What is Trigger Finger?
Trigger finger is characterized as a stenosing tenosynovitis. Stenosing refers to the tightening of the tendon passageway or sheath, and tenosynovitis refers to the inflammation of a tendon. (In this case, the tendons that allow flexion and extension of the fingers and thumb become inflamed.) The trigger effect is much like having a knot in a fishing line that catches as it goes by each of the eyelets on a fishing pole. With a trigger finger, small nodules form on the tendon and prevent smooth gliding of the tendon through the tendon sheath. Figure 1 shows inflammation at the level of the A1 pulley, which greatly restricts the motion of the flexor tendon and causes it to catch. In this way, the trigger effect is much like having a knot in a fishing line that catches as it goes by each of the eyelets on a fishing pole.
Causes can include rheumatoid arthritis, diabetes, heart failure, gout, or other metabolic disorders or rheumatologic conditions such as thyroid disease. Some believe that work activities involving repetitive motions also create a higher risk for trigger finger. Although trigger finger may occur in anyone, it is more common in women, particularly in their 50’s and 60’s. The ring finger is most commonly affected, followed by the thumb, long, index, and small fingers.
Signs and Symptoms:
Trigger finger is first recognized by the patient as soreness in the palm at the base of the thumb or fingers, and accompanying stiffness of the affected digit(s). This is often followed by a painful catching or locking of the fingers in a flexed position. It is often worse in the mornings, and may require forceful extension of the fingers or thumb to return to original position.
Conservative treatment is often utilized at first, as long as there is not prolonged locking of the finger. This may involve a splint to restrict full flexion, anti-inflammatory medications and steroid injections to reduce inflammation and discomfort, and occupational therapy.
If conservative treatment is not effective, surgery may be offered. A small oblique incision is made directly over the site where trigger occurs. The inflamed tendon sheath is released (cut) to permit the tendon to again move smoothly through the sheath.
Post Operative Rehabilitation:
- Expect a surgical bulky dressing to be kept in place for 3-4 days.
- Gentle full motion of fingers encouraged several times a day.
- Elevate and ice for at least 3 days.
- Continue to elevate as often as possible until your next clinic visit. (Elevate above your heart.)
- Shower with a plastic bag covering the splint and seal with tape.
- Take your pain medicine as needed and as prescribed. Call if any problems or questions arise.
3-4 Days Post Op:
- You may remove your bulky dressing and place band aids over your incision area.
- It will be important to keep your incision area clean and dry. (OK to shower over sutures however.)
10-14 Days Post Op (at therapy):
- Sutures will be removed.
- Therapist will address edema and scar management, strengthening exercises, and range of motion exercises.
- Therapist will issue a home exercise program as only a few visits to therapy will be necessary.
4-6 Weeks Post Op:
- Follow up appointment in clinic with the Nurse or P.A.
Note: These instructions are to serve as guidelines and are subject to Physician discretion. Actual progress may be faster or slower depending on the individual.