Trigger Finger

What is Trigger Finger?

Trigger finger is a condition characterised by pain and stiffness in the fingers or thumb, accompanied by a locking sensation during bending and straightening. It affects the tendons that flex the fingers and thumb.

In healthy conditions, these tendons glide smoothly through a series of pulleys in the fingers. Trigger finger arises when the tendon becomes inflamed or swollen, leading to difficulty in movement. This inflammation can be caused by repetitive movements or forceful use of the finger or thumb. The condition is more common in certain fingers, such as the ring finger and thumb.

Symptoms

The symptoms of trigger finger vary in severity but commonly include the following:

• Finger Stiffness
  The affected finger often feels stiff, particularly after waking up. This stiffness can gradually decrease with movement throughout the day.
• Popping or Clicking Sensation
  Individuals may experience a noticeable clicking or snapping sound when bending or straightening the finger. This is due to the tendon catching against the inflamed pulley.
• Pain and Tenderness
  Initially, pain may be felt at the base of the finger or thumb, intensifying with activities that involve gripping. Over time, this pain can persist even when the hand is at rest.
• Nodular Lump
  A palpable tender lump might develop in the palm at the base of the affected finger, corresponding to an inflamed area on the tendon.
• Finger Locking
  In severe cases, the affected finger may lock or get stuck in a bent position. It might require gentle pressure or assistance to straighten.
• Difficulty with Finger Movement
  As the condition progresses, the smoothness of finger motion is disrupted, making everyday tasks challenging.

Causes and Risk Factors

Trigger finger develops due to inflammation and thickening of the tendons that bend the fingers. The precise cause of this inflammation is often unclear, but several factors can increase the risk of developing the condition.

• Repetitive Movements: Frequent and prolonged use of the fingers in gripping activities can contribute to inflammation in the tendons.
• Medical Conditions: Individuals with conditions such as diabetes, rheumatoid arthritis, and gout are at an increased risk.
• Age and Gender: The condition is more common in people between the ages of 40 and 60 and is observed more frequently in women.
• Prior Hand Surgery: Individuals who have undergone carpal tunnel syndrome surgery may have an increased risk, particularly in the first six months post-operation.

Non-Surgical Treatment Options

Non-surgical treatments for trigger finger focus on reducing inflammation, alleviating pain, and restoring normal finger movement.

• Rest and Activity Modification
  Avoiding activities that require repetitive gripping or forceful hand use can reduce stress on the affected tendons.
• Splinting
  Wearing a splint, particularly at night, helps keep the affected finger in an extended position. This reduces the tendon’s irritation and can prevent locking or catching sensations.
• Exercises and Physical Therapy
  Gentle stretching and strengthening exercises can improve the finger’s range of motion and reduce stiffness.
• Medications
  Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation.
• Steroid Injections
  Corticosteroid injections into the tendon sheath can reduce inflammation and alleviate symptoms. This treatment is particularly effective in the early stages of the condition.

Surgical Treatment Options

When non-surgical treatments are ineffective, surgery may be considered to alleviate the symptoms. These procedures aim to relieve the catching or locking of the finger, improve mobility, and reduce pain.

Open Trigger Finger Release Surgery

This is the most common method, performed under local anaesthesia. It involves making a small incision in the palm or finger to cut open the constricted part of the tendon sheath, allowing the tendon to glide more freely.

Percutaneous Trigger Finger Release

A less invasive procedure using a needle-like instrument to break apart the constricted area of the tendon sheath, often resulting in quicker recovery and less scarring.

Endoscopic Trigger Finger Release

Utilises a small camera (endoscope) to guide the surgery, involving minimal incisions and typically offering faster recovery and minimal scarring.

Ultrasound-Guided Trigger Finger Release

Ultrasound imaging can assist surgeons during a trigger finger release procedure. This real-time imaging technique enables precise identification of the constricted section in the tendon sheath, facilitating a more accurate and focused release.

Paediatric Trigger Finger Release

Paediatric trigger finger requires surgical intervention if non-surgical methods prove ineffective. The surgical approach in children mirrors that in adults, focusing on releasing the constricted tendon sheath to restore normal finger mobility.