Trigger finger is an inflammation of the finger or thumb tendon. In its early stages it will cause pain and stiffness in the palm near to the base of the finger. With further inflammation the tendon starts to catch on the edge of its tunnel. Because the finger can get stuck and then it can be released with a sudden click, it seems like a trigger being released.
Understanding The Condition – What is Trigger Finger?
Trigger finger — medically known as stenosing tenosynovitis — occurs when the flexor tendon of a finger or thumb can no longer glide smoothly in and out of a narrow fibrous tunnel. This tunnel is in the palm at the base of the finger.
The problem arises when the tendon becomes inflamed, it swells and this means that it is prone to rubbing and getting stuck.
When the finger is flexed (bent), the zone of swelling is pulled out of the tunnel. On attempting to straighten the finger the zone of swelling finds it difficult to pass back into the tunnel – it catches and then produces a characteristic snapping or triggering sensation when it is finally forced into the tunnel with stronger attempts to straighten the finger. In the severest cases, the finger may become locked in a bent position.
Any finger can be affected with the ring finger and thumb being most commonly involved. The condition may affect more than one finger.
Signs & Symptoms – Recognising the Signs
- Pain and tenderness at the base of the affected finger, in the palm, particularly on gripping
- Affected finger feels stiff and uncomfortable to move
- If several fingers are affected there may be generalised pain in the palm
- A catching, clicking or snapping sensation when bending or straightening the finger
- A palpable nodule or lump at the base of the finger which moves with finger movement
- The finger locking in a bent position requiring the other hand to straighten it
- Symptoms most significant first thing in the morning
- Trigger finger frequently arises in conjunction with carpal tunnel syndrome (tingling / numbness in the fingers)
- Trigger finger may be mistaken for or arise in conjunction with dupuytren’s disease (thickening of tissues in the palm)
Causes and Risk Factors – Who is at risk?
Diabetes
Diabetes mellitus is one of the strongest risk factors for trigger finger. People with diabetes are significantly more likely to develop the condition — often in multiple fingers simultaneously — and may have a higher recurrence rate after treatment.
Sex & Age
Trigger finger is more common in women than men, and most frequently affects people between the ages of 40 and 60. It is uncommon in young adults except when associated with an underlying systemic condition.
Rheumatoid Arthritis
Inflammatory conditions of the joints and tendons — particularly rheumatoid arthritis — are associated with trigger finger. The underlying synovitis causes tenosynovial thickening that narrows the tendon sheath.
Repetitive Gripping
Occupations or hobbies involving prolonged or forceful gripping — such as tool use, musical instruments or certain sports — may predispose to trigger finger through repetitive microtrauma to the flexor tendon sheath.
Other Hand Conditions
Trigger finger is more common in people who also have carpal tunnel syndromed or De Quervain’s tenosynovitis. Having one of these conditions increases the likelihood of developing another.
Thyroid Disorders
Both hypothyroidism and hyperthyroidism have been associated with trigger finger. Any condition that causes fluid retention or changes in connective tissue metabolism may affect the tendon sheath.
First-Line Treatment – Steroid Injection
Corticosteroid injection into the tendon sheath. The usual guidelines are to try 2 injections per affected finger and progress to surgical release if the condition still persists.
The steroid reduces inflammation in the pulley and tendon sheath, relieving the narrowing that causes the triggering. It usually takes a week or so to start working.
Approximately 70% of patients experience significant improvement after a single injection and half of these will find that this cures the condition.
Setting: Outpatient treatment
Duration: Few minutes
Recovery: No downtime, wait approximately 1 week for results
Success Rate: 70%
- Recurrence: 50%
Minor Surgery – Open trigger finger release
The tendon is accessed through a short incision in the palm. The mouth of the tunnel is laid open and this breaks the cycle of inflammation and catching. It is a day case operation. Local anaesthetic is injected to the palm before surgery. Adhesive dressing and a light bandage are applied after operation and gentle activities can be commenced straight away after surgery.
Setting: Day case surgery
- Anaesthetic: Local anaesthetic
Duration: 20 minutes
Recovery: Commence light activities immediately, stronger activities after 3 weeks
Success Rate: 95%
Frequently Asked Questions
Will I lose movement after arthrodesis?
Yes — by design, the fused joint no longer moves. Adjacent joints will usually make up for this.
Will surgery leave a visible scar?
All finger surgery leaves a scar overlying the joint. Finger scars tend to heal well and become inconspicuous over 6–12 months.
How long does fusion take to heal?
The bones typically take at least 6 weeks to grow together (fuse). During this time the finger must be protected from forceful movement. Full return to activities usually takes two to four months.
Which is better — joint replacement or fusion?
There is no single right answer, the best procedure depends on which joint is affected, the type and severity of arthritis, your age, activity level and what you need your hand to do and your personal preferences.
How long do finger joint replacements last?
Silicone finger joint replacements are expected to last at least 10 years in 80% of cases. All implants carry a risk of eventual wear or loosening or breakage and revision surgery could be required.
Do I need rheumatology input before surgery?
For patients with rheumatoid arthritis or other inflammatory conditions, close liaison with a rheumatologist is essential before and after surgery. Disease-modifying drugs and biologic agents need to be reviewed around the time of surgery, as some increase the risk of wound complications and infection.
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