Trigger finger, medically known as Stenosing Tenosynovitis, is a prevalent hand condition. It emerges due to inflammation in a tissue band, known as a “pulley,” which connects tendons to finger bones, most often in the thumb or ring finger, but can affect any digit.
This condition is characterised by the thickening or swelling of the tendons or their safeguarding sheath in the thumb or other digits. Such enlargement hinders the effortless motion of the impacted digits. In acute scenarios, fingers might become immobile in a bent posture.
The term “trigger finger” reflects the condition where fingers remain in a fixed bent position, analogous to pulling an unseen trigger. In such instances, the affected thumb or fingers may remain bent within the palm, making it challenging or unfeasible to straighten the digits. It is advisable to seek consultation from an orthopaedic hand specialist for optimal treatment solutions.
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Causes of trigger finger
Primarily, the onset of trigger finger stems from excessive or repetitive digit movement, causing hand tendon inflammation. Other conditions such as diabetes can predispose an individual to developing trigger finger.
Continued irritation in the tendon, or sheath surrounding it, results in thickening and scarring, affecting movement. In this situation, digit bending tugs the inflamed tendon through a contracted sheath, causing a popping or snapping.
Let’s take a look at the main reasons behind how the condition can develop.
A. Primary causes
· Age-related changes
As the years pass, general wear and tear makes it easier for our tendons to catch in the surrounding sheath, causing this painful condition; those in the 40 – 60 age group are most commonly affected.
· Gender and genetic factors
Statistics reveal that women and those with a family history of trigger finger are more prone to developing the ailment.
B. Secondary causes
· Pre-existing medical conditions
If you already experience certain health conditions such as diabetes, gout or rheumatoid arthritis, it can increase the likelihood of developing trigger finger.
· Repetitive hand movements
Constantly repeating the same hand or finger movements can strain your tendons over time, leading to this condition. Certain occupations have an elevated risk, such as farmers, musicians, industrial workers and individuals with repetitive hand movements, including certain athletes.
· Injury or trauma
Have you damaged your hand recently? Injuries or trauma to the fingers can be inflammation causing precursors. Those who have undergone surgery for Carpal Tunnel syndrome are also at an increased risk.
Signs and symptoms
Not all of these conditions mean the onset of trigger finger, but it’s good to know what to keep an eye out for.
A. Early warning signs
· If your finger feels stiff, particularly in the morning, get yourself checked out by your GP.
· Sore or tender at the base of the affected finger? Another reason to visit your doctor.
B. Progression of symptoms
· Your finger might start to catch or lock in a bent position.
· Ongoing pain or discomfort in the finger is a clear red flag.
· If you’re finding it hard to hold onto things, it could be a sign your finger is not functioning as it should.
C. Impact on daily life and activities
· Trigger finger can seriously interfere with your daily tasks and activities. It can make simple things, like grabbing a drink or typing out a text, feel very difficult. The earlier the condition is identified and action taken, the better the outcome.
Diagnosis follows a comprehensive digit examination and symptom analysis. The examination involves hand movements to identify pain points, locking evidence, and motion smoothness. Generally, X-rays or other imaging tests are unnecessary, but may be used to exclude other pathology.
The treatment will align with the severity of symptoms and most commonly includes:
- Medication: such as NSAIDs like naproxen or ibuprofen, available orally
- Hand Therapy: conventional non-invasive treatments include:
o Rest: cease activities involving repetitive gripping or grasping until symptoms alleviate.
o Splint use: provides hand and digit support
o Exercise: gentle stretches for sustaining finger agility.
For severe symptoms or ineffective standard non operative treatments, medical consultation may propose:
- Steroid injections
Reduces inflammation by injecting steroids into or near the tendon sheath, allowing free movement. The effect can be long lasting, with possible additional injections if required.
- Needle procedure
A numbed palm undergoes a sturdy needle insertion into the tissue around the affected tendon, breaking up the obstructing tissue. Ultrasound-guided procedures enhance the results.
- Active surgery
Surgery involves a small incision at the affected finger base to open the narrowed tendon sheath section.
After sedation and local anaesthesia, a half-inch palm incision is made corresponding to the affected digit. Thehand and wrist surgeon cuts the tendon sheath, checks the finger movement, and sutures the wound.
Outpatient hand and wrist surgeries imply no overnight hospital stay. Post-surgery, patients can leave, the duration varying from a few minutes to a few hours.
Movement is typically possible on the surgery day as numbness diminishes. Work resumption depends on the job type and might take around two weeks for labour-intensive roles. A typical recovery timeline might include the following:
- Initial days: Keep the wound dry and bandaged. Utilise ice packs for potential soreness.
- Following days: Possible referral to a hand therapist for specialised exercises and scar management.
- 5 to 6 days: Resumption of driving is generally feasible (but patient dependent)
- Sport activities: Avoid gripping or grasping activities until complete healing and strength regain.
- 3 to 6 months: Expected time for stiffness and swelling disappearance. Multi-finger surgeries may require a more extended recovery.
This article encapsulates essential details regarding trigger finger and its management. If you are in any doubt about your symptoms, please visit a specialist clinic to undergo a thorough examination.