What is trigger finger? What are the treatments?

Trigger Finger

Trigger finger or "stenosing tenosynovitis" is a condition that may cause pain, popping, locking and stiffness to the affected finger, mostly in the morning. The most common fingers to be affected are the index finger and the thumb. The finger usually gets stuck in a bent position because there is inflammation that narrows the space witihin the sheath that surrounds the tendon of the finger. The most common causes of trigger finger are excess force of the fingers like gripping action, patients with diabetes or rheumatoid arthritis, and complications of carpal tunnel syndrome surgery.

The fingers contain tendons that attach to the muscle that help with the flexion of the finger. For example, when grabbing a bottle of water, the fingers need to flex in order to grab the bottle. These tendons pass through bands of tissues called "pulleys" that are attached at the opening of the tendon sheath or base of the finger on the palm side of the hand. The "pulleys" can become inflamed and make the flexion of the finger more difficult. Over a period of time, the tendon may also become inflamed and develop a palpable nodule in the surface. The sensation of popping/locking is when the finger moves and the nodule passes through the pulley, causing pain.

The diagnosis of this condition is clinical because it is based upon the history and the examination of the patient. The physician during the physical exam would examine for any nodule or tenderness in the palm of the hand at the base of the finger and for any locking/popping when bending and straightening the finger.

The treatment for trigger finger depends on the severity. It can be treated with Non-Steroidal Anti-Inflammatory Drugs or NSAIDS (ex. Naproxen or Ibuprofen), with rest, using a splint at night, gentle stretching exercises to decrease stiffness and steroid injection into the tendon sheath at the base of the finger. If it is greatly severe, a surgical procedure is done, in which an incision with a needle is made on the palm close to the affected finger. The "pulley" is divided or released making the gliding more easily without any pain. The surgery takes to heal completely approximately 4 to 6 weeks. Just like any surgery, there can be complications with this surgery like stiffness, soreness, infection, nerve injury and persistent locking of the finger. However, patients have found great relief and improvement with the function of the finger with this surgery. 

Author
Danielle N. Perez Zamora MS3 Third year medical student at University of Medicine and Health Sciences (UMHS)

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