TRIGGER FINGER

Trigger finger, also known as stenosing tenosynovitis (stuh-NO-sing ten-

o-sin-o-VIE-tis), is a condition in which one of your fingers gets stuck in a
bent position. Your finger may straighten with a snap like a trigger
being pulled and released.

Trigger finger occurs when inflammation narrows the space within the
sheath that surrounds the tendon in the affected finger. If trigger finger
is severe, your finger may become locked in a bent position.

People whose work or hobbies require repetitive gripping actions are at

higher risk of developing trigger finger. The condition is also more
common in women and in anyone with diabetes. Treatment of trigger
finger varies depending on the severity.

Signs and symptoms of trigger finger may progress from mild to severe
and include:

Finger stiffness, particularly in the morning

A popping or clicking sensation as you move your finger

Tenderness or a bump (nodule) in the palm at the base of the affected

finger

Finger catching or locking in a bent position, which suddenly pops

straight

Finger locked in a bent position, which you are unable to straighten

Trigger finger more commonly affects your thumb or your middle or ring
finger. More than one finger may be affected at a time, and both hands
might be involved. Triggering is usually more pronounced in the
morning, while firmly grasping an object or when straightening your
finger.

When to see a doctor

If you have any stiffness or catching in a finger joint, bring it to the

attention of your doctor so that he or she may review your symptoms
and perform a physical evaluation of your hand. If your finger joint is hot
and inflamed, seek immediate medical care because these signs
indicate a possible infection.

Tendons are fibrous cords that attach muscle to bone. Each tendon is
surrounded by a protective sheath. Trigger finger occurs when the
affected finger's tendon sheath becomes irritated and inflamed. This
interferes with the normal gliding motion of the tendon through the
sheath.

Prolonged irritation of the tendon sheath can produce scarring,

thickening and the formation of bumps (nodules) that impede the
tendon's motion even more.
Trigger finger generally results from inflammation within a tendon
sheath, restricting tendon motion. A bump (nodule) also may form.

Factors that put you at risk of developing trigger finger include:

Repeated gripping. Occupations and hobbies that involve repetitive hand

use and prolonged gripping may increase your risk of trigger finger.

Certain health problems. People who have diabetes or rheumatoid

arthritis are at higher risk of developing trigger finger.
Your sex. Trigger finger is more common in women.

You'll probably start by seeing your family doctor or regular health care
provider to determine what could be causing your symptoms.

What you can do

Make sure to bring a list of all the medications and supplements you
take regularly. You might also want to write down some questions for
your doctor in advance. Examples may include:
Is this condition temporary?
What's causing my symptoms?
What treatments are available?
Are there complications associated with this condition or its treatments?
What to expect from your doctor

Your doctor or health care provider is likely to ask you a number of

questions. Being ready to answer them may reserve time to go over
important information a second time.

Questions your doctor might ask include:

What symptoms are you experiencing?
How long have you been experiencing these symptoms?
Do your symptoms seem to come and go, or are they persistent?
Does anything seem to make your symptoms better?
Does anything seem to make your symptoms worse?
Are your symptoms worse in the morning or at any particular time of the
day?
Do you perform repetitive tasks on the job or for hobbies?
Have you recently experienced any injury to your hand?
Diagnosis of trigger finger doesn't require any elaborate testing. Your
doctor or health care provider makes the diagnosis based on your
medical history and a physical exam. During the physical exam, your
doctor will ask you to open and close your hand, checking for areas of
pain, smoothness of motion and evidence of locking. Your doctor will
also feel your palm to see if there is a lump present. If the lump is
associated with trigger finger, the lump will move as the finger moves
because the lump is attached to the tendon that moves the finger.
Trigger finger treatment varies depending on its severity and duration.
Medications
Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin
IB) or naproxen (Aleve) may relieve the pain but are unlikely to relieve
the swelling constricting the tendon sheath or trapping the tendon.
Therapy
Conservative noninvasive treatments may include:
Rest. For at least three to four weeks, avoid activities that require
repetitive gripping, repeated grasping or the prolonged use of vibrating
hand-held machinery.
Ice or heat. Some people experience improvement by icing the palm
several times a day. Others see more benefit with warm-water soaks,
particularly first thing in the morning.
A splint. Your doctor may have you wear a splint at night to keep the
affected finger in an extended position for up to six weeks. The splint
helps rest the tendon. Splinting also helps prevent you from curling your
fingers into a fist while sleeping, which can make it painful to move your
fingers in the morning.
Stretching exercises. Your doctor may also suggest gentle exercises to
help maintain mobility in your finger.
Surgical and other procedures
If your symptoms are severe or if conservative treatments haven't
helped, your doctor might suggest:
Steroid injection. An injection of a steroid medication near or into the
tendon sheath may reduce inflammation and allow the tendon to glide
freely again. This is the most common treatment, and in people who do
not have diabetes, it is effective in up to 90 percent of patients. In
people with diabetes, it is effective about half the time. Sometimes to
obtain these results, a second injection is needed.
Percutaneous release. After numbing your palm, your doctor inserts a
sturdy needle into the tissue around your affected tendon. Moving the
needle and your finger helps break apart the constriction that's blocking
the smooth motion of the tendon. This treatment may be done under
ultrasound control, so the doctor can see where the tip of the needle is
under the skin to be sure it opens the tendon sheath without damaging
the tendon or nearby nerves. This procedure is usually done in the
doctor's office or procedure room.
Surgery. Working through a small incision near the base of your affected
finger, a surgeon can cut open the constricted section of tendon sheath.
This procedure is usually done in an operating room.