Trigger finger

Trigger finger is a condition in which one of your fingers gets stuck in a bent position. Your finger may bend or straighten with a snap — like a trigger being pulled and released.

Trigger finger is also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis). It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position.

People whose work or hobbies require repetitive gripping actions are at higher risk of developing trigger finger. The condition is also more common in women and in anyone with diabetes. Treatment of trigger finger varies depending on the severity.

Symptoms

Signs and symptoms of trigger finger may progress from mild to severe and include:

• Finger stiffness, particularly in the morning
• A popping or clicking sensation as you move your finger
• Tenderness or a bump (nodule) in the palm at the base of the affected finger
• Finger catching or locking in a bent position, which suddenly pops straight
• Finger locked in a bent position, which you are unable to straighten

Trigger finger can affect any finger, including the thumb. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

When to see a doctor

Seek immediate medical care if your finger joint is hot and inflamed, as these signs may indicate an infection.

If you have any stiffness, catching, numbness or pain in a finger joint, or if you can't straighten or bend a finger, make an appointment with your doctor.

Causes

Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath. Trigger finger occurs when the affected finger's tendon sheath becomes irritated and inflamed. This interferes with the normal gliding motion of the tendon through the sheath.

Prolonged irritation of the tendon sheath can produce scarring, thickening and the formation of bumps (nodules) in the tendon that impede the tendon's motion even more.

Risk factors

Factors that put you at risk of developing trigger finger include:

• Repeated gripping. Occupations and hobbies that involve repetitive hand use and prolonged gripping may increase your risk of trigger finger.
• Certain health problems. People who have diabetes or rheumatoid arthritis are at higher risk of developing trigger finger.
• Your sex. Trigger finger is more common in women.
• Carpal tunnel syndrome surgery. Trigger finger may be a complication associated with surgery for carpal tunnel syndrome surgery, especially during the first six months after surgery.

Diagnosis

Diagnosis of trigger finger doesn't require any elaborate testing. Your doctor or health care provider makes the diagnosis based on your medical history and a physical exam. During the physical exam, your doctor will ask you to open and close your hand, checking for areas of pain, smoothness of motion and evidence of locking.

Your doctor will also feel your palm to see if there is a lump present. If the lump is associated with trigger finger, the lump will move as the finger moves because the lump is an area of swelling in part of the tendon that moves the finger.

Treatment

Trigger finger treatment varies depending on its severity and duration.

Medications

Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve) — may relieve the pain but are unlikely to relieve the swelling constricting the tendon sheath or trapping the tendon.

Therapy

Conservative noninvasive treatments may include:

• Rest. Avoid activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating hand-held machinery until your symptoms improve. If you can't avoid these activities altogether, padded gloves may offer some protection.
• A splint. Your doctor may have you wear a splint at night to keep the affected finger in an extended position for up to six weeks. The splint helps rest the tendon.
• Stretching exercises. Your doctor may also suggest gentle exercises to help maintain mobility in your finger.

Surgical and other procedures

If your symptoms are severe or if conservative treatments haven't helped, your doctor might suggest:

• Steroid injection. An injection of a steroid medication near or into the tendon sheath may reduce inflammation and allow the tendon to glide freely again. This is the most common treatment, and it's usually effective for a year or more in most people treated. But sometimes it takes more than one injection.

  For people with diabetes, steroid injections tend to be less effective.

• Percutaneous release. After numbing your palm, your doctor inserts a sturdy needle into the tissue around your affected tendon. Moving the needle and your finger helps break apart the constriction that's blocking the smooth motion of the tendon.

  This treatment may be done under ultrasound control, so the doctor can see where the tip of the needle is under the skin to be sure it opens the tendon sheath without damaging the tendon or nearby nerves. This procedure is usually done in the doctor's office or in an office procedure room.

• Surgery. Working through a small incision near the base of your affected finger, a surgeon can cut open the constricted section of tendon sheath. This procedure is usually done in an operating room.

Preparing for an appointment

You'll probably start by seeing your primary care doctor to determine what could be causing your symptoms.

What you can do

Make sure to bring a list of all the medications and supplements you take regularly. You might also want to write down some questions for your doctor in advance. Examples may include:

• What's causing my symptoms?
• Is this condition temporary or long lasting?
• What treatments are available?
• Are there complications associated with this condition or its treatments?

What to expect from your doctor

Your doctor or health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over important information a second time.

Questions your doctor might ask include:

• What symptoms are you experiencing?
• How long have you been experiencing these symptoms?
• Do your symptoms seem to come and go, or do you always have them?
• Does anything seem to make your symptoms better?
• Does anything seem to make your symptoms worse?
• Are your symptoms worse in the morning or at any particular time of the day?
• Do you perform repetitive tasks on the job or for hobbies?
• Have you recently experienced any injury to your hand?

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