Stenosing Tenosynovitis, or trigger finger is a snapping or locking condition caused by inflammation of the tendons that flex your fingers. The flexor tendon glides easily through the covering tissue (sheath) due to the membrane that surrounds joints (synovium). This helps to keep them lubricated. If the tendon becomes inflamed, it can lead to long-term scarring and thickening that affects the motion of the tendon. This happens when the inflamed tendon is pulled through a narrowed sheath, causing it to snap or pop.
It can cause tenderness and pain and limit your finger’s movement, making it difficult to bend and straighten your finger. Trigger finger most often affects the right or left index finger, but it can affect any finger in the hand, and more than one at a time.
Risk Factors
Repetitive trauma is often the cause of trigger finger, with activities such as gardening (pruning and clipping) common risk factors.
It is sometimes an associated condition resulting from an underlying illness or medical condition, causing inflammation of tissues of the hand. Typical conditions include rheumatoid arthritis, which causes inflammation around the tendons of the palm of the hand where trigger finger can develop.
Other risk factors include:
- Health conditions such as diabetes, gout, rheumatoid arthritis, tuberculosis and hypothyroidism
- Performing repetitive activities
- Age – individuals aged 40 – 60 are more at risk
- Women are more at risk than men
- Surgery following carpal tunnel syndrome, particularly in the first 6 months
- Occupation – it is common amongst industrial workers, farmers, musicians and anyone who repeats finger and thumb movements.
Symptoms of Trigger Finger
Early symptoms can be mild and become worse over time. It tends to be worse in the morning, with the finger relaxing and moving more easily throughout the course of the day. Typical symptoms include:
- A painful snapping or clicking as you move your finger
- A locked finger that you cannot straighten
- Stiffness in the finger, especially in the morning
- Tenderness around the base of the finger or thumb (nodule)
- Grasping an object firmly
If early treatment is not sought, trigger finger can progress. Advanced symptoms include a thumb, another finger or both becoming locked in a bent or straight position.
Diagnosing Trigger Finger
A doctor can usually diagnose trigger finger. A medical history and physical examination is carried out to check for tenderness and nodular irregularity of the involved flexor tendon in the palm of the hand. They will also listen for characteristic clicking upon movement, along with watching you open and close your hand.
Treatment for Trigger Finger
Treatment for trigger finger will depend on the severity of your symptoms. Conservative (non-surgical) treatment is initially recommended for milder symptoms. These include:
- Rest. You may need to stop activities that are causing the problem. A period of 4 – 6 weeks is recommended to see if symptoms improve
- Gently stretching your fingers to enhance their range of motion
- Wearing a splint or brace to restrict motion in the finger
- Over the counter medication such as ibuprofen to ease symptoms
- Steroid injections into the tendon sheath to reduce inflammation
- Applying heat and/or ice to reduce swelling
- Placing your hand in warm water throughout the day to relax the tendons and muscles
If conservative treatment is ineffective, you doctor will discuss the possibility of surgery with you. If you feel this is the best course of action, you will be referred to see a Consultant Orthopaedic Hand & Wrist Surgeon who will explain the procedure to you and what results you can expect.
Trigger finger release is the most common procedure for treating the condition. It is typically carried out on an outpatient basis under local anaesthetic, meaning you will not require an overnight stay.
The surgeon will make a small incision in the palm of the hand at the base of the finger and cut the tightened tendon sheath. Once the tendon sheath is released, the tendon can move freely. The incision is then stitched and bandaged.
Post-Operative Recovery
Recovery from trigger finger release ranges from a few weeks to 6 months. It is recommended that you see a physiotherapist following your procedure; they will provide you with a set of exercises to relieve post-surgery stiffness.
You should be able to return to your normal activities within a few days following trigger finger release surgery. You will be required to attend a follow-up appointment to remove the stitches; usually 7 – 14 days following your procedure.
Complications from Trigger Finger Release
Trigger finger release is considered a safe surgical procedure; however, as with any form of invasive surgery, there are associated risks. These include:
- Scarring and tenderness
- Stiffness or pain in the pain
- Infection
- Tendon in the wrong position (bowstringing)
- Nerve damage
- Pain and swelling in the hand. This usually disappears completely after a few months
Outlook
Prognosis of trigger finger is very good, with most patients making a full recovery, through either conservative treatment or surgery. Surgery will likely correct trigger finger and restore full movement of the finger. However, in severe cases, the surgeon may not be able to straighten the digit.
It is possible to prevent trigger finger by avoiding activities that place strain on the finger flexor tendons in the palm of the hand.
Need Help?
Private trigger finger treatment is available at One Ashford Hospital in Kent with a leading Consultant Hand and Wrist Surgeon and we can book you in for a consultation, usually within 48 hours. One Ashford Hospital is ideally located for patients in Ashford, Maidstone, Dover, Canterbury, Folkestone and all nearby areas. To book an appointment, call the hospital direct on 01233 364 022 or complete our online enquiry form.
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