Trigger Finger

Trigger Finger is a condition that affects the tendons (tissues that connect muscle to bone) of the fingers or thumb. If you have this condition, also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis), one of your fingers or your thumb gets stuck in a bent position and then straightens with a snap. If trigger finger is severe, your finger may become locked in a bent position.

In the case of trigger finger, the flexor tendon, which controls the movements of the finger and thumb, becomes irritated as it slides through the tendon sheath tunnel that keeps the tendon in place next to the bone. As it becomes more and more irritated, the tendon may thicken and nodules may form, making its passage through the tunnel more difficult. The tendon sheath may also thicken, causing the opening of the tunnel to become smaller. As a result, the flexor tendon becomes momentarily stuck at the mouth of the tendon sheath tunnel when you try to straighten your finger. You might feel a pop as the tendon slips through the tight area and your finger will suddenly shoot straight out.

Trigger fingers are more common in women than men, and they tend to occur most frequently in people who are between the ages of 40 and 60 years of age.

In addition, people with certain medical problems, such as diabetes and rheumatoid arthritis, are at increased risk of having this disorder.

Symptoms of trigger finger usually start without any injury, although they may follow a period of heavy hand use. They include: a tender lump in your palm, a catching or popping sensation in your finger or thumb joints, pain when bending or straightening your finger, and swelling. Sometimes, when the tendon breaks free, it may feel like your finger joint is dislocating. In severe cases of trigger finger, the finger cannot be straightened, even with help. Occasionally, more than one finger is affected.

Nonsurgical Treatment

If symptoms are mild, resting the finger may be enough to resolve the problem. Dr. Pianka may recommend a splint to keep your finger in a neutral, resting position. Over-the-counter pain medications, such as non-steroidal anti-inflammatory medicines (NSAIDS) or acetaminophen can be used to relieve the pain.

Dr. Pianka also may choose to inject a corticosteroid — a powerful anti-inflammatory medication — into the tendon sheath. In some cases, this improves the problem only temporarily, and another injection is needed. If two injections fail to resolve the problem, surgery should be considered. Also note that injections are less likely to provide permanent relief if you have had the triggering for a long time, or if you have an associated medical problem, like diabetes.

Surgical Treatment

Trigger finger is not a dangerous condition. The decision to have surgery is a personal one, based on how severe your symptoms are and whether nonsurgical options have failed.

Trigger finger surgery is also known as trigger finger release. Traditionally, it is done through an open incision in the palm of your hand. However, Dr. Pianka offers a more minimally invasive option called percutaneous trigger finger release, which allows for opening of the tendon sheath using a simple needle device that is maneuvered under the skin to open the tendon sheath.  The procedure is performed in his office using local anesthesia. In most cases, the results are immediately apparent. The cost as well as the time spent at the office is significantly less than when this procedure is performed in the operating room. In addition, you’re able to remove the bandage yourself the same day, wash and use your hand correctly, and don’t need physical therapy.

 

1) Patient with trigger finger and 2) percutaneous trigger finger release.