When you hear the words “trigger finger,” you might think of a scene from an action movie – James Bond strolling confidently across the beach, or Arnold Schwarzenegger bursting onto the scene, ready to save the day.
But for those who suffer from the condition, trigger finger, the words might only bring back feelings of frustration and pain. Trigger finger, also known as stenosing tenosynovitis, is a condition in which your fingers or thumb get stuck as you bend them. When you try to straighten your finger or thumb again, it catches and is difficult at first, then “pops” or “snaps” straight rapidly – giving trigger finger its name.
While the name might sound like it refers to your index finger, the ring finger is the most commonly affected digit, followed by the thumb (also called trigger thumb).
Why Does Trigger Finger Happen?
When you bend your fingers, the movement is performed by two muscles in your forearm. Each muscle has tendons that pass through your wrist and down the underside of each finger, attaching to the bone. Each tendon passes through a tendon sheath, fibrous tissue that wraps around the finger and forms a tunnel in which the tendons can glide freely to pull on the bones of the finger.
The action of bending your fingers happens when one of these muscles contracts and shortens, pulling the tendon towards your forearm and acting like a pulley to make your finger curl. The thumb has similar tendons and tendon sheaths, though it’s also helped by a muscle in your palm.
Look at the inside of your wrist and place a finger over it. Bend each of your fingers in turn. You can see or feel the movement of the tendons which are working to bend your fingers.
Trigger finger happens when there’s a problem with the tendons or tendon sheath (the tunnel through which the pulley works) in your finger or thumb. The pressure from swelling, thickening, or the inflammation of the tendon or tendon sheath leads to your tendons getting stuck, catching, or locking in position.
For most people who get trigger finger, we don’t find an underlying cause, though you’re at increased risk if you:
- Are over 40
- Have rheumatoid arthritis
- Have gout
- Have diabetes
- Repeatedly perform strong movements with your fingers
People with jobs that require repetitive or forceful gripping movements, such as farmers, musicians, and factory workers, are also at increased risk of trigger finger.
How Can Trigger Finger Affect My Life?
Although the most common symptom of trigger finger is your finger catching, there are several other symptoms associated with it:
- Finger stiffness that’s typically worse in the morning
- Pain when you bend or straighten your finger
- Your finger or thumb getting stuck in a bent shape
- Your finger “snapping” back into position when you try to straighten it
- Pain and swelling in your palm below the affected finger
- A small tender bump (nodule) at the base of your finger or thumb
When someone suffers from trigger finger for a long time without treatment, they can lose the ability to fully bend or straighten their finger as they try to avoid pain by moving their finger less.
Our hands mean a lot to us, especially our dominant hand. We use our hands most hours of the day and need the dexterity in our fingers to make complex movements. When someone suffers from trigger finger, they may struggle with everyday activities like holding a pen, using a cellphone, or driving their car.
Fortunately, trigger finger is easily treatable!
It might be advisable to visit your doctor even if you suspect that you only have mild trigger finger. Other conditions such as Dupuytren’s Contracture
can mimic trigger finger, and it’s important that you don’t misdiagnose yourself.
Can Trigger Finger Be Treated Without Surgery?
In some cases where the pain or immobility caused by trigger finger is serious, you might need the help of a hand surgeon. Don’t panic though! Mild cases of trigger finger often resolve without medical intervention, and there are plenty of treatments you can try before resorting to surgery.
If your case of trigger finger is causing only mild discomfort, there are treatments you can try at home:
- Anti-inflammatory medication
- Resting the affected finger or thumb
- Avoiding movements that cause pain or “triggering”
If your case is causing serious discomfort or isn’t getting better with home treatment, you should contact your doctor, but this doesn’t mean you need surgery right away. There are other treatments available that can resolve the problem without you ever having to put on a hospital gown. These can include:
- A finger splint to keep your finger or thumb straight
- A cortisone (steroid) injection to reduce pain and swelling
- Physical therapy or stretching exercises
If your trigger finger is still not getting better, your doctor might recommend surgery.
What Can I Expect from Trigger Finger Surgery?
Surgery for trigger finger is often quite simple and can be performed under local anesthetic (numbing part of your hand). There are two main procedures used for trigger finger release:
- Percutaneous release can be done under local anesthetic. Your hand surgeon will use a needle to make more room for the tendon to move and glide freely within the tendon sheath. Your doctor may be able to do this in their office.
- Surgical release, also known as tenolysis, can be performed under local anesthetic, regional anesthetic (numbing your entire arm), or general anesthetic (putting you to sleep). This procedure is done in an operating room. Your hand surgeon will make a small cut on your palm and find the A1 pulley. This is the fibrous band that forms a tunnel through which the tendons glide. The surgeon will release the A1 pulley, allowing your tendons to move more smoothly.
It's likely that you will regain movement in your finger immediately following the surgery, with recovery from the procedure taking only a few days. You might have pain and soreness for the week following surgery, but your hand surgeon will give you instructions to make your recovery more comfortable.
Sometimes, trigger finger release doesn’t give you back 100% of your finger mobility, especially if you weren’t able to fully bend or straighten your finger prior to surgery. The pain and “popping” sensation should improve even if your full mobility does not, and you can expect symptoms to resolve within six weeks of your procedure.
If you’re still struggling with pain, stiffness, or reduced mobility after your procedure, contact your doctor to see whether physical therapy or a splint could help you regain more function.
Dr. Pamela Mehta is an orthopedic surgeon and founder of Resilience Orthopedics in San Jose, CA.