hand - trigger fingers
Introduction
Stenosing tenosynovitis, or “trigger finger” or involves a narrowing of the space that the tendons of the fingers run within. The tendons work like long ropes connecting the muscles of the forearm with the bones of the fingers. Each tendon runs under a set of pulleys in the finger which are a series of rings that form a tunnel through which the tendons must glide. The tendons and the tunnel have a smooth lining that allows easy gliding of the tendon through the pulleys.
Trigger finger occurs when the pulley at the base of the finger becomes too thick around the tendon, making it hard for the tendon to move freely under the pulley. Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the increased resistance to the gliding of the tendon through the pulley, one may feel pain, popping, or a catching feeling in the finger or thumb. When the tendon catches, it produces inflammation and more swelling. This causes a vicious cycle of triggering, inflammation, and swelling. Sometimes the finger becomes stuck or locked in a bent position and is hard to straighten.
Causes for this condition are not always clear. Some trigger fingers are associated with medical conditions such as rheumatoid arthritis, gout, and diabetes. Local trauma to the palm/base of the finger may be a factor on occasion, but in most cases there is not a clear cause. It may also be associated with carpal tunnel syndrome.
Treatment of trigger finger
Treatment of trigger finger is generally non surgical and may involve both of the following:
- Steroid injection into the tendon sheath
- Splints
If non-surgical forms of treatment do not relieve the symptoms, surgery may be recommended.
Surgery is performed in hospital as a day case, usually with a light anaesthesia. The surgery involves division of the pulley at the base of the finger so that the tendon can glide more freely.
Active motion of the finger generally begins immediately after surgery.
Normal use of the hand can usually be resumed when comfortable.
Returning to normal activities is an individual matter, but most people return to work within two to four weeks and to more vigorous activities after six weeks.