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Trigger finger occurs with swelling of the flexor tendons (the tendons that allow you to flex your fingers) or with the sheath surrounding the tendon. This prevents the tendon from gliding smoothly through the sheath. When the patient forces the finger to bend, there may be a painful snap as the tendon passes through the thickened portion of the sheath called "pulleys." The finger may become locked in that bent position so that the patient must use the other hand to straighten it, which causes another painful snap.
The swelling of the flexor tendons and sheaths is sometimes associated with forceful hand use and commonly occurs in the dominant hand. Tasks in which a person continually grips an object, such as scissors or a screwdriver, can irritate the tendons, and care should be taken to alternate these tasks with others, if possible. Injuries to the palm of the hand can also irritate the flexor tendons. For that reason, repetitive stapling or stamping can lead to trigger finger, and care should be taken when performing these tasks in order to give the palm an occasional rest. The symptoms of trigger finger may also be associated with gout, metabolic disorders, or rheumatoid arthritis. Trigger fingers are common in musicians.
While discomfort in the palm at the base of the affected finger may be the first sign of trigger finger, the painful snap when bending and straightening the finger is the most common symptom. The patient feels pain over the top of the finger, in addition to pain in the palm of the hand below the finger. Occasionally, a finger or thumb will lock into position while bent, or less frequently, while straightened. The snapping is often worse overnight, and then improves during the day as the patient uses the finger more often and the nocturnal hand swelling diminishes.
The history related by the patient is usually diagnostic and can be confirmed with the classic physical signs.
Trigger finger is most often treated with non-surgical methods, such as rest with a splint and modification of those activities which may have irritated the tendons. Anti-inflammatory medicines may be given orally or by injection in the form of small doses of steroid to reduce the swelling.
The more severe cases--those in which the finger does not respond to conservative treatment or remains in a locked position--often require surgery. Performed on an outpatient basis under local anesthesia, the surgery involves the cutting of the pulley to widen the narrow tunnel and allow the tendon to glide more smoothly. After surgery, the patient may have some activity restrictions for several weeks, but many people return to work the next day following surgery.Trigger finger is most often treated with non-surgical methods, such as rest with a splint and modification of those activities which may have irritated the tendons. Anti-inflammatory medicines may be given orally or by injection in the form of small doses of steroid to reduce the swelling.
The more severe cases--those in which the finger does not respond to conservative treatment or remains in a locked position--often require surgery. Performed on an outpatient basis under local anesthesia, the surgery involves the cutting of the pulley to widen the narrow tunnel and allow the tendon to glide more smoothly. After surgery, the patient may have some activity restrictions for several weeks, but many people return to work the next day following surgery.
