What is trigger finger?

Trigger finger is a condition in which one of your fingers gets stuck in a bent position. Your finger may bend or straighten with a snap — like a trigger being pulled and released. Trigger finger is also known as stenosing tenosynovitis.

Dr. Bert Perey, MD, FRCPC, discusses trigger finger causes and symptoms. Orthopedic Surgeon

Quiz: Do You Understand Trigger Finger?

Test your knowledge by answering the following questions:

Questions
True
False
1

Trigger finger usually starts in one digit.

Explanation:
The tendon that is affected travels through a tunnel at the base of the finger (think of it as the pulley system of the fingers). As constriction occurs, either from swelling of the tunnel or of the tendon, the finger locks up. Trigger finger usually starts in one digit.
2

Doctors know exactly what causes trigger finger.

Explanation:
It’s not well understood what cause trigger finger. It occurs spontaneously, like many conditions in the hand.
3

People in their 70s and 80s are most commonly affected.

Explanation:
People in their 50s and 60s are most commonly affected, although it can occur in younger and older patients as well. There tends to be a slightly higher predominance among women.
4

If you have trigger finger, surgery is an option.

Explanation:
If you have trigger finger, your physician and/or orthopedic surgeon may recommend surgery. This involves an incision in the palm, which causes a temporary scar reaction in the palm due to the glabrous skin (like the skin of the foot).
5

Scarring should resolve completely over a period of many months.

Explanation:
Scarring resolves completely over a period of many months, unless a patient experiences abnormal scarring. If this happens a patient should seek attention from a physiotherapist for scar massage and scar-improvement tools.
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Dr. Bert Perey, MD, FRCPC, Orthopedic Surgeon talks about the treatment options available to patients with trigger finger.

Dr. Bert Perey, MD, FRCPC, Orthopedic Surgeon, discusses trigger finger symptoms, diagnosis and treatment including surgical options.

Trigger finger treatment options

Some Trigger Fingers will resolve spontaneously. Splinting of the affected digit for a brief period may help resolve the symptoms. Over the counter anti-inflammatories may also help to relieve pain and inflammation.

If the symptoms do not spontaneously resolve within six weeks, a more aggressive form of treatment may be required.

The first line of treatment for most patients is a cortisone injection into the A-1 Pulley of the affected digit. This corticosteroid injection usually shrinks the swelling around the A-1 Pulley causing the finger to move freely, without pain or locking. The overwhelming majority of patients will have complete resolution of their symptoms within six to eight weeks following a cortisone injection. Over 95% of patients who have a Trigger Finger of less than six months duration will realize significant improvement in their symptoms, following the cortisone injection.

Unfortunately, only 2/3 of the patients will have permanent resolution of their symptoms following a cortisone injection. Depending on the severity and chronicity of the problem, a second cortisone injection may be considered. Patients with diabetes, or those with more advanced and chronic symptoms, likely will have a higher rate of failure with cortisone alone.

If Trigger Finger fails to improve with non-surgical treatment, then a surgical procedure, called a Trigger Finger Release, may be required. The goal of the procedure is to release the A-1 Pulley that is blocking tendon movement. The procedure is usually done under local anaesthetic alone. A 1 centimetre incision is made over the A-1 Pulley and the pulley is cut to allow free gliding of the flexor tendon. This usually results in immediate resolution of the problem but patients will have to contend with a small wound on the hand.

The wound is usually dressed for 48 to 72 hours after surgery, at which point the wound may be washed with soap and water. Patients are asked to avoid soaking or a dirty environment for 10 to 14 days. The surgical site usually becomes harder over six weeks and a course of deep massage, after two weeks, is usually encouraged to soften the scar and ease the tenderness. This palmar scar reaction to surgery can often become more significant over the first six weeks after intervention.

The surgical site scar tenderness usually resolves within three to six months and the finger function usually returns to normal. Patients with more advanced cases, prior to surgery, may be left with a small bend in the proximal interphalangeal joint but this rarely causes any functional problems.

Wound infections can occur after surgery and occasionally may require a course of oral antibiotics. Persistent numbness in the finger after surgery is usually caused by an injury to the digital nerve. This will, more likely than not, resolve with time.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

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