What is trigger finger?

Trigger finger restricts the movement of tendons in your hand making it difficult to bend and flex a finger or thumb. It's also known as tenosynovitis and stenosing tenovaginosis.

Sometimes an irregular area on the tendon bunches slightly and catches on the pulleys (structures in your fingers) when you try to bend and straighten your finger - it's often painful and can make a clicking sound. In some cases, the tendon can’t go through the pully and your finger is stuck in a bent position.

It most often affects the thumb, ring finger or little finger of either – or both – hands. You’re more likely to get it in the hand you use most.

What causes the condition?

It's not known exactly what causes trigger finger, but it’s more common:

• In women
• If you're over 40
• If you have certain medical conditions, including carpal tunnel syndrome, diabetes and rheumatoid arthritis

It can often be caused if you put prolonged pressure on the palm of your hand, such as using a screwdriver.

What are the typical signs?

Trigger finger symptoms include:

• Pain when you flex – this is usually in the base of the finger or thumb
• A lump at the base on your finger, on the palm-side
• Stiffness and clicking when you bend and flex a finger or thumb - likely to be worse when you wake up
• Finger may become locked into a bent position and be difficult to straighten.

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and examine your hand for:

• Tenderness
• Thickening or swelling
• Stiffness
• Signs of locking and ‘triggering’ when you bend and straighten your finger.

Treatment

In some cases, trigger finger doesn't need treatment and will get better by itself. However, if it doesn’t improve, treatment is needed otherwise the finger or thumb may become permanently bent.

Non-surgical treatment: Resting the hand and using painkillers. Using a splint on the affected finger to rest it. A Steroid injection into the sheath may lubricate and also damp down the inflammation. Steroid injections can be repeated once. Further attempts may damage the tendon and your consultant will advise surgery after one or two failed injections.

Surgery: The surgery is a day case procedure usually under local anaesthetic and takes about 10 minutes. A tourniquet (a device which applies pressure to a limb or extremity in order to limit – but not stop – the flow of blood) is not often required. Local anaesthetic is infiltrated under the skin in line with the incision at the base of the digit on its flexor (front) surface. Once numb, the skin is incised and then the underlying fat is retracted. Care is taken not to injure nerves and blood vessels to the digit. At the base of the wound is the flexor sheath. The mouth of this structure (A1 pulley) needs to be released to allow the tendon and its nodule to glide in and out without catching. The nodule is not removed. The skin is sutured with absorbable sutures and a bulky dressing is applied.

Recovery

This depends on the type of treatment you’ve had, but can take from between two and four weeks depending on whether you’ve had surgery. Your consultant will be able to advise you on this.

When can I return to normal activities?

• Work - this depends on your individual employment, however if your job mainly involves sitting then you may be able to return immediately. If you have a more active role like, your consultant will be able to advise you on a suitable period of time, however it could take up to six weeks
• Driving - the hand needs to have full control of the steering wheel in case of emergency. Return to safe control of a vehicle varies between individuals but often patients can drive within the first week.
• Exercise - Once the wounds are dry you can start cardiovascular exercise, usually between 7 and 10 days. It may be several weeks before you can use your hand for weight training and gripping type activities.