Trigger finger

Sinonimi: Trigger finger, stenosing tenosynovitis (in medical terms)

Trigger finger is a finger of the hand that gets “stuck” or locked after flexion, and can be extended only with substantial effort or external help, and there is always a “clicking”-like sound when extending it.

In rare cases, other options should be considered:

• Ganglion cyst
• Tendon sheath infection
• Dupuytren’s contracture
• Volkmann’s contracture

In cases of trigger finger phenomenon appearing in more than one finger, blood sugar level should always be checked, for there may be a possibility of diabetes.

The true cause of this phenomenon is unknown. Most probably, an inflammation process is in question, that causes the tendon or it’s sheath to swell.

o Muscle tendons in charge of flexing the fingers lay free in the palm. On the transition from the palm to the fingers, they enter their canals. When there is an inflammatory process of the tendon present, it swells and a nodule is formed in it, that reduces the mobility of the tendon through the canal. When flexing the finger, the nodule gets incarcerated, and disables the finger from willingly extending.

This phenomenon occurs averagely in about 2 out of a 100 persons. It’s more common in women, especially after the age of 40.

Trigger finger is more common in the constellation of rheumatoid arthritis, diabetes, amyloidosis, carpal tunnel syndrome and in persons on dialysis.

• “Stuckage” of the finger after flexion
• Inability to normally extend it
• Pain when attempting extension
• Clicking of the finger when suddenly extending it with the help of the other hand or a stronger force
• Pain in the hand
• Pain along the finger
• Palpable nodule in the palm area
• Crepitations (like rustling) when palpating the area around the nodule

In most cases, a detailed clinical examination with flexion-extension test as well as palpation of the flexor tendons and canals in the region where the canals are beginning (MCP joint region) is enough.

• Prolonged pain
  In all cases when it’s not addressed properly, this phenomenon leads to the appearance of disturbing pain in the hand and along the appropriate finger. Of course, the pain is more pronounced when more fingers are affected.
• Repeating “stuckage” of the finger
  When the phenomenon reappears, the hardships get more pronounced.
• • Reduction in agility during fine operations.
  The pain that persists, and especially repeating “stuckages” of the finger with effort being required to extend the same, reduce the quality of functionality, especially in persons whose work requires high finger functionality.

Spontaneous resolution of the problems happens in 1 of 5 people without any treatment, just by sparing the hand from strains. Use of anti-inflammatory medication (ibuprofen) can be beneficial at this stage. This approach is always recommended when the symptoms first appear.

If the symptoms appear again, along with resting the hand, finger immobilization by an elastic splint is advised. The finger is immobilized in the position of full extension. Immobilization during the whole day is advised, but in certain cases immobilization during the night only can be useful.

In all cases of repeat occurrence of symptoms, and the occurrence of pain, steroid injections can be useful in 9 out of 10 patients. Steroid injections are combined with a local anesthetic, and administered directly into the space between the tendon and it’s canal. The purpose of this injection is it’s anti-inflammatory properties. After administering steroid injections, the finger is immobilized for a few (3 to 7) days. If this approach doesn’t produce satisfying results, or it’s only partial, this treatment can be repeated on the 8th day, and even on the 15th day.

A small incision is made in the skin, (up to 1cm), under local anesthesia, through which the tendon canal and sheath are accessed, and the nodule that causes the symptoms is removed (excised).

This procedure is also performed under local anesthesia, and the space required for the tendon to freely move through it’s canal is made through a needle puncture wound.

This treatment carries a small risk of damaging neurovascular structures in the finger, so tingling in the finger or swelling of the puncture site can occur.