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Trigger Finger

Overview

Trigger finger is a common condition affecting single or multiple fingers or the thumb. The tunnel present at the base of the finger/thumb is thickened, leading to an improper sling of the tendon. The affected finger/thumb mimics the trigger of a gun when an attempt is made to straighten it.

Most of the patients are healthy adults with no underlying cause. However, some risk factors include:

  • Female sex.
  • Diabetes and rheumatoid arthritis.
  • Gripping activities.

  • The primary complaint is clicking or stiffness at the base of the affected finger/thumb, which is more pronounced during early morning or after a period of rest.
  • The patient typically complains of pain at the base of the finger (A1 Pulley) during the initial stages, while fixed locking or even weakness of the affected finger or thumb can occur in the advanced stage of the disease.

  • Physical examination.
  • X-rays to rule out arthritis.
  • Ultrasonography to see the condition of the affected tendon pulley.
  • Magnetic resonance imaging (MRI) to assess any causes for the swelling/compression.

Non-surgical treatment

  • Splinting the finger/thumb in a straight position, especially during the nighttime can be tried in initial cases with some response.
  • Activities like gripping should be avoided in some cases.
  • Physiotherapy may be beneficial in relieving the pressure around the pulley. Additionally, anti-inflammatory medications may provide temporary relief in the initial stages.
  • Around 50%–60% of the patients respond well to local steroid injections around the A1 pulley to reduce the inflammatory process. A maximum of 2 such injections can be tried.

Surgical treatment

  • Surgery:
    • The procedure can be performed under local or regional anaesthesia depending on the medical condition, pain threshold, and disease stage.
    • Open surgery involves an incision of around 2 cm at the base of the finger/thumb and releasing the A1 pulley completely, which is usually seen as a tight constricting band.
  • After surgery:
    • A sterile dressing is applied after the surgery and the patient is asked to do the finger movements as early as possible.
    • Complete recovery can take up to 2–3 weeks.
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