What is trigger finger?

Trigger finger is a condition where a finger in the hand has difficulty and pain when moving and often gets stuck in a bent position. When trying to straighten the finger, there is a sensation that it is caught or stuck and it may suddenly snap open. It can occur in any finger of the hand.

Anatomy

Tendons are a type of connective tissue that link muscles to bones and move the limbs—in this case, the fingers. The flexor muscles are located in the forearm and, through tendons running inside the palm, they bend the fingers. These tendons in the palm area are surrounded by a connective tissue forming a sheath or tunnel, which holds the tendon close to the bone and allows it to glide smoothly. This tunnel starts at the palm’s peripheral area near the finger joint and extends along the length of the fingers. Each time a tendon bends or straightens a finger, it slides inside this tunnel.

How does the trigger finger problem appear?

The tendon may experience friction and irritation as it moves inside the tunnel. As this irritation worsens, both the tendon and its sheath may thicken, causing difficulty in tendon movement within the tunnel. Small nodules may even form, making it almost impossible for the tendon to enter the tunnel.

In trigger finger, the tendon can get caught inside the tunnel and temporarily the finger cannot be straightened. It may require the help of the other hand to straighten the finger, which then snaps open suddenly.

What are the main causes of trigger finger?

In most cases, the causes are unknown. However, some predisposing factors include:

• More common in women
• Age 40-60
• Diabetes mellitus
• Rheumatoid arthritis
• After manual labor or repetitive hand work

What symptoms does trigger finger have?

The most common symptoms include:

• Pain during movement of the affected finger
• Finger catching or locking during bending, often snapping open when trying to straighten
• A palpable and tender lump or nodule in the palm
• Swelling
• In advanced cases, the finger remains stuck in a bent position

Symptoms are usually worse in the morning and after periods of inactivity.

Diagnosis

Diagnosis is made based on the patient’s history and physical examination.

What should you do for conservative treatment of trigger finger?

Rest

If symptoms are mild and recently appeared, a period of rest may help reduce or resolve the problem.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce symptoms along with rest.

Corticosteroid injections

Before considering surgery, in non-chronic cases, a local corticosteroid injection may be tried.

When is surgery recommended for trigger finger?

The decision for surgery depends on the patient and the severity of symptoms. In advanced cases with permanent stiffness, surgery is inevitable.

The procedure is done under local anesthesia, does not require hospitalization, and lasts about 10 minutes.

During surgery, a small incision of about 1 cm is made in the palm near the base of the affected finger. The tendon sheath is then opened to release the tendon.

Recovery

Immediately after surgery, movement of the hand is allowed. Recovery usually lasts a few weeks and depends on the chronicity of the condition. Rarely, physical therapy may be required.