Trigger Finger Release
Stenosing tenosynovitis is commonly known as “trigger finger” or “trigger thumb.” The tendons that bend the fingers glide easily with the help of pulleys. These pulleys hold the tendons close to the bone. This is similar to how a line is held on a fishing rod. Trigger finger occurs when the pulley becomes too thick, so the tendon cannot glide easily through it.
Trigger finger is an extremely common condition of unknown cause, which can affect males and females alike.
It can be associated with rheumatological conditions but can occur spontaneously without any other associations. It can be associated also with carpal tunnel syndrome. The tendons to each finger (2) enter a tunnel system called the pulley system and any increase in size in the tendon or the lining of the tendon tissue can result in difficulty bending or extending the finger. Sometimes a swelling of the tendon itself gets caught in the pulley system and results in the finger being difficult to fully extend and when a fist is made the affected finger will remain stuck in the palm. This is called a trigger finger.
Often the patient themselves have to extend the affected finger with the other hand in order to make it straight. Occasionally this can result in what is called a reverse trigger finger where it is difficult to fully bend the finger down into the palm.
Often patients have pain in the palm around the area where the pulley system starts, a nodule can sometimes be felt here as well.
Usually, if I see a patient with the first presentation of trigger finger, after a suitable evaluation and imaging, I perform a steroid guided injection into the area around the nodule and swelling of the tendon.
In most cases this does actually resolve the trigger finger and sometimes is in association with hand therapy and splinting to try and prevent repetitive movement of the finger.
Usually if the injection is going to work it will work over 4 – 6 weeks.
If injection fails to improve the symptoms, then surgery is sometimes required and this requires a general or local anaesthetic and sedation, where an incision is made in the palm to release the pulley system from the tendon and remove any excess tissue from around the tendon to allow free gliding of the finger. The results are usually extremely good and rapid and return to normal function is anticipated over 4 – 6 weeks.