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Trigger Finger/Trigger Thumb

(Stenosing tenosynovitis)

Have you noticed one of your fingers, or thumb, is painful when you try to straighten it? Or the finger gets stuck bent and you have to physically straighten it? You may have a trigger finger or trigger thumb. Read on to find out more about this common yet treatable condition.

What is a trigger finger?

A trigger finger or trigger thumb sometimes referred to as stenosing tenosynovitis, is a condition that affects one or more of the tendons in the hand making it difficult to bend and/or straighten the affected finger or thumb. The ring finger and thumb are most often affected.

The (A-1) pulley that holds the flexor tendon down in your palm becomes inflamed and thickened making it difficult for the tendon to glide through when the finger bends. With time the tendon may develop a nodule that can usually pass through the pulley but catches when you straighten your fingers causing a popping sensation. The nodule can get stuck but then release suddenly, like a trigger being pulled.

What causes trigger finger?

Activities and occupations that require repeated and prolonged gripping, such as the use of shears or handheld tools, have been associated with developing the painful condition.

Medical conditions like diabetes, rheumatoid arthritis and thyroid disease are known risk factors for developing triggering of the fingers. There is even a link with having carpal tunnel syndrome.

What are the symptoms of trigger finger/trigger thumb?

Symptoms of trigger finger may start with discomfort felt at the base of the affected finger or thumb, where the finger joins the palm. You may experience stiffness with finger motion or a reduction in the range of motion.

As the condition worsens the finger will catch or lock when you attempt to straighten it and this may occur more frequently at night or early in the morning.

How is the diagnosis of trigger finger/trigger thumb made?

The good news is that a trigger finger is easily diagnosed through taking your medical history and performing a physical examination. A diagnostic ultrasound scan, done at the time of your appointment, can help confirm the diagnosis but is not always necessary.

A trigger finger or trigger thumb may be the first sign of a medical condition like poorly controlled diabetes mellitus, so it's important you undergo a thorough medical assessment.

When should you see a doctor?

Getting medical treatment early once you develop symptoms of a trigger finger or trigger thumb reduces your chances of having prolonged or recurrent symptoms.

If your finger is hot and swollen, you should seek medical care urgently as you may have an infection.

How do you treat a trigger finger?

Treatment of a trigger finger is usually based on non-operative management strategies. Outside of activity modification and non-steroidal anti-inflammatory medications treatment options include:

  • Splinting - If you do not want or are not able to have a steroid injection nightly splinting of the involved fingers for several weeks has been shown to be effective at reducing symptoms in up to 65% of patients.
  • Corticosteroid injection - A steroid injection into the tendon sheath (around the tendon), at the level of the symptoms, is very effective at reducing pain and triggering. This is the most commonly used treatment because it is successful in almost all cases unless you have had the condition for a long time,  you have diabetes mellitus or have multiple fingers affected in which case your long-term success rate from an injection can be lower.
  • Surgery - If non-operative/conservative measures fail to relieve your symptoms then surgical release of the A-1 pulley is recommended. This is a very straightforward procedure typically carried out by a hand surgeon.

If you think you have a trigger finger or trigger thumb click here to make an appointment so we can help rid you of this common condition.

I can meet you in Central London or Hertfordshire or via a Zoom video consultation

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