Trigger Finger: Symptoms, Causes, and Treatment Explained by a Hand Surgeon
Trigger finger causes pain, stiffness, and an annoying catching sensation when you try to straighten it. Understanding trigger finger from other hand conditions is an important step towards appropriate treatment. Cynthia Harding, MD, a SIMEDHealth hand surgeon, takes a closer look at the causes of trigger finger, signs and symptoms, treatment options, and when an evaluation from a physician is recommended.
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Dr. Cynthia Harding is located: SIMEDHealth Hand Center - 929 US-441, Suite 401, Lady Lake, FL 32159
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What is a “trigger” finger?
A trigger finger happens when a tendon used to bend a finger cannot glide smoothly through the tunnel where the tendon travels out of the hand and into the finger. There are two tendons that move the finger, one stopping at each finger joint. A series of thick fibrous bands holds the tendons down to the bone, preventing them from pulling away when the finger bends. These fibrous bands work in the same way the eyes on a fishing rod does to hold the line on the rod.
Normally, the tendons fit easily under the bands. However, if the tendons or their linings become irritated, they can swell, or nodules can enlarged along them. When this happens, the tendon no longer moves smoothly through the tunnel, and will take more force to pull through the tunnel, resulting in finger stiffness and pain. If the swelling of the tendon or lining takes the form of a nodule or lump, it may catch as it tries to go under the first fibrous band. This “catch” may cause the finger to stick in a bent position, and “pop” when it is straightened, as the nodule is forced under the band. This is what is known as the “trigger.”
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What causes it?
Sometimes the cause is never identified, and sometimes it may be due to several things occurring together. It’s thought that repetitive or forceful gripping activities may play a role, although this is not always the case. Trauma, diabetes and inflammatory arthritis may make predisposed one to developing a trigger finger. It is more common in women than men, particularly in ages over 40-50 years.
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How can we distinguish pain caused by trigger finger, from arthritis or another condition?
Trigger finger can be identified by the typical symptom of a painful catching of the finger in a bent position, with a subsequent “popping” sensation when you try to straighten it. There is usually a painful area in the palm of the base of the finger at the crease when the fingers bend at the knuckle. This is where the tendons catch on the first band at the entrance to the tendon tunnel. Sometimes, if the tendons or lining are just swollen, without a nodule, there will not be a popping sensation, just stiffness and pain.
Arthritis can cause pain and stiffness as well. If your finger is painful when you press on a joint itself, it is more likely arthritis than a trigger. Arthritic joints may also be enlarged, or crooked. Another condition confused with trigger finger is called Dupuytren’s disease. If you can feel a distinct thickened, non-painful cord, in the palm leading to the finger, this is more likely to be Dupuytren’s disease. In this condition, when the cord contracts, the finger may be pulled forward towards the palm, and unable to be straightened due to the shortening of the cord.
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What non-surgical treatment options are available for trigger finger?
Rest, activity modification, oral and topical anti-inflammatory medications (NSAIDs), and splinting. Treatments with a hand therapist may be recommended for specific exercises and modalities. Finally, steroid injections, although painful, can help resolve the symptoms by decreasing the swelling in and around the tendon lining and allowing the tendons to glide more smoothly. These can last variable periods of time, from a few months to over a year.
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When is surgery recommended, and what does it involve?
If the non-surgical treatment does not work, and the symptoms are functionally bothersome and painful, surgery is an option. The idea of surgery in general is to cut the band the tendon is catching on, and strip off any swollen tendon lining to allow the tendons to move more easily through the tunnel. The bands can be cut by placing a sharp needle through a skin and cutting the band carefully with the point of the needle. A more traditional procedure is done through a small incision in the palm of the hand, over the region where the tendon is catching. With this method, any abnormality in the tendon can be visualized, and any swollen tendon lining removed. In more severe cases, where the tendons themselves are enlarged or frayed, one of the tendons can be split along its length, and a segment removed from the side of the tendon to make it narrower so that it can better fit in the tunnel.
In general, this can be done with a local or regional anesthesia in the office or outpatient surgery center, and takes only 10-15 minutes.
Afterwards, you will be asked to get the finger moving as soon as you can, to prevent stiffness. You may be sent to hand therapy. Bandages usually stay on only a few days, and stitches removed at 10-14 days. Return to activities depends on the patient and activity demands.
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When should an individual see a physician for finger pain?
You should see a physician for hand or finger pain if you are worried about it, or if the pain or stiffness impedes your function. Don’t assume that your symptoms are “just arthritis”, and that nothing can be done. Most things are best treated early, and often with good result.