Hand & Upper Extremity

Trigger Finger

Trigger Finger, also known as stenosing tenosynovitis or flexor tendonitis, is a condition where one of the fingers or thumb of the hand is caught in a bent position. The affected digit may straighten with a quick snap, similar to pulling and releasing the trigger on a gun, hence the name trigger finger.

Commonly reported symptoms associated with trigger finger include the following:-

• Bent finger suddenly pops out and straightens
• Finger movement creates a “popping” or “clicking” sound or sensation
• Finger feels stiff and sore
• Finger becomes bent with inability to straighten
• Symptoms are worse in morning

Causes

Trigger finger is caused by inflammation of the tenosynovium. The tenosynovium is the substance that lines the protective sheath around the tendon in the finger. This substance enables the tendon to glide smoothly within the sheath when the finger is bent or straightened. When inflammation is present, the tendon is unable to glide smoothly within its sheath causing "catching" of the finger in a bent position and then suddenly releasing the finger straight. Causes of trigger finger can include the following:

Repetitive Motion: Individuals who perform heavy, repetitive hand and wrist movements with prolonged gripping at work or play are believed to be at high risk for developing trigger finger.

Medical Conditions: Conditions associated with developing trigger finger include hypothyroidism, rheumatoid arthritis, diabetes, and certain infections such as TB.

Gender: Trigger finger is more common in females than males.

Diagnosis

Hand and wrist conditions should be evaluated by an orthopedic hand surgeon for proper diagnosis and treatment. Trigger finger is diagnosed based on the medical history and physical examination and without any special testing required.

Conservative Treatment Options

Your surgeon will recommend conservative treatment options to treat the trigger finger symptoms. Treatment options will vary depending on the severity of the condition.

Conservative treatment options may include the following:

• Treating any underlying medical conditions that may be causing the problem, such as diabetes or arthritis
• Immobilization: The finger is immobilized in an extended position with a splint for 4-6 weeks. This places the finger in a neutral position enabling the joint to rest.
• Rest the hand for 2-4 weeks or more by avoiding repetitive gripping actions. Avoid activities that tend to bring on the symptoms.
• Strengthening and stretching exercises with the affected finger may be suggested.
• Occupational therapy may be recommended for massage, heat, ice and exercises to improve the finger.
• Ice over the affected finger may help symptoms. Apply ice over a towel for
• 5-15 min, 3-4 x daily.
• Non steroidal anti-inflammatory drugs (NSAID’s) may help to relieve pain and inflammation.
• Steroid injections into the affected finger may help reduce the inflammation in the finger.

If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected, your surgeon may recommend you undergo a percutaneous trigger finger release surgical procedure to release the tendon. This surgery is usually performed in an operating room under local or regional anesthesia on an outpatient basis as day surgery. Your surgeon makes one small incision, about inch long, to the affected finger area. The surgeon then releases the tight portion of the flexor tendon sheath. The incision is then closed with a couple sutures and covered with a sterile dressing.

After surgery your surgeon will give you guidelines to follow. Common postoperative guidelines include:

• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
• Ice packs to the surgical area may be used to reduce pain and swelling.
• The bandage is usually removed after a couple days.
• Once the bandage is removed, full movement of the finger is encouraged.
• Eating a healthy diet and not smoking will promote healing

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

• Allergic reaction to medications
• Blood loss requiring transfusion with its low risk of disease transmission
• Heart attack, strokes, kidney failure, pneumonia, bladder infections
• Complications from nerve blocks such as infection or nerve damage
• Serious medical problems can lead to ongoing health concerns, prolonged  hospitalization, or rarely death

The majority of patients suffer no complications following trigger finger surgery; however, complications can occur and include:

• Infection
• Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
• Stiffness to the finger
• Trigger finger returns if sheath not adequately released

Risk factors that can negatively affect adequate healing after surgery include:

• Poor nutrition
• Smoking
• Alcoholism
• Chronic illness
• Steroid use
• Age (over 60)