Trigger Finger

What is trigger finger?

Trigger finger is a condition that affects the tendons in the hand that makes it difficult to bend the finger or the thumb. Trigger finger, also known as stenosing tenosynovitis, can cause the finger or thumb to become ‘locked’ in place, and can cause pain and discomfort.

Tendons are fibrous cords that connect muscle to the bone. An intricate pulley system of ligaments, which are bands of tissue, holds the tendons in place over the bone, and forms a sheath which allows the tendon to pass over the bone smoothly. When the fingers bend or are straightened, a coating called tenosynovium helps the tendons move through the ligaments reducing friction.

Trigger finger occurs when the tenosynovium is inflamed, making it difficult for the tendons to move through the ligament pulley system, causing it to bunch up and cause a lump and the finger or the thumb can end up ‘stuck’ in a bent position. The finger or thumb can click painfully as it is straightened.

What causes trigger finger?

What causes trigger finger is not always known. However, we do know that it is more prevalent in people over the age of 40 and more cases of trigger finger are diagnosed in women. Certain medical conditions can also increase the likelihood of developing trigger finger, including diabetes and rheumatoid arthritis. Having a pre-existing hand and wrist condition like Dupuytren’s contracture or carpal tunnel syndrome can also increase the risk of trigger finger.

Activities that involve repetitive hand movement and gripping for prolonged periods of time, can also contribute to the cause of trigger finger.

Symptoms of trigger finger

Trigger finger can affect any finger including the thumb, and it can affect more than one finger and you may experience symptoms in both hands at the same time.

Symptoms can be mild to begin with and become more severe over a few weeks or months. People who have trigger finger most commonly experience the following signs:

Stiffness in one of more of your fingers, that is more pronounced in the morning
A popping or catching sensation when you move your finger which can be painful
A sore lump in the palm at the base of the affected finger
Finger becoming ‘locked’ in a bent position and won’t straighten

Non-surgical treatments

In mild cases, trigger finger can resolve on its own with a little bit of help. When symptoms first start to appear, rest the affected hand as much as possible and avoid any activities that make it worse. The use of anti-inflammatory painkillers can be taken to ease any discomfort and help reduce inflammation. You may notice that symptoms settle after a few weeks and normal function of the finger or thumb is restored.

However, some cases of trigger fingers do not resolve by themselves and need further treatment.

Splinting

Applying a splint to the affected finger or thumb helps to restrict movement and keep the joint straight helping it to heal. This treatment reduces the amount of friction between the affected tendon and the tendon sheath. Using a splint for 4-6 weeks is long enough to determine whether it has been successful in reducing symptoms.

Steroid injections

Depending on how severe your symptoms are, your doctor may recommend a steroid injection to ease trigger finger symptoms or when splinting hasn’t been effective.

Steroids work by reducing inflammation and swelling and they are injected into the affected area of the tendon sheath usually with local anaesthetic to numb the areas and ease any discomfort.

You may see an improvement 2-3 days after the injection, but it can take up to a week before you notice any significant changes to the movement of your finger or thumb. You may experience some pain in your hand following the injection, but this will subside.

If the first injection doesn’t improve your symptoms, your doctor may recommend a second steroid injection. However, this type of treatment doesn’t work for everyone and surgery may be recommended to treat the trigger finger or thumb successfully.

Surgery

When all non-surgical treatment methods have been tried and are unsuccessful in treating the condition, your doctor may advise that a minor surgical procedure called ‘trigger finger release’ is the next step. Surgery is also considered the most effective treatment if your finger or thumb is permanently ‘locked’.

Trigger finger release is performed under local anaesthetic by a hand and wrist surgeon. During the procedure, your surgeon will release the restricted pulley in the tendon sheath which is preventing movement. The surgeon will cut through the affected section of the tendon sheath enabling the tendon to move freely again.

Surgery to treat the trigger finger can be highly effective and re-occurrence in the affected finger or thumb is rare. However, it is important to ensure full recovery before resuming normal activities to reduce the risk of complications.

There are two types of surgery that your surgeon can perform to treat trigger finger:

Open surgery

For this procedure, your surgeon will administer local anaesthetic into the palm of your hand to make the area numb, so you won’t be able to feel anything. The surgeon will make a small incision into the palm of your hand along one of the crease lines and will cut through the tendon sheath to widen it to make more room for the tendon. They will flex and extend the affected finger to make sure the tendon can now move freely.

The surgeon will close the wound with stitches and apply a compression dressing.

Percutaneous release surgery

This type of surgery differs from open surgery as instead of making an incision into the skin, a needle is inserted into the base of the affected finger and guided by ultrasound imaging, the surgeon uses the needle to break up constricted tissue around the tendon sheath.

This type of surgery is performed under local anaesthetic as well, however, there is no incision so you will not require stitches or have a wound or a scar. However, there are more risks associated with percutaneous release as there isn’t a clear view of the affected tissue and surrounding tendons and nerves that could be damaged.

Recovery

After surgery, you will have a dressing applied to your wound which you can remove after a few days. You will be able to move your finger straight away and your full range of movement should return within two weeks of your surgery.

The affected hand may be painful and swollen for a few days after your procedure. You can use the following methods to ease any discomfort:

Applying an ice pack for up to 10 minutes three times a day
Keep your hand propped up and elevated above the heart.
Taking anti-inflammatory painkillers

You can start driving again when it feels safe to do so. Normally, this is 3-5 days after surgery, and you may feel that you can write and use a computer again very soon after your operation.

You can resume any sporting activities 2-3 weeks after surgery to ensure full movement and grip have returned and your wound has healed.

Returning to work will depend on the type of job you have. If you work in an office environment, you may feel you can resume work a few days after surgery. If your job involves heavy manual duties, it may be 2 weeks before you can return to work.

If you’ve had surgery on more than one finger, your recovery time may be longer.

Whilst a ‘trigger finger release’ procedure is safe, there are risks associated with this type of surgery. Complications are uncommon, but can include:

Infection
Stiffness
Tender scar
Nerve damage
Tendon bowstringing – this happens when the tendon is in the wrong position
Complex regional pain syndrome – this causes pain and swelling in the hand. It usually settles down after a few months but can cause long-lasting effects

Caring for your wound

You surgeon will advise you on how to care for your wound in the days following your procedure. You will be able to remove the dressing a few days after surgery and mild soap and warm water is all that is needed to keep it clean.

If you have stitches, you will be given an appointment time and date to return to hospital to have them removed.

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Trigger Finger

What is trigger finger?

What causes trigger finger?

Symptoms of trigger finger

Non-surgical treatments

Splinting

Steroid injections

Surgery

Open surgery

Percutaneous release surgery

Recovery

Caring for your wound

Whatever your hand or wrist condition is, we can help.

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