Trigger finger is a disorder of the hand, which can cause painful clicking or locking of the fingers or thumb. The condition limits movement of the flexor tendons on the front of the hand as they run in a narrow tunnel, called the tendon sheath.

Long tendons (flexor tendons) extend from the forearm muscles through the wrist and connect to the small bones of the fingers and thumb. These flexor tendons control the movements of the fingers and thumb. When the finger or thumb is bent, the flexor tendon slides through a tunnel (tendon sheath), which holds the tendon in place next to the bones.

The flexor tendon can become irritated and may thicken and develop nodules (small growth or swelling), which makes passage through the tunnel difficult. The tendon sheath can also thicken, reducing the size of the opening of the tunnel where the flexor tendon fits.

The flexor tendon then can become stuck at the entrance of the tendon sheath tunnel when attempting to straighten the finger. A pop or click may be felt as the flexor tendon attempts to slide through the tightened tunnel area and the finger will suddenly straighten out quickly, or trigger. Eventually, the finger may become permanently locked.

signs and symptoms

The condition is often identified if there is swelling around the affected area, a clicking or popping sensation in the finger or thumb joints, pain when bending or straightening the finger, stiffness, the inability to bend or straighten the finger, or a tender lump in the palm of your hand.

common causes

There are no direct causes of trigger finger. However, it is more likely to develop when involved in heavy gripping activities and if there is arthritis in the hand or fingers. The condition is also more common in some families and in the presence of diabetes.

treatment – non-operative

Rest
The affected finger should avoid gripping or activity that could provoke pain.

Anti-inflammatory medication
Tablets and creams will help relieve pain.

Steroid Injections
Corticosteroids are injected into the tendon sheath to improve the condition by reducing swelling.

Splint support
A splint to protect and keep the finger in a rested position may be used briefly.

treatment – surgery

If conservative treatments do not improve the condition, then surgery may be required.

Surgery will involve widening the tight opening section of the tendon tunnel to enable the flexor tendon to slide through comfortably. A small incision is made into the palm and the tendon sheath is cut. Once healed, the sheath is looser, providing the flexor tendon with more room to move through it, eliminating the triggering. The site of tightening is usually at the A1 pulley of the flexor tendon sheath.

This surgery does not require a general anaesthetic, but sedation can be administered while local anaesthesia is applied to numb the hand for the procedure.

recovery

Immediately following the surgery, the hand and affected finger will be able to move. Some soreness may be experienced in the palm, along with swelling. Raising your hand above your heart can reduce any pain and swelling.

A light dressing is applied to the wound and it can be further reduced 48 hours after surgery.

This procedure is undertaken in day surgery and patients are able to go home on the same day.

The recovery process is complete within a few weeks, but it can take up to six months for all signs of swelling and stiffness to fade. A physical therapy program may be provided by one of our physiotherapists to help combat prolonged stiffness.

Given the small scale of the surgery, patients are able to go home on the same day.

risks and complications

As with all surgical procedures, trigger finger surgery does involve some risks. While your surgeon will take every precaution necessary to minimise risk, complications can occur that may have permanent repercussions.

Some specific risks related to trigger finger surgery include:

• Excessive bleeding or swelling
• Infection
• Nerve irritation or damage resulting in numbness or pain
• Scarring from surgery may be painful
• Triggering may return and require further surgery.

contact

This fact sheet is a brief overview of trigger finger, produced by our Shoulder, Elbow, Wrist and Hand Surgeon Dr Nick Wallwork. To make an appointment or enquiry with Dr Wallwork or one of our upper limb specialists, contact 08 8362 7788 or email ortho@sportsmed.com.au.