Trigger finger, or stenosing tenosynovitis, is a condition that affects the tendons that bend fingers and thumb, which leads to pain and stiffness of digits along with catching or locking sensation when bending and straightening them. While any of the fingers and thumb can be affected, the most frequently affected digits are the ring finger and thumb.
Irritation and swelling of the tendon sheath cause trigger finger, making it difficult for the tendon to slide smoothly. Symptoms include a lump or tenderness in the palm, catching or locking of the finger in a bent position, and pain. More prevalent in women over 50, the disease may result from repetitive gripping, certain health conditions like diabetes or rheumatoid arthritis, and heavy or extensive hand use. The treatment includes rest, splinting, medicines and surgery in severe cases.
What is Trigger Finger/Thumb?
Trigger finger and thumb, or stenosing tenosynovitis, is an inflammatory disorder causing fingers to lock bent and snap when straightened. The disease may involve any digit, but it most commonly affects the ring finger and thumb. The anatomy of the flexor tendons and the role of tendon sheaths and pulleys in the fingers and thumb are as follows:
- Flexor tendons: They are bands of tissue that connect muscles to bones and allow for the bending of fingers as well as thumbs.
- Tendon sheaths: A sheath, which is a tunnel of tissue enabling easy sliding, surrounds these tendons.
- Pulleys: Thick soft tissue bands that adhere the flexor tendons close to the finger bones with movement. There are three main pulleys in the fingers: A1, A2, and A3.
Trigger finger arises due to the thickening or swelling of either tendon or its sheath which makes the movement of affected digits difficult. This may lead to the finger locking in a bent position and then snapping when straightened. Women over 50, more prone to the condition, may experience it due to factors like repetitive gripping, certain health issues such as diabetes or rheumatoid arthritis, and extensive hand use. Treatment methods include rest, casting, medication and in severe cases surgery.
Symptoms and Diagnosis
Trigger finger presents with several symptoms such as pain, stiffness, and the feeling of “clicking” or “snapping” when flexing fingers and thumb. The symptoms may include:
- Tenderness or a lump in the palm at the base of the affected finger or thumb.
- Finger trapping or locking in a bent position that may suddenly pop straight.
- Morning finger stiffness.
- A sensation of catching, popping or locking while moving the finger or thumb.
- A cracking or popping feeling when bending or straightening the finger that is worse with keeping the finger still and better with movement.
Causes and Risk Factors
A trigger finger occurs when a swelling of the tendons in the fingers or thumb causes pain, stiffness, and difficulties in moving the affected digit. The condition is commonly experienced by women over the age of 50 and is associated with various risk factors, including:
- Repeated gripping: Jobs and activities that require repetitive hand usage and sustained gripping might lead to a trigger finger.
- Certain health problems: Trigger finger is more likely to occur in patients with diabetes, hypothyroidism, rheumatoid arthritis, gout and other diseases
The medical community does not have a clear understanding of the precise cause of trigger finger, but it believes it to be multifactorial, with associations to comorbid diseases such as diabetes, rheumatoid arthritis, and other health conditions. Trigger finger is the consequence of repetitive movements or forceful use of the finger or thumb that result in tendon inflammation.
Trigger finger, or stenosing tenosynovitis, causes pain, stiffness, and a catching or locking sensation when bending and straightening fingers and the thumb. Any digit can be involved, but the ring finger and thumb are the most frequently affected. Non-surgical and surgical treatment modalities are available for the management of trigger finger.
Non-operative treatment options for trigger finger include:
- Rest: The condition can be relieved by avoiding activities that cause pain or aggravate the symptoms.
- Splinting: Wearing a splint at night or during aggravating activities helps maintain proper finger position and reduces pain.
- Stretching exercises: Stretching exercises that are gentle can help increase the range of motion and reduce stiffness.
- Cortisone injections: An injection of cortisone may help relieve inflammation at the affected tendon, offering a short-term solution.
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs including ibuprofen can be used to treat the underlying inflammation responsible for the trigger finger. However, they are not advised as a long-term treatment because of the associated side effects.
Surgical interventions for significant trigger finger cases include:
Tendon release surgery involves a small incision on the sheath around the affected tendons to create more space for movement. Trigger finger releases are day-case procedures, which means that patients can go home on the same day.
Treatment selection is based on the severity of the trigger finger and patient-specific factors. Most of the time, nonsurgical treatment is enough to relieve symptoms. However, advanced stages or unsuccessful attempts with other options may necessitate surgery.
Home Remedies and Self-Care
Trigger finger symptoms can be managed with home remedies and self-care measures. Some of these remedies include:
- Rest: This condition can be relieved by avoiding activities that cause pain or increase symptoms.
- Splinting: Wearing a splint at night or during aggravating activities helps maintain proper finger position and minimize pain.
- Stretching exercises: Stretching exercises that are not too strenuous can increase flexibility and relieve stiffness.
- Hot and cold therapy: Switching between hot and cold therapy can help to relieve inflammation and pain.
- Over-the-counter medications: Administering nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen can reduce swelling and pain.
Trigger finger requires an interdisciplinary team that includes nurse practitioners, hand surgeons, plastic surgeons, orthopedic surgeons, and physiotherapists. Trigger finger is first treated conservatively and may include rest, splinting, corticosteroid injections, and physical therapy. If conservative methods do not improve the patient’s condition, surgery may be necessary.
For those with trigger fingers, seeking medical treatment and evaluating options based on individual needs and symptom intensity are crucial. Managing symptoms and improving finger and thumb function is possible by understanding the condition and collaborating with healthcare professionals.
In conclusion, the trigger finger is a widespread and disabling disorder that should be treated by qualified medical specialists. Successful symptom management depends on the understanding of the condition and available treatment alternatives.