TRIGGER FINGER (STENOSING TENOSYNOVITIS)
Stenosing tenosynovitis is a condition more commonly referred to as “trigger finger.” Trigger finger occurs when a finger gets stuck in a bent position and then snaps straight. The ring finger and thumb are most often affected by trigger finger, but it can occur in other fingers as well. When the thumb is affected, the condition is called trigger thumb.
Our fingers are controlled by flexor tendons in our hands. Flexor tendons bend the fingers with the help of pulleys, which hold the tendons close to the bones in our fingers. Trigger finger occurs when the A1 pulley becomes inflamed or thickened, making it difficult for the flexor tendon to gliding through the pulley as the finger bends. Over time, the flexor tendon can also become inflamed and may develop a small nodule on its surface. When the finger flexes and the nodule passes through the pulley, there is a painful sensation of catching or popping.
CAUSES OF TRIGGER FINGER (STENOSING TENOSYNOVITIS)
The causes of trigger finger and trigger thumb are not well known. However, there are a number of factors that may increase your risk for developing the condition, including:
- Medical conditions: such as rheumatoid arthritis, gout, and diabetes put patients at a higher risk of developing trigger finger
- Repetitive use: in a strong and forceful way can lead to trigger finger. Occupations and hobbies that involve repetitive hand use and prolonged gripping may increase your risk for developing trigger finger.
- Gender: trigger finger is more common in women
SYMPTOMS OF TRIGGER FINGER (STENOSING TENOSYNOVITIS)
Symptoms of trigger finger often occur without injury, but may result after a period of heavy or extensive hand use, especially movements that involve pinching and grasping. Symptoms may include:
- Pain: when you bend or straighten the finger
- Locking, popping, or catching: sensation when you bend and straighten your finger
- Stiffness: after period of inactivity, such as when you wake up in the morning
- Tender lump: at the base of the finger on the palm side of the hand
- In severe cases, the finger may become locked in a bend position
Trigger finger is diagnosed by discussing your symptoms and by examining the hand. During the exam, your physician is looking for tenderness over the flexor tendon sheath in the palm, thickening or swelling of the tendon sheath, and triggering when you bend and straighten the finger.
The initial treatment for trigger finger is non-surgical, including:
- Rest: from activities that cause symptoms and irritation
- Splinting: at night to keep the finger or thumb straight while you sleep
- Stretching: can help decrease stiffness and improve range of motion
- Over-the-counter anti-inflammatory medication: such as Ibuprofen (Advil, Motrin) and naproxen (Aleve) can ease mild to moderate pain and reduce inflammation
- Corticosteroid injection: are used to treat symptoms and reduce inflammation
If the finger does not improve with conservative treatment options, surgery may be considered. Additionally, if the finger or thumb is stuck in a flexed or bent position, surgery may be required to prevent permanent stiffness. The procedure used for trigger finger is called “tenolysis” or “trigger finger release.” The goal of surgery is to release the A1 pulley that is restricting movement for the flexor tendon as it passes through the tendon sheath.
Most patients are able to move their finger immediately after surgery. Patients should expect soreness and in the palm after the procedure. Depending on the severity of the condition, complete recovery may take several months for swelling and stiffness to completely go away. Patients that undergo surgery to correct trigger finger or trigger thumb experience significant improvement in function, as well as relief from pain and stiffness. If patients experienced contracture (shortening and hardening of tendons causing deformities), or if loss of movement was present before surgery, complete range of motion in the finger may not be restored.