Trigger finger as the name suggests is a painful condition affecting your hands’ fingers. Typically trigger finger causes a catch or a locking sensation when you try to stretch your bent fingers. You may also experience stiffness and pain in the fingers. Any fingers of your hand may get affected but more commonly fingers are the ring finger and the thumb (often referred to as trigger thumb) when the thumb is involved. Medically the condition is called stenosing tenosynovitis and it is seen when the flexor tendons, the tendons that flex the thumb and fingers are affected.

Before progressing into further details about the condition, let us briefly understand the anatomy of the wrist and the mechanism that causes trigger finger.

Our wrist has long cord-like structures called the flexor tendons (shown in white color in the above figure) that attach the forearm muscles to the finger bones. When we try to bend our fingers there is contraction of the respective muscles and the flexor tendons pull on the bones causing them to bend. The flexor tendons of each of the fingers pass through an individual tubular structure, called a tendon sheath which is firmly attached to the finger bones. There are bands of tissue called pulleys along the tendon sheath that help in holding the flexor tendons closely to the finger bones as we bend and stretch the fingers. 
There is a pulley called the A1 pulley at the base of each finger (the point where the finger meets the palm). It is the A1 pulley that is most often involved in the trigger finger. When you have a trigger finger, the A1 pulley becomes thick and inflamed, due to which the flexor tendon cannot easily glide through as the finger bends. Gradually the flexor tendon may itself become inflamed and develop a small nodule on its surface. When this happens, as you try to bend and stretch your finger the thickened nodule passes through the tight pulley, causing a painful pop or a catching.

Symptoms 

  • In mild cases a painful pop or a catching while stretching the bent finger
  • Stiffness and pain in the fingers
  • In severe cases the finger might get locked (stuck) in a bent position, forcing the patient to use their other hand to straighten the finger
  • In very severe cases, there may be complete failure to stretch the finger without doctor’s intervention

Generally the symptoms are worse after long periods of inactivity, (example - when you wake up in the morning) and improve with consistent use of the hand.

Diagnosis 

Your doctor will typically diagnose a trigger finger by thorough assessment of your symptoms and physical examination of your hand. X-rays or any other tests are generally not necessary to diagnose a trigger finger.

Treatment - Based on the severity of the condition a trigger finger can be treated non surgically or surgically.

Nonsurgical Treatment - The choice of treatment for initial and mild conditions

  • Resting the hand and avoiding activities that worsen the condition
  • Wearing a wrist splint at night to keep the fingers in a straight position
  • Stretching exercises to decrease stiffness and increase the range of motion of the affected finger
  • Pain relief medications such as NSAIDs and acetaminophen 
  • Intralesional steroid injections - injection of corticosteroid at the base of the affected finger, into the tendon sheath (surgery is recommended if the symptoms are not relieved after two steroid injections)

Surgical Treatment - The surgical procedure performed for treating a trigger finger is called the trigger finger release. Surgical treatment is generally recommended:

  • For severe conditions (the affected finger is stuck in bent position and cannot be straightened with gentle manipulation) 
  • When the condition does not improve with nonsurgical treatment. 

During a trigger finger release surgery the A1 pulley is released (cut) to facilitate easy gliding of the flexor tendon through the tendon sheath, and preventing any pop or catching sensation. Typically, trigger finger release is an outpatient procedure, under local anesthesia. 

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