Trigger finger is a type of tendonitis, an inflammation of the tendons which can result from overuse. It occurs when the tendon sheath becomes swollen or thickened within the flexor tendon pulley system preventing the tendon from sliding freely. In some cases, the tendon catches and then releases. This motion is similar to the action of releasing a trigger of a gun.
Trigger finger (stenosing tenosynovitis) is a painful condition that affects the tendons in the hand. As the finger, or thumb, is bent towards the palm, the tendon gets stuck and the finger clicks, or locks.
Where does the condition develop?
The tendons that move the fingers are held in place on the bones by a series of ligaments called pulleys. These ligaments form an arch on the surface of the bone that creates a sort of tunnel for the tendon to run in along the bone. To keep the tendons moving smoothly under the ligaments, the tendons are wrapped in a slippery coating called tenosynovium. The tenosynovium reduces the friction and allows the flexor tendons to glide through the tunnel formed by the pulleys as the hand is used to grasp objects.
Normally, our tendons glide smoothly through the tendon sheath allowing for smooth and easy movements. However, tendons can have difficulty fitting through the tendon sheath if they are swollen or develop a nodule, a small round mass. The tendon sheath may also swell from irritation, creating a smaller opening for the tendons to fit through. When the tendon gets stuck in the tendon sheath it can cause pain, swelling, and a popping or catching feeling. Your finger or thumb may become stuck in one position and may be difficult to bend or straighten.
Tendons are white, fibrous cords that join bone to muscle. They allow the bone to move when the muscle contracts. In the hand, tendons run down the bones in the fingers, and are attached to the muscles in the forearm.
The tendons are held in place on the bones by a series of ligaments (strong bands of tissue) called pulleys. These are shaped like arches over the tendon, attaching it to the bone. The pulleys form a tunnel, or ‘sheath’ on the surface of the bone, which the tendons slide through.
Trigger finger occurs when a problem with the sheath means that the tendon can no longer slide easily through it. As a result, it becomes harder to bend the affected finger or thumb. The tendon can get caught in the opening of the sheath and the finger gives a painful click, like a trigger, as it is straightened.
How common is trigger finger?
Around 2-3% of people will develop trigger finger over the course of their lives. While the cause of trigger finger is not known, certain factors may increase the likelihood of it developing.
For example, it is more common in:
- people who are over 40 years of age, and
- people with certain medical conditions.
These medical conditions include other conditions in the hand, such as Dupuytren’s contracture, and some long-term conditions, like diabetes. Around 10% of people with diabetes develop trigger finger.
Your doctor can diagnose Trigger Finger or Trigger Thumb by examining your hand. Your doctor will ask you about your symptoms and level of pain. Your doctor will feel for any clicking or popping during movement and note any restricted movement. A locked finger or thumb typically leads to diagnoses of Trigger Finger or Trigger Thumb.
The cause of Trigger Finger and Trigger Thumb is not always clear. The condition is more common among women than men. It occurs most often in individuals between the ages of 40 and 60 years old. Trigger Finger and Trigger Thumb develop more frequently in people with certain medical conditions, such as diabetes, rheumatoid arthritis, autoimmune disease, and gout. Additionally, some individuals may be born with a nodule on their tendon. In some cases, repetitive gripping, such as holding tools, can cause the tendons to become irritated.
Often, the cause of trigger finger is unknown. However, many cases of trigger finger are caused by one of the following:
- Overuse of the hand from repetitive motions
- Computer operation
- Machine operation
- Repeated use of hand tools
- Playing musical instruments
- Inflammation caused by a disease
- Rheumatoid arthritis
If you experience any of these symptoms do not assume it is due to trigger finger. Some of these symptoms may be caused by other health conditions. If you experience any one of them for a period of time, see your physician.
- Finger or thumb stiffness
- Finger, thumb, or hand pain
- Swelling or a lump in the palm
- Catching or popping when straightening the finger or thumb
- Finger or thumb stuck in bent position
The swelling and irritation is usually first treated with anti-inflammatory medication or a steroid injection. If the condition does not respond to conservative treatment or if the case is severe, surgery to release the tendon may be performed.
The procedure involves making a small cut in the first pulley overlying the inflamed tendon. This procedure is done on an outpatient basis under local anesthesia with the patient free to resume normal activities in a few days.
The typical form of treatment for trigger finger involves the injection of steroids, like a cortisone injection. This injection occurs in the flexor tendon sheath and is designed to limit the swelling within the tendon, as well as restore the normal function of the flexor tendon.
Typically, only one cortisone injection is needed to correct your trigger finger problem. This will be a temporary fix, and the chance of it being a permanent fix is about 50%.
But like all forms of tendonitis and most tendon problems, if you catch it early it can be treated without the need to go and see a doctor. The earlier you catch and start treating the symptoms of tendonitis the less chance there is that the condition may become permanent.
You'll wear a bandage over the area after surgery until the stitches are removed. You will probably have a fairly large padded bandage on your hand when you return from surgery. This is to provide gentle compression and reduce the bleeding and swelling that occurs immediately after surgery. This can be removed fairly quickly, and usually only a bandage is required after the first 24 to 48 hours. You'll begin gentle range-of-motion exercises a few days after surgery.
Most patients won't need to participate in a formal rehabilitation program unless the finger or thumb was locked for a while before surgery. In these cases, the finger or thumb may not straighten out right away after the surgery. A physical or occupational therapist may apply a special brace to get the finger or thumb to straighten. The therapist may also apply heat treatments, soft-tissue massage, and hands-on stretching to help with the range of motion.
Some of the exercises you'll begin to do are to help strengthen and stabilize the muscles and joints in the hand. Other exercises are used to improve fine motor control and dexterity. You'll be given tips on ways to do your activities while avoiding extra strain on the healing tendon. You may need to return to therapy two to three sessions each week for up to six weeks
There are a couple of surgical options for trigger finger and trigger thumb, and your doctor will help you decide which is best for you. One surgery is performed on an outpatient basis. Your surgeon will numb the area and make a small opening on the palm side of your hand. Your surgeon will make an incision in the tendon sheath. This will create a larger tunnel for the tendons to fit through and enable them to glide easily.
Another option is a procedure that can take place in your doctor’s office. In some cases, the tendon sheath can be safely opened with the tip of a needle. This will also create a larger tunnel for your tendons to move through with ease.
Recovery is individualized and dependent on the extent of the condition and the type of surgery performed. Your doctor will be able to tell you what to expect. You will be able to move your fingers or thumb immediately following surgery. You may experience discomfort or swelling for a short period.
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