What is a trigger finger, and how is it treated?

Trigger finger or trigger thumb may require a surgical releaseTrigger finger refers to a condition which causes a catching or locking sensation in the fingers (or thumb). It may begin only with pain, and but can progress to a situation where a finger gets stuck in the bent position and cannot be straightened (locked finger). In the early stages the finger may respond to cortisone injections. If this fails, a simple surgical procedure will resolve the problem…

Trigger finger is a painful condition of the fingers which can cause the finger to become locked. This means it may be possible to bend the finger but the finger then gets stuck in the bent position. Sometimes the other hand is needed to straighten the finger. In the most severe cases the finger may be unable to straighten at all (locked). The condition also affects the thumb and is then called a trigger thumb. The thumb and ring fingers are most commonly affected digits. More that one finger can be affected at the same time.

The most common complaint is that of pain in the palm of the hand when bending and straightening the finger. This may progress to the clicking, catching or locking as described. With time a mobile, painful nodule may be felt in the palm as the finger moves.

What is the cause of a trigger finger?

Trigger finger can cause painful lockingA trigger finger commonly occurs in people who have arthritis. There is also an association with diabetes and rheumatoid arthritis. It can sometimes occur after using the hand and fingers forcefully for a period of time. Sometimes the reason it occurs is not clear.

Bending of the fingers is controlled by flexor tendons in the hand. For the tendons to glide freely they are covered by a lining called the tendon sheath. To prevent the tendons from bow-stringing or moving out of position, they are held in place by several pulleys. These are made of strong fibrous tissue.

The problem occurs at the level of the A1 pulley. The A1 pulley is the first pulley which stabilises the tendon. It is located on the palm side of the hand, just before the start of the finger. With a trigger finger the lining of the tendon sheath becomes inflamed. This makes it difficult to pass through the A1 pulley. Bending and straightening of the finger will therefore cause pain and further inflammation.

What will happen if a trigger finger is not treated?

With time a small nodule can develop on the tendon. This can increase in size and worsen the problem. As the condition gets worse the patient can feel a catching or clicking sensation. The finger begins to lock. At this stage it is still possible to straighten the finger, sometimes using other hand. In the most severe form the finger gets stuck in the bent position and cannot be straightened.

Can a trigger finger heal on its own?

A trigger finger may heal on its own, especially if caused by a strenuous activity involving the hands and fingers. With rest, splinting and anti-inflammatories, the inflammation may resolve. If there is arthritis or rheumatoid arthritis it is less likely to heal its own.

What is the best thing to do for a trigger finger?

Initial treatment consists of rest and anti-inflammatories. A splint may be tried to immobilise the finger and reduce inflammation. If this does not help a cortisone injection may be beneficial. Cortisone is a strong anti-inflammatory and this is injected around the tendon sheath. This reduces inflammation and allows the tendon to glide freely without causing catching or locking.

Sometimes the triggering may resolve only to occur again after a few weeks or months. Two or three cortisone injections may be given. If the problem persists then surgery is considered.

What does surgery involve?

A small surgical procedure may be required to treat a trigger fingerSurgery is a simple procedure which is done on an outpatient basis. This means you do not have to spend the night in hospital. The operation is done under local anaesthetic and you will not feel anything. You also given a light sedation to allow you to sleep during the procedure, and you will not remember anything of the operation.

The surgery involves releasing (cutting through) the A1 pulley. There are various techniques – my preferred approach is to perform a small “open procedure”. This involves making a small cut on the skin. The incision is made on the palm of the hand just before the start finger. The A1 pulley is located and released. Any excessive inflammatory tissue can be removed.

Trigger finger sometimes occurs in patients with carpal tunnel syndrome. A trigger finger release and a carpal tunnel release can be performed at the same time (read: Performing surgery for carpal tunnel syndrome).

Other methods involve cutting the pulley through the skin using a needle. As this is not done under direct vision, there is an increased risk of incomplete release and of damage to surrounding nerves.

How long does it take to recover from surgery ?

After the operation the skin is closed with two or three small nylon structures. These are removed 10 days after the surgery. No splint is used, and movement of the finger is encouraged straight away. After successful surgery there is an immediate resolution of the locking and catching. Residual swelling and inflammation may take many weeks to resolve, however.

Yours in good health,

Dr Warren Matthee

MB BCh (Wits), MRCS (England), MMed (Ortho Surg), FC Orth (SA)

Orthopaedic Surgeon

admin@drmatthee.com

(011) 304 6784

About the author…

I am an orthopaedic surgeon with a special interest in sports injuries and minimally invasive (arthroscopic) surgery of the knee and shoulder. I treat patients at Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. Besides these, I also treat patients from other areas as well, including Rosebank, Sunninghill and Fourways.

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