common hand conditions
What is a trigger finger?
A trigger finger (stenosing tenosynovitis of the flexor tendons of the finger) is a very common condition affecting the hand. It presents with pain and a finger that “gets stuck” either while opening or closing the hand.
What causes a trigger finger?
It can either occur spontaneously or as a result of previous trauma.
Some patients are more prone to having trigger fingers such as diabetics, those with inflammatory disorders and gout.
The flexor tendons of our fingers glide within a sheath or tunnel which starts at the end of the palm (distal palmar crease or lifeline). Normally there is very little resistance to movement within the sheath because of the synovium which provides lubrication and a smooth gliding surface for the tendons.
As we get older our tendons are subject to wear and tear like everything else in our bodies. This may cause localized thickening of the tendon and or the entrance of the tunnel. Thickening can also occur because of inflammation (synovitis) from gout, repetitive trauma and long standing diabetes.
This localized thickening causes resistance to movement of the tendon within the tunnel.
Do I have a trigger finger?
Clinically a trigger finger presents with pain and difficulty bending or straightening the finger. This is often worse when waking in the morning or after heavy use of the hands. The flexed finger appears to initially catch and then spring open suddenly. It can also happen when trying to make a fist. The pain is felt at the entrance to the tunnel at the base of the finger. It may spread into the finger as a “pulling sensation”
How do you treat a trigger finger?
Treatment of a trigger finger is usually non surgical to start with unless severe.
Anti inflammatory medication may initially help as will trying to sleep with the fingers straight, not flexed into a fist. (A night splint can be made to assist with this).
Many trigger fingers can be successfully treated with 1 or more local steroid injections. This consists of an injection of local anaesthetic (lignocaine) and long acting steroid (Prenisolone) next to the tendon at the entrance to the tunnel. Steroids are very powerful blockers of inflammation.
For those not responding to an injection or in fingers that become “stuck” surgery successfully treats the triggering by releasing the entrance to the tunnel (dividing the A1 pulley).
This is a small procedure performed as a day case operation under either regional or general anaesthetic.
It is unusual for trigger fingers to recur but some patients especially diabetics may be prone to trigger fingers in multiple digits.