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Trigger Finger and Trigger Thumb

What is Trigger Finger?

This is a condition where a finger or thumb can get stuck in a bent position and either click or pop when the finger straightens back out. This condition was first described by a French physician in 1850. Approximately, 2-5% of the population may develop a trigger finger over a lifetime increasing to 10% in diabetics.

Anatomy and Causes

The flexor tendons in our fingers all run through a tunnel. People can then develop a thickening of the tendon and sheath to the point where it has difficulty moving in the tunnel. Subsequently, the swelling gets to a point where it can catch. This happens at the end of the hand on the palm side just before the fingers (A1 pulley). It is more common in people with metabolic disorders like diabetes and thyroid, autoimmune disorders, women, and those over 50.

Symptoms & Associations

  • Locking or catching of the finger
  • Pain and swelling of the finger
  • Unable to straighten the finger all the way out
  • Palpable nodule in the distal palm
  • Often worse in the morning
  • Can involve multiple fingers or both hands
  • Often associated with Carpal Tunnel Syndrome

In general trigger fingers are fairly easy to treat. This is a space problem (not enough room in the tunnel for the tendon). If you have an eight foot semi-truck and a seven foot bridge, you either have to shrink the semi or make a bigger tunnel.

Non-operative (try and shrink semi-truck)

Non-steroidal or steroid oral medication

Splint the finger out straight (usually at night)

Corticosteroid injection (most common) – not as effective in diabetics

Operative (make a bigger tunnel)

Operatively open the A1 pulley which makes a bigger tunnel thus curing the problem. The surgery is an outpatient surgery often performed with sedation and local anesthesia or with local anesthesia only.

De Quervain’s Tenosynovitis

In 1895 a Swiss physician described this entity, which is characteristically pain along the thumb side of the wrist. Just like the trigger finger, this is a disorder where the tendon doesn’t have enough room to move within a tunnel.

Anatomy and Causes

There is rubbing that creates a thickening (stenosing) of the sheath and swelling of the tendon. It is often seen in combination with trigger fingers since the mechanics of the disorder are essentially the same. Repetitive activity using the thumb may aggravate symptoms. Similarly this entity is more common in metabolic disorders (i.e. diabetes), women, pregnancy, and new moms.

Symptoms and Associations

  • Pain on the thumb side of the wrist
  • Sometimes with a nodule or noticeable swelling
  • Pain when bending the wrist towards the pinky with thumb tucked
  • Pain with motion and gripping with the thumb
  • Associated with trigger fingers and carpal tunnel syndrome
  • Can be seen in pregnancy and new moms

Treatment

Essentially the treatment is the same as trigger fingers, in that this is a space issue.

Non-operative

  • Non-steroidal and steroid oral medication
  • Bracing to rest the thumb tendons (brace needs to include the thumb and go above the wrist)
  • Corticosteroid injection (most common) to shrink the tendon

Operative

Similarly to trigger fingers the surgery is to open the tendon compartment to allow for more room for the tendon. It is also an outpatient surgery, and surgery usually cures this disorder.

If you have any of these symptoms or any numbness in the fingers at night (possible carpal tunnel syndrome), call the Reno Orthopedic Center at 775-786-3040 and the upper extremity hand team would be happy to evaluate you.