Trigger Finger
What is trigger finger?
Trigger finger, or stenosing tenosynovitis, is an inflammation of the flexor tendon sheath in the palm side of the knuckle. The tendon sheath is a tunnel or channel that holds a tendon close to the bone.
What causes trigger finger?
The condition has no direct cause, but is often associated with repetitive gripping or squeezing hand motions as well as medical conditions such as rheumatoid arthritis, gout and diabetes.
What are the symptoms of trigger finger?
Symptoms include soreness at the base or lowest joint of the finger, a painful clicking or snapping sensation while flexing or extending the finger, as well as difficulty bending or straightening the finger.
In some cases, the affected finger may become locked up in a bent position and a person must be gently straighten it using their other hand.
Illustration of trigger finger where the finger is locked in flexed position.
How is trigger finger treated?
Conservative treatments include splinting the finger in a straightened position or, in some cases, a cortisone injection. If this doesn't work, a hand surgeon may need to release the first annular ligament of the finger (a small ring in the flexor tendon sheath also known as the A1 pulley) to ease the restriction of movement caused by inflammation in the sheath.
The release of the A1 pulley is conducted by dividing the stenotic sheath. This may be done either by making an incision in the palm of the hand or by a minimally invasive percutaneous technique using a special needle instead of an open incision.
Illustration of percutaneous trigger finger release.
The first step in treatment is to reduce activities that aggravate the condition. When extension splints are used, they are initially worn at only nighttime for a few weeks. This should allow for the swelling around the tendon sheath to calm down. If the splint is not successful, an injection of cortisone may be recommended, but this is not the best option for certain patients, depending on other medical conditions they may have.
Conservative methods are always preferred to surgery, and they are usually successful for most hand disorders. However, if conservative methods are not working for particular case, surgical methods are recommended as a last resort.
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