What is trigger finger?
Trigger finger is a common condition affecting the hand. It
starts as pain in the palm of the hand in line with the affected finger. A
secondary pain may also be felt over the back of the knuckle of the finger.
Later, this may progress to a sense of catching as the affected finger
is flexed and extended. This catching may be painful. Eventually, the catching
may be so severe that it is impossible to flex or straighten the finger without
help from the other hand. The finger becomes unstuck suddenly, and this is the
“triggering” that gives the condition its name.
Trigger finger is also known as “trigger thumb”
when it affects the thumb.
What causes trigger finger?
As the flexor tendon from the forearm to the finger passes
through the palm of the hand, it passes through various tunnels, known as
pulleys. These help guide the tendon to the correct finger. Trigger finger
occurs when the tendon develops a lump which catches and irritates the pulley
in the palm. As the irritation increases, the area becomes more swollen,
leading to further tightening and irritation.
This then becomes a vicious
circle of inflammation - pain - swelling - inflammation - etc.
It may be related to certain other conditions, such as
diabetes, inflammatory arthritis (eg. rheumatoid arthritis), partial tendon
lacerations, or highly repetitive work, but in most cases, no known cause is
found for the condition.
How is trigger finger diagnosed?
Trigger finger is diagnosed from the patient’s
history and the examination. Generally, further tests are not required.
How is trigger finger treated?
The crux of non-surgical treatment is to break the cycle of
inflammation and pain. These are often best used in combination.
A splint fitted by a hand therapist can help rest the finger by keeping it
tablets or creams.
injection is very good at settling inflammation and swelling, and thus
relieving pain. This may need repeating once to fully resolve the symptoms.
Surgery is recommended if the finger is locking in position,
or if other treatment fails.
Surgery is performed via a small incision in the palm of the
hand, and the pulley is released where the tendon is catching.
Surgery is done as a day-only procedure in a hospital. It
can be performed under local anaesthetic with the patient awake, or under
general anaesthesia with the patient asleep. The advantage of doing this under
local anaesthesia is being able to have the patient bend the finger during the
operation to ensure the triggering has fully resolved once the pulley has been
What to expect after the operation:
A bulky dressing will be applied to the surgical site in the
operating room at the end of the operation. This should be kept dry and
elevated until your follow-up appointment in about 10 days.
Sometimes, a hand therapist to helpful to assist with
regaining motion and strength.
Despite the small incision, soreness at the operative site
usually persists for a while and it often takes 3 months to return to full
What are the risks of surgery?
Complications from trigger finger surgery are uncommon. The usual risks
- Nerve, tendon or blood vessel damage
- Ongoing pain
- Persistent triggering is rare
- Recurrent triggering is rare. However, it may occur in
other fingers, especially if there is a general underlying medical cause, such
as diabetes or rheumatoid arthritis
- Complex regional pain syndrome.