Orthopedics:
Conditions

Stenosing tenosynovitis, commonly known as “trigger finger” or “trigger thumb”, involves the tendons in the hand that bend the fingers. The tendons work like long ropes connecting the muscles of the forearm with the bones of the fingers and thumb. In the finger, the pulleys are a series of rings that form a tunnel through which the tendons must glide, much like the guides on a fishing rod through which the line (or tendon) must pass.

Trigger finger/thumb occurs when the pulley at the base of the finger becomes too thick and constricting around the tendon, making it hard for the tendon to move freely through the pulley. Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the increased resistance to the gliding of the tendon through the pulley, one may feel pain, popping, or a catching feeling in the finger or thumb. When the tendon catches, it produces irritation and more swelling of the pulley. This causes a vicious cycle of triggering and thickening of the pulley. Sometimes the finger becomes stuck or locked, and is hard to straighten or bend. Causes for this condition are not always clear. Some trigger fingers are associated with medical conditions such as rheumatoid arthritis, gout, and diabetes.

• Trigger finger/thumb may start with discomfort felt at the base of the finger or thumb, where they join the palm.
• Area is often tender to local pressure.
• A nodule may sometimes appear at the base of the finger or thumb.
• The finger begins to trigger or lock.

The goal of treatment in trigger finger/thumb is to eliminate the catching or locking and allow full movement of the finger or thumb without discomfort. The wearing of a splint or taking an oral anti-inflammatory medication may sometimes help. Treatment may also include changing activities to reduce swelling. An injection of steroid into the area around the tendon and pulley is often effective in relieving the trigger finger/thumb.

If non-surgical forms of treatment do not relieve the symptoms, a surgical procedure known as Trigger Finger Release 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. Active motion of the finger generally begins immediately after surgery. Some patients may feel tenderness, discomfort, and swelling about the area of their surgery longer than others. Occasionally, hand therapy is required after surgery to regain better use.

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