What is trigger finger?
Stenosing tenosynovitis, or trigger finger, is inflammation and swelling around the tendons that bend the finger. The tendons are tough, fibrous cords that connect the muscles of the forearm to the bones of the fingers and thumb. The tendons glide through a protective covering called the tendon sheath. The sheath is like a tunnel lined with a thin membrane called synovium. The synovial lining helps reduce friction as the tendons glide through the tendon sheath.
When inflamed, the synovium can be thickened to several times its normal size. This thickening reduces the amount of space through which the tendons are able to pass, thereby preventing the tendons from gliding freely through the sheath.
The “triggering”, painful snapping, or locking of the finger or thumb occurs when the finger or thumb is bent, and the swollen portion of the tendon is caught on the opening of the sheath. Straightening the finger or thumb may require using the non-affected hand to pull the finger back into an extended position, causing another painful snap as the swollen portion of the tendon passes back into the sheath.
What are the symptoms of trigger finger?
One of the earliest symptoms of trigger finger is discomfort in the area of the palm directly below the affected finger. This may lead to a painful clicking or snapping sensation during finger motion known as triggering.
As the condition progresses, the finger or thumb may actually become locked in a bent position. Though the middle joint of the finger may jump or lock, the true problem is around the base of the finger or thumb where the smooth gliding of the tendon becomes obstructed, and maximal tenderness to pressure is found.
What causes trigger finger?
In most cases, the exact cause of trigger finger is unclear. It may be the result of repetitive activities or associated with conditions such as rheumatoid arthritis, gout or metabolic disorders that produce thickening connective tissues and synovium, such as diabetes.
What are the treatment options for trigger finger?
Non-surgical treatment options:
- Activity modification and oral anti-inflammatories: These treatments are used shortly after the onset of symptoms to treat mild conditions.
- Cortisone injections: reduce swelling and inflammation in the sheath, allowing the tendon to glide without catching on the entrance to the tendon sheath. Important things to know:
- Two-thirds of patients are cured with one injection.
- One-fourth of patients are cured with two injections.
- Ten percent (10%) of trigger finger patients will not be helped by cortisone injections or their symptoms will return – a third injection is not likely to help.
- Cortisone injections do not work as well in patients with diabetes or those who have had symptoms for six months or longer.
Surgical treatment option:
Trigger finger release is a surgical treatment option for many patients. Frequently asked questions about this procedure include:
What does trigger finger release surgery entail?
- The procedure involves releasing the opening of the tendon sheath to relieve the constriction of the tendon as it passes though the sheath.
- An incision approximately one inch long is made in the palm at the base of the affected finger, and the tendon sheath is opened.
- Additional removal of thickened tendon lining and other surrounding tissue may be necessary.
- The incision is closed with nylon sutures, a dressing and an ace wrap that allows for motion of the finger.
How long will it take to recover from surgery?
The dressing will remain on the hand for 7-10 days. Activities are allowed as long as they are comfortable.
Will this surgery relieve my symptoms?
After surgery, the tendon will no longer rub on the sheath as the inflammation and swelling go down. The portion of the tendon sheath remains open, and in most instances, full finger motion returns following recovery. The risk of recurrence is very small.
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