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.

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. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.    

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

Trigger Finger is a condition that causes pain, stiffness, and a sensation of locking or catching when a finger is moved. These symptoms can occur together or independently. The medical term for this condition is stenosing tenosynovitis. The ring finger and the thumb are the most commonly affected digits but it can occur in all digits.

Trigger Finger affects the flexor tendons to the digits. Flexor tendons are spaghetti-like structures that bend our digits. There are two flexor tendons for the index, long, ring, and little finger but there is only one flexor tendon for the thumb.

Each of the flexor tendons passes through a tunnel in the palm and the digit that allows it to glide smoothly as the finger bends and straightens. This tunnel is called the tendon sheath. The tendon sheath is formed by a series of pulleys that span the distal palm to the tip of the finger. The first pulley, named the A-1 Pulley, is a structure that causes the pathology in this condition. This pulley is located between the distal palm crease and the base of the finger; for the thumb, it is located under the palmar crease at the base of the thumb.

Trigger finger occurs when the A-1 Pulley becomes thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may develop a small nodule, just proximal to the A-1 Pulley. This nodule can become stuck as it enters and exits the tunnel, causing a catching or snapping sensation, which is often painful. In more advance cases, the finger can become stuck in a bent position. Long-standing cases can lead to significant, and sometimes permanent, stiffness of the finger.

Trigger Finger is usually an idiopathic condition. This means that there are no defined causes for this problem and the etiology likely remains genetic. The average age of presentation is in the fifth decade of the life. The condition is more common in women. Trigger Finger can affect multiple fingers but most patients do not become symptomatic in more than one or two digits in their lifetime. Repetitive, heavy use of the hand, or trauma, can accelerate the onset of Trigger Finger. For most patients, however, there is no history of trauma or abnormal use. Trigger Finger is more common in patients with a history of Carpal Tunnel Syndrome. Dr. Bert Perey, MD, FRCPC, Orthopedic Surgeon