Trigger finger, also known as stenosing tenosynovitis, is a condition affecting the tendons in the fingers or thumb. It occurs when the tendon sheath, which surrounds the flexor tendons responsible for bending your fingers, becomes inflamed or thickened. This can cause the affected finger to catch or lock in a bent position, making it difficult to straighten or move smoothly. While it can affect any finger, the ring finger and thumb are most commonly involved. Trigger finger can range from mild discomfort to severe, limiting hand function.
Signs & Symptoms
The main symptoms of trigger finger include:
- Pain: Pain is typically felt at the base of the affected finger or thumb, especially when bending or straightening it.
- Clicking or popping sensation: As the tendon moves through the inflamed area, a distinct clicking or popping may be felt or heard when moving the finger.
- Stiffness: The finger may feel stiff, especially in the morning or after periods of inactivity.
- Locking: The finger may become temporarily stuck in a bent or straightened position. When the finger releases, it may snap straight suddenly, similar to the action of pulling a trigger.
- Tenderness: The area at the base of the finger or thumb may be tender to touch, and there may be a small lump (nodule) in this region.
- Reduced range of motion: As the condition worsens, you may have difficulty fully bending or straightening the affected finger or thumb.
These symptoms may develop gradually over time or appear suddenly. In severe cases, the finger may become completely locked in a bent position and may need to be straightened manually.
Causes and Contributing Factors
Trigger finger occurs when the sheath surrounding the tendon in the finger becomes narrowed or inflamed. This causes difficulty in the smooth gliding of the tendon as the finger moves. Various factors may contribute to the development of this condition, including:
- Repetitive hand use: Jobs or activities that involve frequent gripping, pinching, or repeated use of the hands can increase the risk of developing trigger finger. People who use tools that require constant gripping (e.g., farmers, musicians, or manual workers) are at higher risk.
- Age and gender: Trigger finger is more common in people aged 40-60 and tends to affect women more frequently than men.
- Medical conditions: Certain conditions such as diabetes, rheumatoid arthritis, and hypothyroidism increase the likelihood of developing trigger finger. These conditions can cause changes in the tendons and their sheaths, making them more prone to inflammation.
- Inflammation: Any form of tendonitis (inflammation of the tendon) can also contribute to trigger finger.
- Previous injury: Hand or finger injuries may increase the risk, especially if scar tissue develops around the tendons.
Grading
Trigger finger can be graded based on its severity:
- Grade 1 (Mild): Pain and tenderness are present, but no locking of the finger occurs. The finger may feel stiff, particularly in the morning.
- Grade 2 (Moderate): The finger may catch or lock occasionally but can be straightened without assistance. The clicking or popping is more noticeable.
- Grade 3 (Severe): The finger locks frequently, requiring manual assistance to straighten. Pain is often severe, and hand function becomes significantly limited.
- Grade 4 (Very severe): The finger is permanently locked in a bent position and cannot be straightened, even with assistance. This severely impacts daily activities and hand function.
Prognosis
The prognosis for trigger finger largely depends on the severity of the condition and the timeliness of treatment. Mild to moderate cases often respond well to non-surgical treatments, such as physiotherapy and splinting, with many people experiencing significant symptom relief within a few weeks to months.
For more severe cases, particularly those where the finger becomes stuck or permanently locked, surgical intervention may be necessary to release the tendon sheath and restore full function. Surgical outcomes are generally very positive, with a high success rate and minimal recovery time.
Early intervention usually leads to a better outcome, so it is important to seek treatment as soon as symptoms appear. However, even with treatment, trigger finger can sometimes recur.
Treatment
Trigger finger can be treated using both non-surgical and surgical approaches. The choice of treatment depends on the severity of the condition and the impact on daily activities.
Non-Surgical Treatments:
- Rest and activity modification: Reducing or avoiding activities that aggravate the condition, such as repetitive gripping, can help relieve symptoms. Resting the affected hand for a period allows the inflammation to subside.
- Splinting: A splint can be used to keep the affected finger in a straightened position, preventing it from locking. This can be worn at night or during the day to help the tendon heal.
- Physiotherapy: Physiotherapy plays a critical role in managing and rehabilitating trigger finger. A physiotherapist can provide:
- Stretching exercises: Gentle stretching can help improve the flexibility of the affected finger and reduce stiffness.
- Strengthening exercises: Specific exercises to strengthen the muscles and tendons around the finger can improve function and prevent further injury.
- Soft tissue massage: A physiotherapist may use techniques like soft tissue massage to reduce inflammation and pain.
- Ultrasound therapy: This can help reduce swelling and improve the mobility of the tendon.
- Heat and cold therapy: Alternating between heat and ice packs can be effective for reducing pain and inflammation.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain and inflammation. These are typically used in conjunction with other treatments.
Steroid Injections:
If non-surgical treatments are not effective, a corticosteroid injection may be administered directly into the tendon sheath. This helps reduce inflammation and allows the tendon to glide more freely. Steroid injections are usually very effective, especially in the early stages of trigger finger, though in some cases, symptoms may return after a few months.
Surgical Treatment:
For more severe or persistent cases of trigger finger, surgery may be recommended. The procedure, known as a tenolysis or trigger finger release, involves cutting the tendon sheath to widen the space and allow the tendon to move more easily. It is a minor procedure usually performed under local anaesthetic, and most patients regain full movement and function within a few weeks.
Post-surgery, physiotherapy is often recommended to restore strength and mobility in the affected finger. Hand therapy exercises will aid in speeding up recovery and preventing stiffness or scarring around the tendon.
Information is provided for education purposes only. Always consult your physiotherapist or other health professional.