Trigger Finger aka Stenosing Tenosynovitis

Orthopaedic & Spine Center

 

Trigger Finger

 by Boyd W. Haynes III, MD

Trigger finger, aka stenosing tenosynovitis, is the term used to describe a condition where one or more fingers of the hand can lock or snap into a bent position, causing pain and lack of function on attempted straightening.  In this article, I will discuss the causes, symptoms and treatment for this common musculoskeletal condition.

Our fingers are controlled by flexor tendons, which are attached to and moved by the muscles in the forearm.  These tendons have to travel through the wrist and through the tendon sheath, a tunnel (located in the fingers) that helps the tendons to stay in place.  Sometimes these flexor tendons can get irritated as they move and they can thicken and develop nodules.  The tendon will actually become temporarily stuck in the tunnel when the finger is moved and will “pop” out, hence the term “trigger finger”. This momentary sticking causes difficulty in moving the finger, resulting in lack of function and pain.

stenosing tenosynovitis is also known as trigger finger

We are not sure what causes Trigger Finger, but we do know that there are several factors that can put someone at increased risk for developing this disorder:

  • Doing repetitive activities that cause someone to grip or strain the hand constantly; such as playing a musical instrument or working with tools
  • Being Female
  • Being middle-aged (40-60)
  • Having certain medical conditions; such as, diabetes, thyroid conditions and rheumatoid arthritis

The symptoms of Trigger Finger are very straightforward:  The “trigger” effect when straightening or bending the finger, pain when moving the finger, swelling and a sore lump in the palm of the hand. Stiffness may be worse in the morning, and the condition tends to occur in the person’s dominant hand.

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I make a diagnosis by discussing the symptoms with the patient and doing a physical exam.  I do not take x-rays unless I am trying to rule out other causes for the condition, nor do I order an MRI, as neither of these is helpful in visualizing the problem.

There are conservative ways to treat Trigger Finger and I usually start with those first.  If we catch the condition early after onset, conservative treatment has its best chance to work.  I might recommend a splint to be put on the finger(s) to allow it to rest and to allow for the swelling and inflammation of the flexor tendon to subside.  Taking Aleve or Ibuprofen can also be helpful with the pain and inflammation.  Soaking the affected fingers in warm water may be soothing, as massage may be. If the problem is more severe, I may inject the patient with a steroid medication to reduce inflammation.  If one injection does not work, another injection may be recommended, depending upon the time interval.  If the condition does not resolve, then surgery would have to be considered.

The surgical treatment for Trigger Finger is an outpatient procedure that has been done for decades and is very effective in relieving the problem.   It involves putting the patient under light sedation (only if necessary—I prefer local anesthesia) and then creating a small (1 cm.) incision in the palm.  I then cut the tendon sheath pulley.  When the tendon sheath heals, it will have loosened and will allow the flexor tendon to move more easily through it.

Recovery from the procedure is fairly quick and easy.  Most patients can move their fingers immediately after their surgery.  There will be some soreness as the incision heals.  Swelling and stiffness may persist up to 2 months after the surgery, but is rare.  Physical Therapy may be recommended for those persons who had significant loss of range of motion in their finger, so that the finger(s) can be stretched and flexed to achieve normal range of motion; however, PT is usually not required.  The patient may also be given finger stretching exercises to do at home.

Any surgery carries with it a risk of complications, although in my practice, I rarely see these develop.  The main concern is infection, especially in my patients who are Diabetic.  Recurrence rates of Trigger Finger are less than 1%.

Although most patients are reluctant to see a doctor until symptoms become severe, it is better to treat the problem sooner, rather than later, for the best chance at symptom resolution with conservative treatment.

Boyd W. Haynes III, MD is a fellowship-trained, board certified Orthopaedic Specialist with Orthopaedic and Spine Center in Newport News, Virginia.  Voted a “2013 Top Doc” in a physician survey conducted by Hampton Roads Magazine, Dr. Haynes specializes in Sports Medicine, Total and Partial Joint Replacement, Robotic and Computer-Assisted Joint Replacements and Outpatient Total Joint Replacement.  For more information about Dr. Haynes or OSC, please go to www.osc-ortho.com or call 757-596-1900 for a consultation.