When a finger or the thumb becomes locked in a bent-down position and is unable to straighten out on its own, there is a strong likelihood that it’s the result of trigger finger.
“A common disorder I treat is trigger finger,” says Bruce A. Monaghan, M.D., a board-certified orthopaedic surgeon at Advanced Orthopaedic Centers, specializing in the hand and upper extremity. “The long technical name is stenosing tenosynovitis of the finger. It doesn’t always happen in your trigger finger, but it can happen in any of the fingers of the hand.”
Trigger finger is a painful condition resulting from the tendons in the hand becoming inflamed. The muscles and tendons responsible for moving the fingers originate in the forearm and extend down into the hand where they coalesce into a narrow shaft.
“The tendons that flex your finger go into a very tight tunnel, right across the inner palm of the hand,” explains Dr. Monaghan. “There are two tendons: one that bends the finger near the top, and one that bends it at the middle joint. So there’s a lot of stuff in a tight space.”
Trigger finger can result from overuse and repetitive strain on the hand. As the tendons move through the sheath tunnel, they can become inflamed over time and even develop bumps, wreaking havoc with the normal functioning of the fingers.
“If the wall of the tunnel gets tight, if the tissue between the tunnel gets swollen or if the tendon develops a nodule, you actually have too much stuff in there and it’s like trying to fit a square peg in a round hole,” says Dr. Monaghan. “And people can’t move their fingers or they get stuck down, and they actually have to straighten it and it pops, which can be very uncomfortable, or they have to push it up with their other fingers.”
What Causes Trigger Finger?
The exact causes of trigger finger are hard to pin down, but certain factors can increase one’s chances of developing it. Trigger finger is seen more frequently in women than in men and occurs most often in individuals between 40 to 60 years old. Certain conditions (rheumatoid arthritis, gout, and diabetes) have been linked to increased incidences of trigger finger.
In addition, physical activities or repetitive motions can stimulate trigger finger. Some of these activities involve repeated motions when working on a farm, in a factory, or playing a musical instrument. The strain caused by continuous firm grasping of sporting equipment or power tools can also lead to trigger finger.
Symptoms of Trigger Finger
Dr. Monaghan with a patient.
The symptoms associated with trigger finger can range from infrequent, innocuous snapping of the finger, to serious debilitation and pain as a result of the finger locking in a downward position in the palm of the hand.
The thumb, middle or ring fingers are the most commonly affected, but numerous fingers can be afflicted at the same time. Common symptoms of trigger finger include:
Pain, sensitivity or bumps at the base of the finger
A popping or clicking feeling when moving the finger
An inability to straighten a locked, bent-down finger
Limited movement of the finger
Dr. Monaghan adds: “It’s sometimes worse in the morning because the individual has slept the whole night with their finger down.”
Trigger Finger Treatment
If symptoms are mild, rest, splinting and avoiding repetitive gripping motions can be used to allow the tendons to relax until the problem resolves. Anti-inflammatory medicine may be recommended by one’s doctor to relieve pain and discomfort. Stretching exercises can also help improve the finger’s mobility and function.
Steroid injection into the tendon sheath is considered to be the most effective remedy for trigger finger. Despite some patients’ reservations about the effectiveness of steroid injections, Dr. Monaghan wholehearted affirms the success his practice has had with it.
“It’s surprising, some people come in with this idea that cortisone just masks symptoms, but this is one of those disorders in orthopaedics in general where cortisone shots can cure this disorder,” he says. “So that’s usually where we start for an overwhelming majority of people.”
When conservative methods fail to alleviate the symptoms of trigger finger, outpatient surgery may be recommended as a last resort to resolve the problem.
An orthopaedic surgeon’s objective during surgery will be to release the tunnel and free the pulley at the base of the finger allowing the tendons to move more smoothly through the tendon sheath. During the procedure, the surgeon will carve a tiny incision at the base of the finger and cut out the affected portion of the sheath tunnel.
“That 10-30% of people where the cortisone shot will not work, you open the part of the tunnel that’s too tight,” says Dr. Monaghan. “It’s a small outpatient surgery and it’s actually an interactive surgery. You might not remember helping me, but during the surgery you’ve shown me that you’re no longer locking, so I know we’ve done the job. Then we close the area of the tunnel with about two little stitches and put a slightly large band-aid on for around ten days.”
After the incision heals, the tendon will be able to slide more freely through the sheath tunnel thereby restoring normal functioning of the finger.
Recovery After Outpatient Surgery
The vast majority of patients experience a complete resolution of their symptoms following surgery, with many people able to move their fingers right after the procedure. Hand therapy or physical therapy may be recommended in some cases to restore optimal use of the fingers.
Dr. Monaghan concurs: “Most people do very, very well,” he says. “It’s usually a very quick, simple home-run for that problem.”