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Trigger Finger

What is trigger finger?

Trigger finger is a painful condition in which a finger or thumb clicks or locks as it is bent towards the palm. Patients may notice intermittent locking or catching, but when severe, may not be able to re-open the finger after it is bent or flexed into the palm. Trigger finger is also known as “stenosing tenosynovitis”.

What causes trigger finger?

In most cases, the true cause of trigger finger is unknown. Generally speaking, most believe that a thickening in the outer covering or tunnel of the tendon (the “pulley”) leads to an inability of the tendon to glide freely through the tunnel. The tendon then catches on the thickened pulley, causing the catching or locking that patients suffer from. Triggering is sometimes due to tendon nodules in people known to have rheumatoid arthritis. People with insulin-dependent diabetes are especially prone to triggering, but most trigger digits occur in people without diabetes.

What are the symptoms of trigger finger?

Trigger finger usually starts with discomfort or pain at the base of the finger or the thumb. The area is often sensitive to touch or pressure, and patients may feel a lump or “nodule” in the area. As the symptoms progress, patients may experience clicking or popping of the finger during movement, or may suffer from the finger locking in a bent position. These symptoms are often worse in the morning. The finger may need to be straightened with pressure from the opposite hand.

How is trigger finger diagnosed?

The diagnosis of trigger finger is generally made on physical examination. Your doctor will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if trigger finger is suspected. Additional testing such as an ultrasound may be requested to help diagnose the injury.

What treatments are available for trigger finger?

The goal in treating trigger finger is to eliminate the swelling and catching/locking, allowing full, painless movement of the finger or thumb. At The Center for Hand & Upper Extremity Surgery, we use an algorithmic approach to treating this common problem.

First, we start with a steroid injection. This is a simple procedure that can be done in the office, and is effective in fully treating the condition with a permanent cure in about 50% of patients. If the triggering returns, another steroid injection can be administered with the same potential for curing the condition.

If triggering returns after the second steroid injection, no further injections will be administered due to increased risk of injuring the tendons. From this point, we will release the compressed tendon tunnel in a small operative procedure. Under local anesthesia, a small incision will be made to meticulously dissect away the important nerves and vessels, and decompress the tunnel with an incision through its roof. Stitches are used to close the incision, and patients will be asked to perform light exercises immediately after surgery. Pain relief is rapid and recurrence of any triggering after surgery is extremely rare.

Will I need therapy after trigger finger surgery?

Most patients do not require formal hand therapy after trigger finger release. Motion is started immediately after surgery, and stiffness is uncommon.