Trigger Finger

by Dr. Cao Manh Lieu*

What is a Trigger finger?

Trigger finger, also called stenosing tenosynovitis in medical terms, is a condition where one of your fingers can get stuck in a bent position. From there your finger may bend or straighten with a snap — like pulling and releasing a trigger.

The tendons in your fingers are fibrous cords that attach muscle to bone. They are surrounded by a protective sheath. An inflammation or irritation can cause the space between the tendon and the sheath to narrow (stenosing), this in turn limits the tendon’s capability to easily glide through the sheath when in motion. If the cause of the irritation continues, scarring and further thickening of the sheath can occur with the formation of small bumps, which will restrict the tendon’s movement even more and your finger can get “locked “in a certain position.

Causes

Trigger finger is more common in women and in people with certain conditions such as diabetes and rheumatoid arthritis. It is also more common in persons who perform repetitive and strong gripping actions for either their work or a hobby, but most of the times the cause remains unknown.

Signs and symptoms

Trigger finger usually starts out mild, mostly with tenderness or a small bump felt at the base of the finger, where it joins the palm. It can affect one finger or thumb, or multiple fingers and it can affect both hands. More severe symptoms usually develop over time, which may include:

• Finger stiffness, particularly in the morning, while trying to grasp an object or straighten your finger.
• A popping or clicking sensation when moving your finger
• Finger getting stuck in a bent position, which suddenly pops straight
• Finger getting stuck in a bent position, without being able to straighten it

Diagnosis

Diagnosis of trigger finger usually happens in the doctor’s consultation room. It does not require any specific tests but a diagnosis is made via physical examination and your doctor asking about your medical history. The physical examination involves checking for pain, tenderness and bumps on your palm and fingers and to see how smoothly your hands and fingers can open and close and whether there is any sign of locking.

Treatment

Trigger finger treatment depends largely on sever the symptoms are and since when you had them.

Medications such as nonsteroidal anti-inflammatory drugs (ibuprofen, voltaren, etc) may relive pain but will not affect the underlying cause which is the narrowing of your tendon sheath. Like with Carpal Tunnel Syndrome, there are several, non-invasive treatments available that may alleviate your symptoms, such as:

• Take rest and avoid activities that require repeated grasping or gripping until your symptoms improve.
• If this does not help your doctor may prescribe a splint to wear at night. The splint will keep the finger in an extended position and help rest the tendon, it will have to be worn for up to six weeks.
• Hand physiotherapy or stretching exercises may help to improve symptoms and your doctor may prescribe them for you.

If your symptoms are severe or if non-invasive treatments do not improve your condition, your doctor might suggest one of the following:

• An injection of a steroid medication near or into the tendon sheath can help reduce inflammation and free your tendon. This is a very common treatment, and symptoms may improve for up to one year in most people, sometimes however more than one injection is needed.
• Ultrasound guided percutaneous release of the blockage. This can be done in the doctor’s consultation or procedure room in the outpatient area. The doctor will apply a local anesthetic to your palm and fingers to numb the sensation, then he will insert a sturdy needle into the tissue around the tendon and break up the blockage under ultrasound guidance.
• Sometimes surgical treatment may be necessary. This is usually done in the operating theatre as a daycare procedure. During the surgery under local anesthesia, the doctor will make a small opening (incision) near the base of the affected finger where it joins your palm. From this opening your doctor will then cut open the section of the tendon sheath which is too tight. Sometimes you will require physiotherapy after surgery to regain smooth gliding in your tendon and full motion and of your finger but symptoms will generally stop immediately after the procedure.

Ask your doctor for advice if you experience stiffness, discomfort, problems with straightening or bending a finger, or your finger getting stuck in a certain position. — Hanoi French Hospital

* Dr. Cao Manh Lieu is an internationally trained Orthopedic Surgeon at the Hanoi French Hospital with long term expertise in the treatment of conditions and injuries of the bones, joints and muscles.

If you have any questions or want to book an appointment with our doctors, please contact us on 84 – 24.3577.1100, access www.hfh.com.vn, or email us at contact@hfh.com.vn. Address: 1 Phuong Mai St, Dong Da Dist, Ha Noi