Trigger Finger

What is a trigger finger?

Trigger finger is a condition that causes pain, stiffness and a sensation of catching or locking when you bend or straighten your finger. This condition is also known as “Stenosing Tenosynovitis”. The middle and ring fingers are most commonly affected, but any of the other fingers or thumb can be affected as well.

What causes the triggering?

Most of the time, it results from a repetitive movement or forceful use of your finger or thumb. A tendon usually glides easily through the tissue that covers it (called a sheath) thanks to the synovium, a membrane that surrounds joints and keeps them lubricated.

Sometimes a tendon gets inflamed and swollen. Long-term irritation of the tendon sheath can lead to scarring and thickening that affect the tendon’s motion. When this happens, bending your finger or thumb pulls the inflamed tendon through a narrowed sheath and makes it catch or pop. This catching may eventually progress to reduced movement of the finger joints and finally to a fixed locked finger in flexion.

Risk factors

Trigger finger is a common condition affecting 2 – 3 % of the population, and usually the result of repetitive movement of the hand (affects musicians, housewives, workers, etc). It usually shows up between ages of 40 – 60. It is more common in Diabetes, affecting up to 10% of Diabetics.

Trigger finger is occasionally associated with other conditions such as:

Rheumatoid arthritis

Calcific tendinitis

Previous infection

Carpal tunnel syndrome > 60% of patients with trigger digits have clinical or electrodiagnostic evidence of carpal tunnel syndrome

Amyloidosis

Hypothyroidism

Sarcoidosis

Gout/Pseudogout

How is is treated?

Treatment really depends on how severe your symptoms are.

For mild symptoms (Grade 1 and 2), we will start with:

Rest – Activity modification to reduce pain and swelling in the affected finger.

Splinting – restricts movement and prevents triggering. This will allow some of the inflammation to settle down.

Oral anti-inflammatory medications such as Arcoxia or Celebrex

Steroid injections (H and L)

A mixture of corticosteroid (such as Triamcinolone) and local anaesthetic (such as Lignocaine or Marcaine) is injected into the affect tendon sheath. This technique can give good relief to symptoms for early stages (Grade 1 – 2) of the disease.

Some patients may require 2 injections to obtain resolutions of symptoms. Also, this modality of treatment may be less effective in longstanding or later stages of the disease (Grade 3 and 4).

Release of Trigger Finger

Surgical release of trigger finger is a very common procedure bearing excellent results with 97% complete resolution of triggering. Release is done by dividing the A1 pulley which is the usual site of the stenosis. This can be done with one of two techniques; Open or Percutaneous.

Open release

The doctor will make a small cut at the base of the finger and open the sheath around the tendon. This will probably take place in an operating room.

Percutaneous Release

The doctor will numb the palm of your hand then insert a needle into the area around the affected tendon. They’ll move the needle and your finger to loosen the tendon and make it work smoothly. This will probably happen in the doctor’s office. They might use ultrasound to see where the tip of the needle is.

How Long Does Recovery From Surgery Take?

The time it takes to get better depends on how bad your condition is. The choice of treatment also affects recovery. For example, you may need to wear a splint for 6 weeks. But most patients with trigger finger recover within a few weeks by resting the finger and using anti-inflammatory drugs.

You should be able to move your finger just after surgery. Raising your hand above your heart can ease swelling and pain. Full recovery may take a few weeks, but swelling and stiffness may linger for a few months.

If your finger was super stiff before surgery, the doctor will probably suggest  physiotherapy to teach you exercises to help loosen it.