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    Trigger Finger (1)

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    Trigger Finger

    Uploaded by

    TJPlayz

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    Trigger Finger

    A trigger finger is a very common and treatable problem.


    It can occur in both fingers and the thumbs, which have
    tendons that help them to bend. The flexor tendons that
    bend the fingers have a lining on the outside. This lining is
    called tenosynovium. The tendon and lining are covered
    by a series of thick, soft tissue called pulleys. The tendon
    and its lining are designed to glide through the pulleys
    without friction. The pulleys are similar to how a line is
    held on a fishing rod (Figure 1).

    A trigger finger, sometimes referred to as a trigger


    thumb or stenosing tenosynovitis, can occur if one of
    three things happen: 1. The tendon enlarges (does not fit
    through pulley well); 2. The lining increases in thickness
    (does not fit through pulley well); 3. the pulley becomes
    thicker (the opening for the tendon gets smaller). The fin-
    ger tendon and pulley system is designed to have the ex-
    Figure 1: The pulley and tendon in a finger, gliding
    act right sizes of each structure. The change in size of any
    normally.
    of the important finger structures can cause problems.
    If the tendon becomes tight within the pulley, the lining
    gets squeezed and reacts with thickening. The bigger lin-
    ing then produces more fluid. And the higher volume of
    fluid increases pressure. The undersurface of the pulley
    can also change and thicken. This thicker pulley causes
    friction on the moving tendon. This makes it difficult for
    the tendon to move back and forth (Figure 2).

    The good news is that trigger finger can be diagnosed by


    the history, symptoms, and a physical exam. It is rare to
    require other diagnostic testing. It is also helpful to know
    this problem has several very successful treatments.

    Causes
    Trigger fingers are more common with certain medical
    conditions. Rheumatoid arthritis, gout and diabetes are
    risk factors for this condition. Repeated and strong grip-
    ping may lead to the condition. In most cases, the cause of Figure 2: As in trigger finger, if the pulley becomes
    the trigger finger is not known. too thick, the tendon cannot glide through it.

    Signs and Symptoms to a nodular swelling within the tendon or the


    Some symptoms of trigger finger can include: development of a fluid filled cyst. The cyst is called
    a flexor sheath ganglion.
    • Pain: Trigger finger may start with discomfort felt • Stiffness or loss of motion: A trigger finger may
    at the base of the affected finger or thumb, where result in loss of the ability to bend the finger. This
    the finger joins the palm. This may be the only ini- can be estimated by how far the tip of the finger
    tial symptom. This pain occurs with pressure over is from the palm of the hand when the patient
    the A1 pulley area. The pain is often only present is asked to bend the finger as much as they can.
    with activity such as gripping. When at rest, it This is most common in chronic, untreated trigger
    may not hurt. Over time, if there is increased fluid fingers. It can be painful to try and bend the finger
    production in the tendon sheath, this may cause due to the compression of the fluid. Over time, the
    pressure and pain even without hand use. person may start to avoid a bent position of the
    • Swelling: Over time there may be the develop- finger to limit pain. Trigger fingers can also result
    ment of a lump at the A1 pulley. This can be due in loss of the ability to straighten the finger. Some

    © 2020 American Society for Surgery of the Hand | www.HandCare.org


    Trigger Finger

    patients will feel pain trying to fully straighten. • Hand therapy. Patients may benefit from some
    When the joint does not fully straighten for several supervised and home exercises. It can be help-
    weeks, a ligament called the volar plate becomes ful to have a hand therapist teach concepts and
    shortened and limits motion. techniques such as passive joint motion, tendon
    • Mechanical symptoms: A trigger finger can cause differential tendon gliding, proximal joint blocking
    abnormal sensations or movement that are often to isolate more distal joints, edema control, and
    described as popping, catching, or locking. Some- other treatments.
    times these abnormal sensations occur while
    bending or straightening the finger, or both. Early If non-surgical treatments do not relieve the symptoms,
    on, the symptoms may be mildly painful, but as the surgery may be recommended. The goal of surgery is to
    tendon and pulley interaction becomes tighter, the open the pulley at the base of the finger so that the ten-
    pain can increase. don can glide more freely. The clicking or popping goes
    away in most cases after cutting the A1 pulley. If there are
    Treatment still mechanical symptoms after a trigger finger release,
    The goal of treatment in a trigger finger is to reduce or a flexor tenosynovectomy can be considered. This pro-
    eliminate the swelling and catching/locking, allowing full, cedure removes the thickened lining from the surface of
    painless movement of the finger or thumb. The ability to the tendons. If there are still mechanical symptoms, then
    restore the finger to what the patient believes is normal part of the superficial tendon can be removed to reduce
    or 100% is easier when the problem is diagnosed and the volume of tendon moving in and out of the rest of the
    treated as soon as possible. pulley system. It is optimal if all the above surgical treat-
    ments can be performed during the same procedure.
    Common treatment options include, but are not limited
    to: With surgical treatment, the chances of recognizing and
    treating all changes to the finger is improved when it is
    • Splinting at night. It is estimated that much of possible for the patient to be awake at the end of the
    the body’s fluid volume pools in the legs during procedure to follow instructions. By having the patient
    the day when we sit and stand due to the effects able to actively bend and straighten their fingers several
    of gravity. When someone lays flat at night, the times, the surgeon can verify the mechanical symptoms
    effect of gravity on the legs is more similar to the are absent. Finger motion can return at different speeds
    arms, so fluid may shift from the legs to the arms. depending on each patient and their unique timing of
    This may increase swelling in the fingers where symptom development, when treatments begin, and the
    pain and locking can be more frequent at night effectiveness of each type of treatment. Your orthopaedic
    and the early morning. By using a night splint to hand surgeon will develop an individual treatment plan
    keep the finger straight, it can prevent painful for you. There are different ways to perform the surgery.
    locking during sleep. However, keeping the finger There are several different surgical techniques, anesthesia
    straight all night could result in the need to spend options, and locations where the procedure can occur.
    some time and effort getting it to move smoothly
    the next morning. There can be some ongoing stiffness after hand surgery
    • Nonsteroidal anti-inflammatory drugs (NSAIDs). even if there is no more locking, and it may remain long-
    Many times, oral or topical anti-inflammatory term. Therefore, hand therapy can be beneficial after
    medication (like ibuprofen or naproxen) can be surgery whether or not it was used before surgery. There
    tried to relieve pain and improve ability to move may be some mild to moderate tenderness at the surgery
    the finger through a large arc. area for up to several months after surgery. However,
    • Changing your activity. It may be possible to limit most patients resume their normal lifestyles within a few
    or space out the amount of time spent in forceful, weeks.
    repetitive, or sustained gripping.
    • Steroid injection. Corticosteroid injections, also Learn more about common conditions of the hand and
    known as a cortisone shot, can be given at any upper extremity, including carpal tunnel syndrome and
    stage of symptoms or duration. However, there de Quervain’s tenosynovitis, by browsing the full list of
    may be better success when they are given early. diseases and conditions on HandCare.

    © 2020 American Society for Surgery of the Hand | www.HandCare.org

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