period will be shorter. However, percutaneous trigger finger release surgery has a higher risk of damaging important arteries and veins close to the tendon sheath. Thus, usually an open surgery is preferred.

Over the time, as the cut tendon sheath heals, the sheath become loose and the tendon will have more space to move through it.

Risks and complications:
The open trigger finger release surgery is relatively safe. Some complications that may be associated with the surgery may include infection, excessive release of the sheath causing bowstringing, incomplete extension of the affected finger or persistent triggering due to incomplete release even after the surgery.

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