By Dr. Michael G. Soojian, Coastal Orthopaedics
If you are unable to fully flex and/or extend one or more of your fingers, you may be suffering from “trigger finger.” This limited finger mobility is often associated with pain as well as a locking or catching sensation. Trigger fingers occur as a result of a localized or diffuse swelling of the tendons that bend your fingers and allow you to make a fist. The swollen tendons are then unable to pass smoothly back and forth within the tendon sheaths (or tunnels) that start at the crease of your palm and extend to each fingertip. Symptoms can range from only pain and swelling to intermittent locking and catching to a locked finger that cannot even be manually unlocked. This condition can also involve the thumb in which case it is referred to as “trigger thumb.” Overall, the ring finger is most commonly affected, followed by the thumb, middle finger, index finger, and pinky finger in that order.
Trigger finger is a clinical diagnosis, meaning imaging studies and other tests are not typically a necessary part of the work up. The majority of trigger fingers are “primary” trigger fingers, in that there is no underlying cause other than repetitive typical everyday activities. In some cases, trigger fingers can be associated with diabetes, rheumatoid arthritis, or other hand problems such as carpal tunnel syndrome. Symptoms are often worst early in the morning and get better as the day progresses. Patients who present to the office with long standing trigger fingers can often have stiffness of the neighboring joints.
Trigger fingers and trigger thumbs are usually treated without surgery. Conservative management is most successful when patients present with less than three months of symptoms. Non-surgical treatment options include rest, anti-inflammatory medicine, icing, splinting, and cortisone injections. Cortisone injections are the most effective means of treating a trigger finger without surgery. By injecting cortisone (an anti-inflammatory liquid medication) into the tendon sheath or tunnel, the tendon swelling can be reduced and the painful locking sensation can be alleviated. The goal of cortisone injection is to eliminate the problem as opposed to providing temporary relief. More severe trigger fingers and trigger thumbs may require a series of 2 or 3 injections.
When conservative treatment fails, surgery is recommended. This entails a small incision at the base of the finger in order to gain access to the tendon sheath. The opening of the tendon sheath is then widened by cutting through it lengthwise. Overall, trigger finger release is considered a minor surgery and is performed in an operating room often under local anesthesia with a light sedative. The majority of surgical pain is gone within 48 hours and most patients are fully recovered within 3 to 4 weeks. Post-operative hand therapy can be helpful for those patients who had significant stiffness prior to surgery or who had more than one finger operated on in one setting.