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Trigger finger

Description

Trigger finger occurs when a finger or thumb gets stuck in a bent position, as if you were squeezing a trigger. Once it gets unstuck, the finger pops straight out, like a trigger being released.

In severe cases, the finger cannot be straightened. Surgery is needed to correct it.

Alternative Names

Digital stenosing tenosynovitis; Trigger digit; Trigger finger release; Locked finger; Digital flexor tenosynovitis

What is a Trigger Finger?

Tendons connect muscles to bones. When you tighten a muscle, it pulls on the tendon, and this causes the bone to move.

The tendons that move your finger slide through a tendon sheath (tunnel) as you bend your finger.

• If the tunnel swells and becomes smaller, or the tendon has a bump on it, the tendon cannot slide smoothly through the tunnel.
• When it cannot slide smoothly, the tendon may become stuck when you try to straighten your finger.

About Trigger Finger

If you have a trigger finger:

• Your finger is stiff or it locks in a bent position.
• You may have painful snapping or popping when you bend and straighten your finger.
• Your symptoms are often worse in the morning.
• You have a tender bump on the palm side of your hand at the base of your finger.

Trigger finger can occur in both children and adults. It is more common in people who:

• Are over 45 years old
• Are female
• Have diabetes, rheumatoid arthritis, or gout
• Do work or activities that require repeated gripping of their hands
• Pregnancy

Trigger finger is diagnosed by medical history and a physical exam. Trigger finger usually does not require x-rays or lab tests. You can have more than one trigger finger, including your thumb and it can develop in both hands.

Treating Trigger Finger Without Surgery

In mild cases, the goal is to decrease swelling in the tunnel.

Self-care management mainly includes:

• Allowing the tendon to rest. Your health care provider may ask you to wear a splint. Or, the provider may tape your finger to one of your other fingers (called buddy taping).
• Applying heat and ice and stretching may also be helpful.

Your provider may also give you a shot of a medicine called cortisone. The shot goes into the tunnel that the tendon goes through. This can help reduce swelling. Your provider may try a second shot if the first one does not work. After the injection, you can work on your finger motion to avoid the tendon getting swollen again.

Surgery for Trigger Finger

You may need surgery if your finger is locked in a bent position or does not get better with other treatment. The surgery is done under local anesthesia or a nerve block. This prevents pain. You may be awake during surgery.

During the surgery your surgeon will:

• Make a small cut in your skin just below the tunnel (sheath covering the tendon) of your trigger finger.
• Then make a small cut in the tunnel. If you are awake during surgery, you may be asked to move your finger.
• Close your skin with stitches and put a compression or tight bandage on your hand.

After surgery:

• Keep the bandage on for 48 hours. After that, you can use a simple bandage, like a Band-Aid.
• Your stitches will be removed after about 2 weeks.
• You can start bending and extending your finger right away and return to using your finger normally once it has healed.

When to Call the Doctor

If you notice signs of infection, contact your surgeon right away. Signs of infection include:

• Redness in your cut or hand
• Swelling or warmth in your cut or hand
• Yellow or green drainage from the cut
• Hand pain or discomfort
• Fever

If your trigger finger returns, contact your surgeon. You may need another surgery.

References

Wainberg MC, Bengtson KA, Silver JK. Trigger finger. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 37.

Wolf JM. Tendinopathy. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 8h ed. Philadelphia, PA: Elsevier; 2022:chap 56.

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