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Trigger Finger

Trigger finger, also known as stenosing tenosynovitis, is associated with pain, stiffness, and a locking or catching sensation when you bend or straighten a specific finger. Although it can occur in any finger, it is most commonly seen in the ring finger and thumb. Symptoms usually begin spontaneously, without a prior history of trauma or change in activity level. This locking sensation occurs when the flexor tendon cannot smoothly glide through the tendon sheath, therefore disrupting the pulley system of your finger. While the cause of trigger finger is often not clear, it is commonly seen with overuse or repetitive movements.

 

Symptoms of Trigger Finger:

  • Initially: painless snapping, catching, or locking of one or more fingers during flexion/extension of the affected digit
  • Progresses to pain with difficulty extending the affected digit
  • Localized pain and/or tenderness at the base of the finger radiating into the palm or the distal finger
  • May awaken with the finger locked in a bent position
  • May or may not have multiple digits effected
  • Tender nodule (thickening of the tendons) over affected joint
  • Worsening of pain by stretching in extension or by resisting flexion

 

 

Evaluation of Trigger Finger:

Trigger finger is primarily a clinical diagnosis based upon a history and physical exam of locking or clicking during finger flexion and extension. During an examination, the patient is asked to actively flex and extend the fingers with their hands in a palm-up position. With these movements, we are trying to reproduce the finger locking or catching. If active triggering is not present, the examiner can feel for a loss of smooth motion over the proximal interphalangeal joint (PIP). Locking may come and go, therefore it may not always be reproducible during an examination, this does not exclude the diagnosis.

Radiographs are not necessary for the diagnosis of Trigger Finger.

 

 

Treatment for Trigger Finger:

The goals of treatment are to decrease pain and improve the movement of the finger allowing for smoother flexion and extension without locking. Treatment options vary based on presentation, therefore it is very important to be evaluated by a hand surgeon specialist before preceding with a treatment.

The initial approach often includes conservative treatment:

  • Activity modification (avoid pinching or grasping of the fingers) x 3-6 weeks
  • Splinting (keep the MCP joint in slight flexion)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, if able
  • Glucocorticoid injections

 

However, when pain and locking persist despite conservative therapy and local glucocorticoid injections, surgical release is often recommended. Surgical technique options include:

  • Ultrasound-guided percutaneous release of the first annular (A1) pulley ligament
  • Open surgical release of the first annular (A1) pulley ligament

Both options are very effective with only an approximately 3% recurrence rate. Patients are often very satisfied after surgery, as the ideal candidate typically has a poor prognosis and very limited use of the finger before surgery. However, if a patient is diabetic, studies show the outcomes of surgery may not be as successful. Diabetic patients may also have higher risks of complications including infections and surgical revisions therefore surgery may not be the most ideal treatment option for diabetics.

Characteristics suggestive of a favorable surgical outcome:

  • Failed 4-6 week trial of conservative treatment
  • Persistent symptoms despite glucocorticoid injection
  • No history of diabetes
  • No associated contractures

 

 

What to expect after surgery:

After surgery, you can resume simple daily activities within a few days. More demanding activities such as lifting objects with the affected hand may take a couple of weeks to resume. The patients with the best prognosis include those without diabetes and without associated contractures.

 

Please call our office at (703) 574-2588 for more information, or to schedule an appointment with Dr. Fadi Nukta at NOVA Plastic Surgery and Dermatology

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