Trigger Finger

  • the flexor tendon of the finger becomes inflamed (tendonitis) and does not glide through the tendon sheath properly often clicking or getting stuck flexed and snapped back straight.

  • the patient will complain of pain, clicking, locking, or inability to flex the finger. Symptoms are typically worse in the morning or shortly after waking as individuals usually sleep with their hands in clenched position for some duration throughout the night.

  • Trigger finger is the result of chronic inflammation of the tendon or tendon lining called tenosynovitis or chronic inflammation of the pulley. This could be a result of overuse, repetitive motion, or simply an increase in inflammation from lifestyle.

  • The physician can feel the tendon catching or grinding at the entrance of the tunnel

  • No test is needed

The Basics

  • Splinting and anti-inflammatory medications such as ibuprofen or naproxen can be helpful if started soon after symptoms arise

  • Steroid injection is the best initial treatment. Injections work about 80% of the time and can often be a permanent cure. The injection does hurt because the palm is sensitive but it only takes a few seconds to administer. You generally see improvement within 3-4 days. You can try up to 3 shots to get rid of the symptoms.

  • Surgery is an option after a failed injection. The procedure (trigger finger release) involves a small incision and an incision / release of the entrance of the tunnel (A1 pulley). The whole surgery takes about 5 minutes.

    Additional Considerations:
    4. Recovery- You will be bandaged with your fingers free for 4 days. After 4 days you remove the bandage and cover the incision with a bandaid. You can get the incision wet with soap and clean water but do not submerge and no ocean, river, bay, or pool water. No antibiotic ointments or lotions. Activities as tolerated. Stitches come out about 10-14 days later. Almost all patients have complete relief in a few days.

    5. Anesthesia- some patients are sedated and given a numbing injection which means you feel no pain but you need pre op medical clearance , you can not eat or drink after midnight the night before the surgery, and you need a ride to and from the procedure. Other patients have the procedure done under local anesthetic ( numbing shot ) which means no pre op clearance is needed, there are no eating/drinking restrictions , and no driving restrictions.. The shot hurts about as much as the steroid shot and you will have a tourniquet on your arm. The decision boils down to the pain of the shot or the hassle of getting a pre op examination if you decide to be sedated.

    6. Therapy is rarely needed, but occasionally required to help regain range of motion or help with stretching if the patient is very stiff or for scar sensitivity

    7. Recurrence does not happen. Rarely delayed recovery occurs when the swelling of the tendon needs time to improve after the pulley is released. Failure is extremely rare and occurs because the tendon is still catching on the rest of the tunnel. You can not remove the whole tunnel so we narrow the tendon system by removing part of the tendon

Treatments

Prevention

Trigger finger is a disease of chronic inflammation. It is not contagious to other fingers but if you have enough chronic inflammation to get it in one finger you can get it in another. Lowering your chronic inflammation decreases your chance of getting a trigger finger and getting any disease of chronic inflammation. . This can be done by improving your nutrition, fitness, sleep, stress, or by using anti-inflammatory medications / supplements.