Trigger finger
Trigger finger (“stenosing tenosynovitis”) is an inflammation of the tissue inside your finger or thumb, causing pain, stiffness and a sensation of locking or catching when you bend or straighten your finger.
With trigger finger or trigger thumb, the flexor tendons become swollen along with the sheath and synovium, soft tissue that allows the tendons to move easily within its sheath. This makes it hard to straighten the finger or thumb. Your finger may bend or straighten with a snap, like a trigger being pulled and released.
Trigger finger: causes and common symptoms
We can’t always determine the cause of trigger finger, but we frequently see it happen from repeated use of a tool with strong gripping, such as a drill or wrench. It is also more common in people with certain medical conditions, such as rheumatoid arthritis, gout and diabetes. To diagnose trigger finger, your provider will look for typical signs and symptoms, such as:
- Finger catching in a bent position, which suddenly pops straight, called triggering. This is more pronounced in the morning, while firmly grasping an object or when straightening your finger.
- Finger permanently locked in a bent position.
- Finger stiffness, particularly in the morning.
- Popping or clicking sensation when you move your finger.
- Tenderness or a bump in the palm at the base of finger, usually the first symptom.
Your provider will also perform a physical exam and may order imaging tests for a proper diagnosis. Trigger finger is not a form of arthritis and will not heal on its own, so you will need treatment.
Treatments for trigger finger
Nonsurgical treatments
Your provider will customize the best treatment plan for you based on the severity of your case. Typically, a patient with trigger finger will start with conservative, nonsurgical treatments, such as:
- Corticosteroid injection(s). The most common treatment, which is typically effective for a year or more. This steroid injection near or into the tendon sheath may reduce inflammation and allow the tendon to glide freely again. More than one injection may be needed.
- Heat and ice. Periodically ice the affected digit to reduce pain and inflammation. Placing it in warm water several times a day will relax the tendons and muscles.
- Medications. Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen may relieve pain but are unlikely to relieve the swelling constricting the tendon sheath or trapping the tendon.
- Percutaneous release. Your provider numbs your palm, then inserts a needle into the tissue around your affected tendon. They then move the needle and your finger to break apart the constriction.
- Rest. You’ll need to avoid activities that require repetitive gripping or the prolonged use of vibrating hand-held tools.
- Splints. Wearing a splint at night keeps the affected digit in an extended position for up to six weeks, helping rest the tendon.
- Stretching exercises. Your doctor may also suggest gentle exercises to help maintain mobility in your finger.
Surgical treatments
If your symptoms are severe or if conservative treatments aren’t working, your provider might recommend a surgical treatment called tenolysis. In this procedure, your orthopedic surgeon makes a small incision near the base of your affected finger, then cuts open the constricted section of tendon sheath so the flexor tendon can glide more easily through the sheath.
Swelling and stiffness should go away completely in four to six months. In severe cases where a contracture, or loss of motion, was present before surgery, we may not be able to restore a complete range of motion.
Your recovery from trigger finger
Most of our patients respond successfully to conservative treatments, and our patients who do have surgery experience significant improvement in function as well as relief from the pain.
Let us work with you on a treatment plan that will help you get beyond trigger finger and back to the daily activities you love.
References
Orthoinfo: American Academy of Orthopaedic Surgeons. Trigger Finger – Trigger Thumb (https://orthoinfo.aaos.org/en/diseases–conditions/trigger-finger/)
American Society for Surgery of the Hand. Trigger Finger (https://www.assh.org/handcare/condition/trigger-finger)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Trigger Finger (https://www.ncbi.nlm.nih.gov/books/NBK459310/)