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Trigger Finger

What is trigger finger?

Trigger finger is a condition that affects the tendons that flex (bend) the fingers and thumb. Tendons are the tough cords that attach muscles to bones. When a tendon becomes inflamed and swollen, it can get stuck in the sheath that surrounds it, or can get caught up against one of the pulleys that attaches the tendon to the bone. This can cause the finger or thumb to lock in a bent position and then suddenly snap straight, resulting in a painful popping or clicking.

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Who is affected by trigger finger?

Trigger finger can affect people of all ages, but it is most common in adults above the age of 50. It is also more common in women than in men. People who are at increased risk of developing trigger finger include those who:

  • Participate in activities that require repetitive finger movements, such as typing, sewing, or playing musical instruments

  • Have diabetes

  • Have rheumatoid arthritis

  • Have a history of hand injuries

What are the main symptoms of trigger finger?

 

The main symptom of trigger finger is pain, tenderness, and a popping or clicking in the affected finger or thumb. The finger or thumb may also lock in a bent position and then suddenly snap straight. Other symptoms of trigger finger may include:

Stiffness in the affected finger or thumb

Weakness in the affected finger or thumb

A lump or nodule on the affected finger or thumb

How is trigger finger diagnosed?

Trigger finger is usually diagnosed based on a physical exam and the patient's medical history. The doctor will ask about the patient's symptoms and activities. The doctor will also examine the finger or thumb for pain, tenderness, and range of motion limitations. The patient is asked to bend the finger or thumb in towards the hand and then straighten the digit.  In trigger finger the digit will often catch when straightening and sometimes the finger cannot be fully bent or straightened.

Imaging tests, such as ultrasound can help to formally diagnose trigger finger, where the doctor will assess for thickening of the tendon or pulley, look for fluid within the tendon sheath (tenosynovitis) and try to identify the point of catching, which is usually noted at the A1 pulley, which sits in the palm side of the knuckle joint.

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How is trigger finger treated?

 

Treatment for trigger finger depends on the severity of the condition. Non-surgical treatments are often effective. Non-surgical treatments may include:

  • Rest:

    Avoiding activities that aggravate the symptoms.
  • Splinting:

    Wearing a splint can help to keep the finger or thumb straight and reduce inflammation.
  • Stretching exercises:

    Stretching exercises can help to improve range of motion in the affected finger or thumb.
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen or naproxen, can help to relieve pain and inflammation.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain in the tendon sheath.

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a seated position across the couch.  The hand is placed palm up on the couch and the digit is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The tendon sheath/pulley injection is performed with a small dose of steroid and local anaesthetic.

The injection itself is normally completed within 15-30 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments are not effective, surgery may be an option. Surgery for trigger finger is a minimally invasive procedure that involves cutting open the tendon sheath/pulley and releasing the trapped tendon.

Additional tips for managing trigger finger pain:

  • Apply ice to the affected finger or thumb for 10-15 minutes at a time, several times a day.
  • Use a soft brace to support the affected finger or thumb, especially at night.
  • Avoid activities that aggravate the symptoms, such as typing for long periods of time or playing music for extended periods.

If you are experiencing pain, stiffness, or popping or clicking sounds in a finger or thumb, it is important to see a doctor to get a diagnosis and discuss treatment options. With early diagnosis and treatment, most people with trigger finger can recover fully and return to their normal activities.