Trigger finger

What is trigger finger?

Trigger finger is a disorder where a finger or thumb gets stuck in a bent position, as if you were squeezing a trigger. Also, once it gets unstuck, the finger pops straight out, like a trigger being released.

Post operative photo of trigger finger release surgery in a diabetic patient

What causes trigger finger?

• The tendons that move the finger slide through a tendon sheath and if the tunnel swells and becomes smaller, or the tendon has a bump on it, the tendon cannot slide smoothly through the tunnel.
• When it cannot slide smoothly, the tendon may become stuck when you try to straighten your finger.

Signs and symptoms

• Symptoms include catching or locking of the involved finger.
• In the ring and middle fingers, often a nodule can be felt at the area of the hand where the palm meets the finger.

Diagnosis

• Diagnosis is made almost exclusively by history and physical examination alone.
• More than one finger may be affected at a time, though it usually affects the index, thumb, middle, or ring finger.
• The triggering is usually more pronounced late at night and into the morning, or while gripping an object firmly.

Treatment

• Treatment consists of injection of a corticosteroid such as methylprednisolone often combined with a local anesthetic (lidocaine) at the site of maximal inflammation or tenderness around the A1 pulley of the finger in the palm.
• The infiltration of the affected site can be performed using standard anatomic landmarks or sonographically guided, and often needs to be repeated 2 or three times to achieve remission.
• An irreducibly locked trigger, often associated with a flexion contracture of the PIP joint, should not be treated by injections.

Surgery

For symptoms that have persisted or recurred for more than 6 months and/or have been unresponsive to conservative treatment, surgical release of the pulley may be indicated.

Prognosis

• The natural history of disease for trigger finger remains uncertain.
• There is some evidence that idiopathic trigger finger behaves differently in people with diabetes.
• Recurrent triggering is unusual after successful injection and rare after successful surgery.

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