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Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website |
Trigger Finger or Thumb
"My finger locks or catches when I make a fist. I wake up in the morning & one of my fingers is stuck in my palm!!"
Triggering of the fingers or thumb is known as stenosing tenosynovitis. It is a common disorder in the hand that can cause painful snapping or locking of the fingers or the thumb. The sensation of locking or catching has often been referred to as triggering.
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 Triggering involves the tendons and pulleys in the hand that bend the fingers. The tendons are long cords that connect the muscles of the forearm to the bones of the fingers and thumb allowing them to bend the digits into a fist. The pulleys are a series of thickened bands that form a tunnel (called the flexor tendon sheath) through which the tendons must glide. The tunnel holds the tendons close to the bone for better pull much like the eyes of a fishing rod hold the fishing line near the rod. The tendons and the tunnel have a slick covering called tenosynovium that allows smooth gliding of the tendon through the tendon sheath.
If there is thickening of the tenosynovium, the tendon or the first annular pulley of the tendon sheath, the tendon may have a difficult time moving freely in and out of the mouth
of the tunnel at the first annular pulley.
The tendon may develop a nodule that is tender in the palm. As the tendon movement is further compromised, the finger begins to trigger or lock as the tendon catches as it moves in and out of the tunnel. When the tendon catches, it produces irritation and more swelling. This causes a vicious cycle of triggering, irritation and swelling. Sometimes the finger becomes stuck and is difficult to bend or straighten.
What causes it?
Trigger fingers are more common in women than in men between the ages of 40 and 60. A variety of different factors can lead to thickening of the tendon or its tenosynovium. Medical conditions such as diabetes, rheumatoid arthritis, hypothyroidism and gout are associated with trigger fingers. Mechanical events such as repetitive grasping with the use of hand tools and weight bearing on the hand with using a cane or crutches can cause trigger fingers. Often, the cause is unknown.
What are the signs and symptoms?
 Before developing actual triggering, the patient may first develop pain in the palm directly below the affected finger. This area is often tender to touch. Painful catching of the finger with flexion and extension is the most common symptom. The patient may feel pain at the middle knuckle of the finger or at the last knuckle of the thumb despite the triggering occurring at the base of the finger or thumb.
How is it treated?
The goal of treatment is to stop the triggering and allow full movement of the finger or
thumb without pain. The swelling around the tendon and tendon sheath needs to be
reduced to allow smooth gliding of the tendon. Sometimes, using a night splint or oral anti-inflammatory medications may improve the symptoms. An injection of corticosteroid (a strong anti-inflammatory medication) into the tendon sheath will reduce the pain and triggering over a course of a couple of weeks. Depending on the cause and duration of the triggering, the injection may resolve the triggering up to 80% of the time. If two injections fail to resolve the problem, surgery should be considered.
The surgery is a minor procedure that can be done under a local anesthetic. It is done as an outpatient procedure. A small incision is made in the palm in line with the affected digit. The tendon sheath is opened at its leading edge in the palm allowing the tendons to glide smoothly without locking or catching. The patient may be asked to move their finger during the procedure to ensure that the triggering has resolved or if further release needs to be done. A light dressing is applied over the incision. The patient can begin moving the
 finger as normally as possible as soon as the surgery is completed to prevent stiffness and regain normal motion. The patient can return to normal activities as comfort permits. There is typically discomfort in the palm overlying the incision as the wound heals. Sometimes patients will be referred to hand therapy to help regain their motion and use of their hand especially if their finger was quite stiff before the surgery.
If you have any questions or wish to schedule an evaluation, please call us at (253) 833-7750. At Cascade Orthopaedics, we have two experienced hand surgeons (Drs. Blauvelt and Smith) to assess and treat your trigger fingers. We have clinics in both Auburn and Bonney Lake to better serve you.
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