Trigger finger (or stenosing tenovaginitis) is a condition that affects the pulleys and tendons that bend your fingers. It causes painful ‘catching’ or ‘locking’ of the fingers or thumb.
The tendons are fibrous cords that connect the muscles in your forearm to the bones in your fingers and thumb. The pulleys are a series of rings anchoring the tunnel through which the tendons pass (the ‘tendon sheath’) to the bone.
You get trigger finger or thumb when the tendon sheath becomes inflamed, the pulley at the base of a finger or thumb thickens and constricts the tendon, or the tendon itself enlarges. In each case, the tendon is restricted in its passage through the tendon sheath. This usually results in discomfort and/or a feeling of ‘popping’ or ‘catching’ in the affected finger or thumb. Each time the tendon ‘catches’ it becomes more irritated and swollen. Your finger may become difficult to bend or straighten, or it may even become ‘locked’ in one position.
Causes
Often the direct cause of trigger in an individual is unclear, and there can be more than one contributing factor, including:
- Arthritis
- Diabetes
- Gout
- Repeated gripping (eg of a power tool or musical instrument) over a period of time
Occasionally trigger finger may begin with an injury to the base of the affected finger or palm, but this is relatively uncommon. Trigger finger occurs most commonly in women, and most often in people over 40.
Symptoms
Symptoms of trigger finger include:
- Discomfort or tenderness where your finger or thumb joins the palm
- A nodule or ‘knot’ at the base of your finger or thumb
- Difficulty bending and/or straightening your finger or thumb
- Finger stiffness, especially when you first wake in the morning
- A ‘catching’ sensation when your finger is bent, before it ‘pops’ straight
- ‘Locking’ of the finger in a bent position
Trigger finger most often occurs in your dominant hand, and most often affects your thumb, middle or ring finger. However, both hands and more than one finger may be affected at a one time.
You should consult your local GP or contact the Hand Centre if you experience any of these symptoms.
Diagnosis
Trigger finger is diagnosed by taking a detailed history and conducting a thorough examination. It is relatively straightforward. Your specialist may ask you to open and close your hand, check for areas of pain, discomfort and swelling, and investigate smoothness of motion and evidence of locking in your fingers.
Treatment
In mild cases of trigger finger, splinting and/or an oral anti-inflammatory medication may be sufficient to reduce the swelling in the tendon, prevent ‘catching’ or ‘locking’ and permit full and free movement of the finger or thumb. In more severe cases, or where non-surgical treatments do not relieve the symptoms, surgery may be the best option.
Conservative treatment
If your trigger finger is mild and you choose a non-surgical treatment, the hand surgeons and hand therapists at the Hand Centre will work with you to determine the best management plan for you. Such a plan might involve:
- Splinting for up to 6 weeks to rest your affected finger or thumb in an extended, and to prevent you from curling your fingers during sleep.
- Finger exercises to assist in maintaining mobility in your finger or thumb
- A change in activity for 3 to 4 weeks, avoiding repetitive and prolonged gripping
- Advice on ways to use your hand so as to prevent further aggravation of the condition
- Oral anti-inflammatories to relieve swelling and pain.
- Steroidal injections into the area around the tendon and pulley to reduce inflammation and swelling. These are usually most beneficial if given soon after symptoms begin.
Operative treatment
If your trigger finger is moderate to severe, or if non-surgical treatment has failed to relieve your symptoms, you may choose to undergo surgery to open the pulley at the base your affected finger or thumb so that the tendon can move through it freely. This procedure is usually referred to as a trigger finger release. It can be performed in a hospital or a day surgery, either under a general anaesthetic or under sedation with a local anaesthetic. It is most common for the surgery to be performed under a general anaesthetic.
If you are a public patient, you will go on a waiting list for your surgery. The waiting time can be up to two years. If you are a private patient, you can generally have your surgery at a time that is convenient to you, usually within a few weeks of diagnosis.
During your surgery, your surgeon will make a small incision in your palm at the base of the affected finger or thumb and cut through the first pulley, relieving the constriction on the tendon as is passes through the tendon sheath. If the lining of the tendon itself is inflamed, your surgeon may also remove the thickened covering of the tendon, in a procedure is called a tenosynovectomy. Once this is done, your surgeon will suture up the cut and apply a light dressing to protect the wound but allow the affected finger to move.
At the Hand Centre, both private and public trigger finger procedures are usually performed under general anaesthetic.
Post-operative treatment
Following your trigger finger release, you will usually be able to go home once you have recovered from the anaesthetic. Your hand will be dressed, and you will have to keep the hand dry for a week or so. You will likely be given pain medication for the first few days and a list of instructions about what to do. If you have non-dissolving sutures, they will be removed 10 to 14 days after your operation.
You will generally be encouraged to start moving your finger almost immediately after surgery, and to return to normal activities as soon as you are able. You should see your surgeon 4 to 6 weeks after your operation. You may experience soreness at the site of the cut and general discomfort for the first 6 to 8 weeks.
You will not usually require hand therapy following a trigger finger release, unless, for example, you are experiencing greater-than-usual post-operative discomfort, require assistance in reducing post-operative scarring, or if you are returning to an activity that caused or exacerbated your trigger finger. If you require therapy, the hand surgeons and hand therapists at the Hand Centre will work with you to determine the best therapy plan for you.