TRIGGER FINGERS

GENERAL

Trigger finger, also called "Stenosing Tenosynovitis", is a common hand ailment. The first sign of the condition may be a slight difficulty or clicking when bending a finger to make a fist. Later, you may need to use your other hand to bend or straighten the finger. When the finger does move, you may feel a snap or click, as it suddenly gets "unstuck". This is the triggering that gives the condition its name, which is often worse in the morning. Often there is no cause found for the condition.

The diagnosis of a trigger finger is made with a simple physical examination. X-rays and other tests generally are not needed unless multiple fingers are triggering.

  

 

POSSIBLE CAUSES

• Highly repetitive work.
• Gardening, especially pruning.
• Renovating.
• Motor bike clutch.
• Diabetes.
• High Cholesterol.
• Middle-aged women.
• Inflammatory arthritis e.g. Rrheumatoid Arthritis.
• Partial tendon lacerations.

HOW DOES THE PROBLEM DEVELOP?

On the front of each joint in your finger is a little sling or pulley that the tendon moves through. The pulleys form a smooth tunnel (Flexor sheath) lined by synovium through which the tendons pass.

A Trigger finger develops when the synovium around a tendon in a finger or thumb becomes chronically inflamed and thickened. The tendon starts catching as it enters the opening of the tunnel. The tendon bunches up on itself forming a nodule that can be felt in the palm. The nodule catches as it enters the opening of the tunnel.

The more the tendon catches the more inflamed it becomes and a vicious cycle is set up.

TREATMENT

1. Rest.

2. Antivibration glove, e.g. for power tool workers.

3. Anti-inflammatory tablets or creams.

4. Cortisone injection: 1 or 2 only - multiple injections can damage the tendon and should be avoided. See information on Cortisone Injections.

5. Surgery:

May be recommended when other treatment fails or when the finger is locking.

Involves making a small incision in the palm and cutting the tight A1 pulley to free the tendon.

After the procedure, finger exercises are encouraged immediately. Once the bandage is removed, the hand and finger may be used as comfort permits. Recovery usually is complete within a few weeks.

Long-term results from the procedure are usually good. It is very uncommon for the triggering to recur. This is most likely when the tenosynovitis is generalised (affects many parts of the body). Generalised Tenosynovitis may occur in people with conditions such as Diabetes or Rheumatoid Arthritis. It is much more common that the triggering will arise in another finger in these conditions.