Trigger Finger

Trigger finger (stenosing tenosynovitis) is a condition that makes it difficult to move a finger or thumb and is accompanied by pain and stiffness. Sometimes, the finger or thumb becomes stuck in a bent position, and when released, it extends straight out, similar to a trigger being released. 

The tendons in the hand connect the muscles to bones, and when a muscle tightens, it pulls on the tendon, causing the bone to move. The tendons that move the finger slide through a tendon sheath (tunnel) as the finger is bent. If the tunnel swells and becomes smaller or the tendon has a bump, it cannot slide smoothly through the tunnel. This results in the tendon sticking when you try to straighten your finger.

Trigger finger occurs when a finger or thumb gets stuck in a bent position, as if squeezing a trigger. Once unstuck, the finger pops straight out, like a trigger being released. In severe cases, the finger cannot be straightened, and surgery is needed to correct it.

The cause of trigger finger is inflammation of the tendon sheath, a tunnel-like structure surrounding the tendons in the fingers and thumb. Repetitive motions, overuse, injury or certain medical conditions, such as rheumatoid arthritis or diabetes, can cause this inflammation.

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
• Are pregnant

Trigger finger is often a result of repetitive motions due to vocation, hobbies or underlying conditions. The following steps can reduce risk or help to manage symptoms: 

• Avoid repetitive motions that aggravate the condition.
• Use proper lifting techniques.
• Strengthen the hand and finger muscles.
• Manage underlying medical conditions that may contribute to trigger finger.

Primary symptoms of trigger finger include stiffness, swelling, pain and difficulty moving the finger or thumb. In addition, some individuals experience the following symptoms:

• 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 of your hand at the base of your finger.

Trigger finger is diagnosed by medical history and a physical exam and 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.

During the examination, your physician will check your hand carefully for areas of pain, mobility and any signs of locking. You will be asked to open and close your hand, making a fist and alternately splaying open the fingers.

In mild cases, the goal is to decrease swelling in the tunnel. Your provider may also give you a shot of a medicine called cortisone. The shot goes into the tunnel the tendon passes through, helping to reduce swelling. If the first shot does not work, your provider may try a second one. After the injection, you can work on your finger motion to prevent the tendon from getting swollen again.

Self-care management mainly includes:

• Allowing the tendon to rest
• Applying heat and ice and stretching 
• Your healthcare provider may ask you to wear a splint or may tape your finger to one of your other fingers (called buddy taping).

If your finger is locked in a bent position or does not improve with other treatments, you may need surgery. The surgery is done under local anesthesia or a nerve block, which prevents pain. You may be awake during surgery.

During the surgery, your surgeon will first make a small cut in your skin just below the tunnel (the sheath covering the tendon) of your trigger finger and then make a small cut in the tunnel. You may be asked to move your finger if you are awake during surgery. Lastly, your surgeon will close your skin with stitches and put a compression or tight bandage on your hand to restrict mobility while healing.

In severe cases of trigger finger requiring surgery, your care team will advise you to 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 two weeks, and you can start bending and extending your finger right away. Most individuals will generally return to using their fingers and hand once healed.

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

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