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Trigger Finger 101.

What is Trigger Finger?

Trigger finger, or stenosing tenosynovitis, is a painful condition of the hand associated with a clicking sensation during finger extension, or locking in a bent position during gripping activities.

A 'pop' or 'click' is felt as you straighten your finger or thumb, much like a trigger being pulled and released. This is often associated with pain in palm at the base of the affected finger. In severe cases, the finger may become locked in a bent position.

Signs & Symptoms of Trigger Finger

Trigger finger symptoms usually progress from mild to severe and often begin with finger stiffness, especially in the mornings. It can affect any of the fingers or the thumb. A painful clicking or snapping sensation is felt as you flex and extend your finger.

Occasionally, a tender lump or nodule can be felt at the base of the affected finger (in the palm). As the condition progresses, fingers can sometimes be locked in a bent position and unable to straighten.

Causes & Risk factors for Trigger Finger

Trigger finger is caused by local swelling due to inflammation of the flexor tendon sheath of the affected finger, at the level of the palm. This may be due to repetitive strain injury, overuse or underlying inflammatory conditions. As the space within the tendon sheath narrows, it hinders the smooth gliding of the tendon, and causes catching of the finger in a bent position before popping straight.

As the catching persists, the tendon itself becomes irritated and inflamed, worsening the problem. Scarring and thickening (fibrosis) can occur and bumps (nodules) can form with prolonged inflammation.

Work or hobbies that require repetitive gripping actions increase the risk this inflammation. Female gender, patients with diabetes or underlying conditions such as rheumatoid arthritis are also at increased risk.

Treatments for Trigger Finger

Trigger finger treatments depend on the severity of the condition.

In the early stages, rest, splinting and non-steroidal anti-inflammatory (NSAID) medications such as naproxen, ibuprofen or diclofenac can relieve the inflammation and swelling that led to the constriction of the tendon sheath and trapping of the tendon, and relieves the pain associated with trigger finger.

A local steroid injection (e.g. cortisone), in the region of the tendon sheath is a rapid and effective treatment that will reduce inflammation of the sheath. Injections are most effective when given soon after symptoms begin and may be repeated if necessary, although repeated injections may not be as effective as the initial injection and carrying increased risks of potential side effects. Steroid injections may not be as effective in people with other medical conditions such as rheumatoid arthritis or diabetes.

Hand surgery is recommended for cases that are unresponsive to the above treatments, or for trigger fingers that persists or recurs after two steroid injections. The procedure involves the release of the locked finger through a small incision in the palm and is often performed under local anesthesia as a day surgery or clinic-based procedure.

Self-care and Prevention

Gentle finger exercises and stretching of the affected finger can help maintain mobility of the finger.

To rest the fingers, avoid activities that involve repetitive gripping, grasping and the use of vibrating machinery for three or four weeks.

Soaking your hands in warm water, especially in the morning, helps relieve stiffness and may reduce the severity of the catching sensation during the day. This can be repeated several times throughout the day.

Gentle massage of the affected fingers doesn't reduce inflammation, but does little harm and may feel good and helps relieve your pain.