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Trigger Finger

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What is Trigger Finger

Stenosing tenosynovitis is often referred to as “trigger finger.” It is a sometimes painful hand condition characterized by a difficulty to straighten your fingers and a popping sensation when you are able to straighten them. After the pop, the finger will suddenly shoot straight out. The thumb or any finger can become a trigger finger, and the base of the problem is the pulley at the base of a finger thickening and tightening around a tendon, restricting the tendon’s movement. The affected finger can even get stiff and locked. Trigger finger is generally more common in women.

 

Causes

Trigger finger happens when the flexor tendons of the hand swell. The flexor tendons are cords of tissue that connect the muscles to the bones in your fingers. One of the most important functions of these tendons is to help the muscles bend and straighten the fingers and the thumb.

Normally, the flexor tendons pass smoothly through a small tunnel of tissue that surrounds the tendon, called the tendon sheath. The tendon sheath keeps the tendons attached to the bones. However, if you suffer from trigger finger, your flexor tendons can become so swollen that they are no longer able to easily glide through the small tendon sheath tunnel. Consequently, the tendons lose their ability to control the bending and the straightening of your fingers or thumb, causing them to get stuck in the bent position. This swelling of the flexor tendons is called trigger finger.

Trigger finger can be caused by a variety of factors. Repetitive motions or overuse of the fingers and thumb can contribute to its development, and therefore, individuals who work with their hands, or participate in hobbies that require heavy hand use, especially heavy grasping or gripping, generally suffer from trigger finger more often than others. For example, industrial workers and individuals who craft are at a higher risk of developing this condition. Furthermore, rheumatoid arthritis, diabetes, or a previous injury can also contribute to its development.

Sign & Symptoms

Trigger finger can come on gradually, with soreness when pressed, and there may be general discomfort at the base of the thumb or finger. Soreness or stiffness can be early warning signs of trigger finger. However, the most common characteristic symptom of trigger finger is difficulty straightening the fingers or the thumb and the catching or popping sensation that happens when you are able to straighten them. This action resembles pulling and releasing a trigger because your finger or thumb is stuck in a bent position and then it suddenly shoots straight out.

Typically, the affected finger or thumb will be visibly swollen or inflamed, and pain will develop. Trigger finger can affect several fingers and both hands at a time, and a nodule may also be found as a symptom of trigger finger.

  • Difficulty straightening the fingers or thumb
  • Catching or popping sensation when straightening fingers or thumb
  • Affected finger or thumb is swollen or inflamed
  • Affected finger or thumb is in pain
  • Soreness in the base of the finger or thumb
  • Stiffness of the fingers

 

Diagnosis & Treatment

Diagnosis can be determined by a physical examination and discussion of medical history. Depending on severity and circumstances, trigger finger may be treated either non-surgically or surgically.

Non Surgical Treatment

Typically the first step in the overall treatment of trigger finger is to rest the affected fingers or thumb. A splint may also be used to aid the rest. Anti-inflammatory medicines can be used to help get the swelling down.

Steroid Injections

If these initial, non-invasive treatment options don’t help alleviate the symptoms, a steroid medication injection may be recommended. The injection helps get the swelling down, and thus enables the flexor tendon to pass smoothly through the tendon sheath tunnel. There is a 33% chance that the trigger finger will be healed after one injection. If not, a second injection is sometimes delivered to alleviate the condition.

Surgical Options

In more serious cases, a surgery is necessary to widen the opening of the sheath tunnel so that the flexor tendon can slide through it more easily. Surgery offers a 98% chance that the condition will be resolved. There are several surgical treatment options for trigger finger release, but the two methods that HSST recommends are an open procedure or an endoscopic procedure.

A traditional surgical method to release trigger finger is typically a 10-minute open procedure. The type of open incision will vary by surgeon, but you can opt to be fully awake and receive local anesthesia, be sedated, or receive general anesthesia. In the open procedure, the skin and the subcutaneous tissues are dissected down to the tight pulley that is restricting the flexor tendon below them. The pulley is released, and the skin is then closed with stitches.

Instead of an open procedure, trigger finger can also be released using a minimally invasive endoscopic trigger finger release. In this method, smaller incisions are used, and the surgery is performed with a video camera. The endoscopic trigger finger release takes approximately the same amount of time as the open surgery. After the procedure, no stitches are needed and the results are comparable to those of the open procedure. However, it takes a very skilled surgeon to perform an endoscopic trigger finger release.

Here at the Hand Surgery Specialists of Texas, we pride ourselves on the individualized care that each one of our highly trained physicians provides to every patient. Through our state-of-the-art facility, we are able to properly diagnose and treat a variety of hand, wrist, and elbow conditions. One of our nationally recognized surgeons, Dr. Lopez, is exceptionally skilled in performing the endoscopic trigger finger release. This procedure is his surgical option of choice for trigger finger, and he has performed this particular procedure for over 10 years in Houston with excellent patient results.

 

Recovery

Non-surgical recovery focuses on reducing swelling around the flexor tendon and tendon sheath, most likely through rest, wearing a splint, taking an oral anti-inflammatory medication, or injecting a steroid into the area around the tendon and pulley.

After surgery, normal motion is usually restored immediately. If we opt for the “No Stitch” release, this is a minimally invasive procedure that results in little or no scarring, no stitches are required, and patients resume normal activity within about three weeks. Hand therapy is sometimes needed after surgery to regain better use.

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