The pulleys are similar to how a line is held on a fishing rod Figure 1. A trigger finger, sometimes referred to as a trigger thumb or stenosing tenosynovitis, can occur if one of three things happen: 1.
The tendon enlarges does not fit through pulley well ; 2. The lining increases in thickness does not fit through pulley well ; 3. The finger tendon and pulley system is designed to have the exact right sizes of each structure. The change in size of any of the important finger structures can cause problems. If the tendon becomes tight within the pulley, the lining gets squeezed and reacts with thickening. The bigger lining then produces more fluid.
And the higher volume of fluid increases pressure. The undersurface of the pulley can also change and thicken. This thicker pulley causes friction on the moving tendon.
This makes it difficult for the tendon to move back and forth Figure 2. The good news is that trigger finger can be diagnosed by the history, symptoms, and a physical exam. It is rare to require other diagnostic testing. It is also helpful to know this problem has several very successful treatments. Trigger fingers are more common with certain medical conditions. Rheumatoid arthritis , gout and diabetes are risk factors for this condition. Repeated and strong gripping may lead to the condition.
In most cases, the cause of the trigger finger is not known. Common treatment options include, but are not limited to:. If non-surgical treatments do not relieve the symptoms, surgery may be recommended.
The goal of surgery is to open the pulley at the base of the finger so that the tendon can glide more freely. The clicking or popping goes away in most cases after cutting the A1 pulley. If there are still mechanical symptoms after a trigger finger release, a flexor tenosynovectomy can be considered.
This procedure removes the thickened lining from the surface of the tendons. If there are still mechanical symptoms, then part of the superficial tendon can be removed to reduce the volume of tendon moving in and out of the rest of the pulley system.
It is optimal if all the above surgical treatments can be performed during the same procedure. With surgical treatment, the chances of recognizing and treating all changes to the finger is improved when it is possible for the patient to be awake at the end of the procedure to follow instructions.
By having the patient able to actively bend and straighten their fingers several times, the surgeon can verify the mechanical symptoms are absent. Finger motion can return at different speeds depending on each patient and their unique timing of symptom development, when treatments begin, and the effectiveness of each type of treatment. This content does not have an English version. This content does not have an Arabic version. Overview Trigger finger is a condition in which one of your fingers gets stuck in a bent position.
Request an Appointment at Mayo Clinic. Trigger finger Open pop-up dialog box Close. Trigger finger Trigger finger generally results from inflammation within a tendon sheath, restricting tendon motion. Share on: Facebook Twitter. Show references Ferri FF. Trigger finger. In: Ferri's Clinical Advisor Philadelphia, Pa. Accessed Aug. Blazar PE. Trigger finger stenosing flexor tenosynovitis. Trigger digits. Rochester, Minn. Lin FY, et al. Incidence of trigger digits following carpal tunnel release: A nationwide, population-based retrospective cohort study.
With any treatment or procedure, there are risks. Trigger finger cortisone injections are fairly painful, and especially if more than one injection is given at a time can cause the blood sugar level of diabetics to go up for a few days. They also can rarely cause flexor tendon rupture, which is why we limit injections to a maximum of 3 in a one year period. With trigger finger surgery, as with many other hand surgeries, the risks are of infection, nerve damage to the digital nerves that run next to the flexor tendons and supply sensation to your fingers , tendon damage, failure to relieve symptoms due to incorrect diagnosis or unusual cause of the triggering , loss of motion after surgery, continued tenderness, and anesthetic complications.
As I tell my patients, the risk of having any of these problems is small, but not zero. After you have the surgery, whichever way it is performed, the most important things are to keep the dressing clean and dry, and to start bending your fingers right away. You will need to keep working on finger motion every hour while awake. For the first 48 hours, elevate your hand as much as possible. You may start to use the hand for light activities up to 2 lbs of lifting right away.
Sutures if any will be removed about days after the surgery. It is normal for the area at the base of the finger to remain sore for up to two months, but it is not unusual for people to resume normal activities within weeks. Occasionally, I send a post-op patient for hand therapy so that they may help the patient achieve their functional goals more quickly, or if the fingers are unusually stiff when they return for their first visit after the surgery.
Carl B.
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