Trigger finger is one of most common causes of pain and disability in the hand. It is most prevalent in adults ages 55 to 60 and occurs more often in women than men as well as in those with diabetes. This condition is characterized by pain, stiffness, and locking of one or more digits. In adults, either the ring or middle finger is most frequently affected, while in children, it is the thumb. As the disease progresses, the affected finger may catch as it is being extended and then suddenly snap into a straightened position. Such popping or triggering is regularly accompanied by significant pain. In severe cases, the involved finger may become locked in a flexed position and extended only by applying an external force. Sometimes it cannot be straightened at all, requiring a trigger finger treatment.
Trigger finger develops when flexor tendons, which pull the digits into a fist, become stuck within the tendon sheath. Normally, the sheath allows it to glide through surrounding tissue. When this covering is inflamed and too narrow or the tendon itself is too thick, the tendon is no longer able to move smoothly. Often a small bump or nodule grows on the tendon, preventing it from sliding easily past a portion of the sheath called the A1 pulley. The pulley is a thicker, stronger band of tissue that provides structure and keeps the tendon running on its track. Triggering occurs as the nodule becomes trapped on the pulley and then releases. Underlying causes of this condition are not known, but it is sometimes related to diseases such as rheumatoid arthritis, gout, and diabetes, which affect connective tissue.
Trigger finger is diagnosed based on a physical examination and reported symptoms. Your physician will check for tenderness, palpable snapping or clicking as the finger is flexed and extended, and for a nodule near the A1 pulley. Lab tests, ultrasound, and x-ray are only used to rule out potentially related problems.
Trigger Finger Treatment
Depending on the severity and duration of the disease, the initial trigger finger treatment is either oral nonsteroidal anti-inflammatory drugs (NSAIDs) or a corticosteroid injection into the tendon sheath.
If symptoms do not improve after 1-3 injections or if they are severe and long-lasting, surgery is recommended. Under local anesthetic, a hand surgeon will cut the A1 pulley, allowing the tendon to move freely again without negatively affecting the function of the finger. Surgical release has very high rates of success and very few complications. Risks sometimes associated with this procedure include infection, nerve injury, and recurrence of symptoms. If you have any questions about potential treatment or just questions about the condition itself, please reach out to us!