Trigger Finger

Do you experience pain, Stiffness, and a sensation of “locking” when you flex(bend) or straighten(extend) your finger? If so, you may be experiencing the common symptoms of “trigger finger”. Trigger finger or “stenosing tenosynovitis” is a common, but most importantly treatable, problem. Trigger finger can occur not only in your fingers but also your thumb which is known as “trigger thumb”. 

How does a finger bend?

Flexor tendons are cord – like structures that attach the musculature of the forearm to the bones of the fingers. When the muscles contract the flexor tendons allow the fingers to initiate the “bending” motion. These flexor tendons pass through a tunnel in the palm as well as the fingers. This tunnel is called the “tendon sheath” and allows for the flexor tendons to glide smoothly as the fingers bend and straighten(2). Following the tendon sheath there are bands of tissue called “pulleys” these pulleys hold the flexor tendons closely to the finger bones. The pulley at the base of the finger is called the “A1 pulley”. The A1 pulley is most often involved with trigger finger. 

How do the symptoms arise? 

As mentioned earlier the A1 pulley is most often involved with trigger finger. The symptoms begin to arise when the A1 pulley at the base of the finger becomes inflamed or begins to thicken(2). This anatomical change makes it harder for the flexor tendon to pass through the A1 pulley as the finger bends. As time goes on the flexor tendon may become inflamed and develop small nodules on its surface. These nodules are what create the sensation of  popping or catching which can be painful. In severe cases the finger locks and becomes stuck in a bent position. The condition is more common with certain medical conditions. Rheumatoid arthritis, gout and diabetes are risk factors for this condition. Repeated and strong gripping may lead to the condition. In most cases, the cause of the trigger finger is not known(1)

What can be done?

Many patients have partial or complete reduction of symptoms with conservative treatment. This non-surgical approach may consist of:

Hand exercises – A hand therapist will teach techniques like passive joint motion,tendon gliding, proximal joint blocking which is necessary to isolate more distal joints while protecting the A1 pulley (1).

Splinting – A splint keeps the affected finger or thumb in a protective position to prevent any painful locking and help reduce inflammation (2).

NSAIDS – Over the counter medications like (NSAIDs) can help relieve pain and inflammation.

Steroid injections – Corticosteroid, or cortisone, is an anti-inflammatory agent that can be injected into the tendon sheath at the base of the trigger finger. A steroid injection may resolve the triggering over a period of one day to several weeks(2) in the event that the injections do not yield any relief then a surgical procedure may be the only option..

Lastly the surgical approach is a procedure called “tenolysis” or “trigger finger release”. The goal of this procedure is to release the A1 pulley that is blocking tendon movement so that the flexor tendon can pass through the tendon sheath more easily. 

A combination of these treatments and others can be used to effectively treat trigger fingers. At Allied Health Solutions we treat stenosing tenosynovitis, so if you or a loved one suffers from trigger finger please do not hesitate to reach out!

Resources

  1. Trigger finger: What is? Symptoms, causes, & treatment: The hand society. (n.d.). Retrieved May 05, 2021, from https://www.assh.org/handcare/condition/trigger-finger
  2. Trigger finger – trigger thumb – orthoinfo – aaos. (n.d.). Retrieved May 05, 2021, from https://www.orthoinfo.org/en/diseases–conditions/trigger-finger/
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