Trigger Finger: Symptoms, Causes, and Treatment Options

Trigger finger

If bending and straightening your fingers causes pain, and pressing down also results in discomfort, along with a feeling of tightness in the fingers that has persisted for a month, it is important to consult a healthcare professional.
They can assess your condition and determine whether surgical intervention is necessary.

qq, 50~59 year old female. Ask Date: 2004/06/08

Dr. Chen Xingyuan reply Orthopedics

Dear Readers,
Trigger finger, formally known as stenosing tenosynovitis of the flexor tendon, is typically caused by narrowing of the first annular pulley of the flexor sheath.
This condition leads to finger pain and difficulty in extending the proximal interphalangeal joint.
The finger often gets stuck in a flexed position and cannot straighten on its own; when forcefully straightened, it suddenly snaps back, resembling the action of pulling a trigger, hence the name "trigger finger."
Normal hand function relies on the smooth and nearly frictionless gliding of tendons.
Inflammation of the tendon sheath can cause narrowing, thereby affecting tendon function.
Patients may experience pain and restricted joint movement.
Causes include acute injury, repetitive minor trauma from work or sports, tumors, infections, gout, rheumatoid arthritis, or metabolic disorders.
Trigger finger can also be idiopathic, meaning the cause is unknown, and it commonly occurs in middle-aged women, often in conjunction with De Quervain's tenosynovitis or carpal tunnel syndrome.
Studies indicate that about two-thirds of patients may have concurrent stenosing tenosynovitis in other fingers, and sometimes two or three fingers may be affected simultaneously, with 25% experiencing symptoms in both hands.
Physical examination reveals tenderness at the distal palmar crease or the metacarpophalangeal joint, and sometimes a movable nodule can be palpated.
This nodule may catch during finger flexion or extension, causing significant pain, and some individuals may be unable to fully extend their fingers.
Diagnosis primarily relies on clinical examination and medical history, without the need for X-rays or other tests.
Differential diagnoses include diabetes, rheumatoid arthritis, ganglion cysts, and hand contractures.
In severe cases, it may lead to flexion contracture of the proximal interphalangeal joint or permanent stiffness.
Treatment mainly involves oral non-steroidal anti-inflammatory drugs (NSAIDs) along with appropriate rest, or the injection of a small amount of corticosteroid into the tendon sheath.
If symptoms persist, a second corticosteroid injection may be administered after three to four weeks.
Corticosteroid injections are generally reserved for the acute phase, as repeated injections may lead to tendon rupture, elevated blood sugar levels, nerve injury, or bacterial infection.
Long-term use of medications may also result in gastric ulcers or other side effects.
In general, if symptoms do not improve after more than two injections, surgical intervention is recommended.
Surgery is safe and effective, performed under local anesthesia, typically taking about ten minutes, and can be done on an outpatient basis without the need for hospitalization.
Post-operative pain is minimal, and patients can resume function after a few days of rest.
Wishing you health and safety!
Sincerely,
Dr.
Chen

Reply Date: 2004/06/08

More Info

Trigger finger, also known as stenosing tenosynovitis, is a condition that affects the tendons in the fingers, leading to pain, stiffness, and difficulty in extending the affected finger. The symptoms you are experiencing, such as pain when bending and straightening your finger, as well as a sensation of tightness, are classic signs of this condition.

Symptoms
The primary symptoms of trigger finger include:
- Pain: This is often felt at the base of the affected finger, especially when trying to bend or straighten it.

- Stiffness: You may notice that your finger feels stiff, particularly in the morning or after periods of inactivity.

- Clicking or Popping: Some individuals experience a clicking sensation when moving the finger, which occurs as the tendon catches on the sheath.

- Locking: In more severe cases, the finger may lock in a bent position and may require manual assistance to straighten.

Causes
Trigger finger can occur due to several factors:
- Repetitive Motion: Activities that involve repetitive gripping or grasping can irritate the tendons.

- Inflammation: Conditions such as rheumatoid arthritis or diabetes can increase the risk of developing trigger finger due to inflammation of the tendon sheath.

- Age and Gender: It is more common in women and tends to occur in individuals between the ages of 40 and 60.

Treatment Options
The treatment for trigger finger can vary depending on the severity of the condition. Here are some common approaches:
1. Conservative Management:
- Rest: Avoiding activities that exacerbate the symptoms can help reduce inflammation.

- Splinting: Wearing a splint to keep the finger in an extended position can help alleviate symptoms, especially at night.

- Ice Therapy: Applying ice to the affected area can reduce swelling and pain.

2. Medications:
- NSAIDs: Non-steroidal anti-inflammatory drugs (like ibuprofen) can help relieve pain and reduce inflammation.

- Corticosteroid Injections: If conservative measures fail, a corticosteroid injection into the tendon sheath can provide significant relief and reduce inflammation.

3. Physical Therapy: Engaging in physical therapy can help improve flexibility and strength in the affected finger.

4. Surgery: If symptoms persist despite conservative treatment, surgery may be necessary. The procedure involves releasing the constricted tendon sheath, allowing the tendon to glide freely. Surgery is typically considered when:
- Symptoms have lasted for several months without improvement.

- The locking or catching of the finger significantly affects daily activities.

Conclusion
In your case, since you have been experiencing symptoms for a month, it is advisable to consult with a healthcare professional for a thorough evaluation. They may recommend starting with conservative treatments such as rest, splinting, and possibly corticosteroid injections before considering surgery. Early intervention can often prevent the need for surgical procedures and improve your overall function and quality of life.
If you do not see improvement with conservative measures, or if the pain becomes unbearable, discussing surgical options with your doctor would be the next logical step. Remember, each case is unique, and a tailored approach based on your specific situation is essential for effective treatment.

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