Trigger Finger
What is
it?
Stenosing tenosynovitis, commonly known as
trigger finger or trigger thumb, involves
the pulleys and tendons in the hand that
bend the fingers (see Diagram). The tendons
work like long ropes connecting the muscles
of the forearm with the bones of the fingers
and thumb. In the finger, the pulleys form a
tunnel under which the tendons must glide.
These pulleys hold the tendons close against
the bone. The tendons and the tunnel have a
slick lining that allows easy gliding inside
the pulleys (see Diagram 1).
Trigger
finger/thumb happens when the tendon
develops a nodule (knot) or swelling of its
lining. When the tendon swells, it must
squeeze through the opening of the tunnel
(flexor sheath) which causes pain, popping,
or a catching feeling in the finger or thumb
(see Diagram 2). When the tendon catches, it
produces inflammation and more swelling.
This causes a vicious cycle of triggering,
inflammation, and swelling. Sometimes the
finger becomes stuck (locked) and is hard to
straighten or bend.
What
causes it?
Causes for this condition are not always
clear. The medical conditions of rheumatoid
arthritis, gout, and diabetes may be
associated with trigger finger/thumb
symptoms.
Signs
and symptoms.
Trigger finger/thumb may start with
discomfort felt at the base of the finger or
thumb. A thickening may be found in this
area. When the finger begins to trigger or
lock, the patient may think the problem is
at the middle knuckle of the finger or the
tip knuckle of the thumb.
Treatment.
The goal of treatment in trigger
finger/thumb is to eliminate the catching or
locking and allow full movement of the
finger or thumb without discomfort. Swelling
around the flexor tendon and tendon sheath
must be reduced to allow smooth gliding of
the tendon. The wearing of a splint or
taking anti-inflammatory medication by mouth
or an injection into the area around the
tendon may be recommended to reduce
swelling. Treatment may also include
changing activities to reduce swelling.
If non-surgical
forms of treatment do not improve symptoms,
surgery may be recommended. This surgery is
performed as an outpatient. The goal of
surgery is to open the first pulley so the
tendon will glide more freely. Active motion
of the finger generally begins immediately
after surgery. Normal use of the hand can
usually be resumed once comfort permits.
Some patients may feel tenderness,
discomfort, and swelling about the area of
their surgery longer than others.
Occasionally, hand therapy is required after
surgery to regain better use.
To find a qualified
hand surgeon near you,
click here.
Diagram 1
Normal anatomy flexor sheath
showing pulley, tendon, and tenosynovium.
Diagram 2
Abnormal anatomy showing enlarged tendon
catching on flexor sheath.
Copyright ©
American Society for Surgery of the Hand
2001
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