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Trigger Finger
What is trigger finger?
The technical term is stenosing tenosynovitis. This occurs when a tendon (which is what moves the finger or thumb) is swollen and it cannot slide through the tight tunnel which keeps the tendon next to the bone. At times the tendon may even have a knot in it. When this knot is forced into the tunnel or out of it, the finger will trigger. Every time the finger triggers it swells more and the process worsens. Though the problem is in the palm at the level of the creases, it can feel as though it is in the finger itself.
What causes this problem?
Most times the cause is unknown but it can be associated with rheumatoid arthritis and diabetes.
My finger hurts at the crease but it does not trigger. Why is this?
A trigger finger can start as discomfort at the base of the thumb or the finger but not yet start to trigger.
What can I do?
The goal is to stop the locking and the pain. In the early period, a splint at night can be worn to prevent locking at night and thereby decrease swelling in the tendon. Anti-inflammatory medicine (Advil) can be taken to decrease the swelling also. Often times a cortisone shot is used to control the swelling. Only two shots of cortisone are given and are separated by one month. This prevents weakening of the tendon which can then result in rupture.
I did all that and it did not work. What now?
Surgery works very well to stop the locking and get rid of the pain. Under local anesthesia (novacaine) a cut is made in the palm and the tight tunnel is cut. Then you are asked to make a fist to show that there is no more triggering. You are moving your hand the same day and have to limit the lifting for the first week. Flexion contracture can develop in some patients, especially diabetics. Therapy can be utilized to resolve this but at times it is permanent.
It is an irritation of the tendons of the thumb side of the wrist. Two of the tendons that move the thumb are swollen and cannot slide through their tunnel normally. It can be gradual in onset or can come from a traumatic episode.
Who gets this problem?
Though it can happen in anyone, it is associated with overuse and is oftentimes seen in new mothers (from lifting the baby).
How is it diagnosed?
A history of pain and swelling, sometimes a lump, on the thumb side of the wrist is usually a giveaway. On examination, tenderness over the tendons and pain with deviation of the wrist away from the thumb while the thumb is clasped (Finkelstein's test) are positive signs of the problem.
How do I treat it?
Conservative treatments start with anti-inflammatory medication (Motrin) and splinting that includes the thumb. Some patients will find it difficult to work with this splint on. Cortisone shots in the area will help to relieve the inflammation and get rid of the problem possibly forever.
What is the surgery like?
Under local anesthesia the tight tunnel is release to make more room for the tendons. The biggest risk of the surgery is injury to a nerve in the area of the tunnel. This can cause chronic pain and number and is difficult to treat. It happens less than 1-percent of the time.
How long does it take to get better?
Most patients get better in less than 6 weeks but some take up to 6 months for full recover. Some patients will require therapy.
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