Trigger Finger (stenosing tenosynovitis)
At the Hand Center of Louisiana, we often treat patients with trigger finger, a painful condition that is caused by certain medical conditions, such as rheumatoid arthritis or diabetes, or forceful hand activities such as repeated and excessive pinching and grasping. Understanding this injury, including its causes, symptoms, and resulting treatments, can help you decide if you need to see an orthopaedic surgeon for evaluation.
What is Trigger Finger (stenosing tenosynovitis)?
Stenosing tenosynovitis, commonly known as “trigger finger” or “trigger thumb”, involves the pulleys and tendons in the hand that bend the fingers. The tendons work like long ropes connecting the muscles of the forearm with the bones of the fingers and thumb. In the finger, the pulleys are a series of rings that form a tunnel through which the tendons must glide, much like the guides on a fishing rod through which the line (or tendon) must pass. These pulleys hold the tendons close against the bone. The tendons and the tunnel have a slick lining that allows easy gliding of the tendon through the pulleys.
Trigger finger/thumb occurs when the pulley at the base of the finger becomes too thick and constricting around the tendon, making it hard for the tendon to move freely through the pulley. Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the increased resistance to the gliding of the tendon through the pulley, one may feel pain, popping, or a catching feeling in the finger or thumb. The catching or triggering action is distinctive of a ring trigger finger. When the tendon catches, it produces inflammation and more swelling. This causes a vicious cycle of triggering, inflammation, and swelling. Sometimes the finger becomes stuck or locked, and is hard to straighten or bend.
What Causes Trigger Finger (stenosing tenosynovitis)?
Causes for this condition are not always clear. Some trigger fingers are associated with medical conditions such as rheumatoid arthritis, gout, and diabetes. Local trauma to the palm/base of the finger may be a factor on occasion, but in most cases there is not a clear cause.
Signs and Symptoms of Trigger Finger (stenosing tenosynovitis)
Trigger finger/thumb may start with discomfort felt at the base of the finger or thumb, where they join the palm. This area is often tender to local pressure. A nodule may sometimes be found in this area. When the finger begins to trigger or lock, the patient may think the problem is at the middle knuckle of the finger or the tip knuckle of the thumb, since the tendon that is sticking is the one that moves these joints.
Treatment of Trigger Finger
Trigger finger treatment varies depending on severity and duration. Your physician will determine the appropriate treatment by reviewing your medical history and performing a physical exam. Based on this analysis, your physician will recommend a treatment plan consisting of one or more non-surgical and/or surgical options. Your treatment plan will depend on the severity of your symptoms and response to treatment.
Trigger Finger Treatment Without Surgery
Trigger finger treatment may call for non-surgical interventions. The goal of any treatment in trigger finger/thumb is to eliminate the catching or locking and allow full movement of the finger or thumb without discomfort. Swelling around the flexor tendon and tendon sheath must be reduced to allow smooth gliding of the tendon. Trigger finger treatment without surgery may call for the wearing of a splint or taking an oral anti-inflammatory medication. Treatment may also include changing activities to reduce swelling. An injection of steroid into the area around the tendon and pulley is often effective in relieving the trigger finger/thumb.
Trigger Finger Release Surgery
If non-surgical forms of treatment do not relieve the symptoms, trigger finger release surgery may be recommended. This surgery, known as trigger finger release (tenolysis), is performed as an outpatient, usually with simple local anesthesia. The trigger finger release may be performed through a small incision in the palm or with the use of an ultrasound-guided needle. The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. Both types of surgery are very low risk; most patients experience a full recovery.
Trigger Finger Surgery Recovery
Trigger finger surgery recovery time varies among patients. Active motion of the finger generally begins immediately after surgery. Normal use of the hand can usually be resumed once comfort permits. Some patients may feel tenderness, discomfort, and swelling about the area of their surgery longer than others. Occasionally, hand therapy is required after surgery to regain better use.
The recovery timeline varies for patients. Patients needing hand therapy may need to participate for up to six weeks, with multiple sessions each week. Hand therapy often uses heat treatments, soft-tissue massage, and stretching exercises to improve range of motion, as well as other exercises to strengthen hand muscles and joints, and improve dexterity and fine motor skills.
Our Orthopedic Surgeons and Therapists: Trigger Finger Surgery – New Orleans and the Gulf South Region
Trigger finger is a common hand condition that can impose on daily activities. The condition may be caused by a medical condition or certain hand activities that result in tenderness at the base of the affected finger(s), a “locking” sensation with finger movement, and/or pain with finger movement. Treating trigger finger includes non-surgical and/or surgical interventions.
If you believe you have trigger finger, contact us today to schedule an appointment with one of our highly trained physicians, who can evaluate your condition and determine the best treatment approach for you.