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TRIGGER FINGER
Trigger finger or stenosing tenosynovitis
Trigger finger is a condition affecting tendons that flex the fingers and thumb, typically resulting in a sensation of locking or catching when you bend and straighten your digits. Other symptoms may include pain and stiffness in the fingers and thumb.
The ring finger and thumb are most commonly affected digits; however, the condition can affect any of the digits. When the thumb is involved, the condition is, appropriately, called trigger thumb.
Anatomy
The flexor tendons are long cord-like structures that attach the muscles of the forearm to the bones of the fingers and thumb. When the respective muscles contract, the flexor tendons pull on the bones of the fingers and thumb, causing them to bend.
Each of the flexor tendons to the fingers and thumb passes through a separate tubular structure, called a tendon sheath, as the tendon makes its way across the palm and into the digit. The tendon sheaths are firmly attached to the finger or thumb bones.
Along the tendon sheath, bands of tissue called pulleys hold the flexor tendons closely to the finger bones as the fingers flex and extend. The pulley at the base of each digit where the digit meets the palm is called the A1 pulley. This is the pulley that is most often involved in trigger finger. As long as the other pulleys are functioning, the A1 pulley can be sacrificed, if necessary, to treat a trigger finger.
Symptoms and Signs
In a patient with trigger finger, the A1 pulley becomes inflamed and thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may also become inflamed and develop a small nodule on its surface, further aggravating the condition. When the digit flexes and the thickened nodule passes through the tight pulley, there is a sensation of catching or popping. This is often painful.
In a severe case of trigger finger, the digit locks and becomes stuck in a bent position. Sometimes the patient must use their other hand to straighten the finger or thumb manually.
In the worst cases, the digit can't be straightened at all without intervention by a healthcare provider.
Symptoms may include:
- A tender lump at the base of the finger or thumb on the palm side of the hand
- A catching, popping, or locking sensation with finger or thumb movement
- Pain when bending or straightening the digit
- Stiffness and locking tend to be worse after periods of inactivity, such as when you wake up in the morning.
Treatment
NON SURGICAL TREATMENT
Initial treatment for a trigger finger is usually nonsurgical.
Rest. Resting your hand and avoiding activities that make it worse may help to resolve the problem.
Splinting. Wearing a splint at night to keep the affected finger or thumb in a straight position while you sleep may be helpful.
Exercises. Gentle stretching exercises can help decrease stiffness and improve range of motion in the involved digit.
Medications. Over-the-counter medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), can help relieve pain and inflammation.
Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the tendon sheath at the base of the affected digit. In many cases, a steroid injection can resolve the condition. If symptoms do not improve with one injection or improve but then come back after a period of time, a second injection may be given. If two injections do not help the problem, surgery is often recommend
SURGICAL TREATMENT
If your trigger finger does not get better with nonsurgical treatment, you may wish to consider surgery. The decision to have surgery is based typically on how much pain or loss of function you have in your digit. If, however, your finger or thumb is stuck in a flexed or bent position and cannot be straightened with gentle manipulation, your doctor may recommend surgery to prevent permanent stiffness.