Mr Apurv Sinha 

Consultant Trauma and orthopaedics 

 

 

TRIGGER FINGER

 

Trigger Finger is a condition affecting the tendons in the hand. It can affect one or more fingers and sometimes the thumb. When bending the finger it can “click” or lockdown – this is due to a build-up of swelling in the tendon.

Tendons are fibrous cords in the body joining bones to muscles allowing bones to move. These tendons are held in place by strong bands of tissue called ligaments. In the fingers, these ligaments are arch-shaped forming a protective tunnel/ sheath to allow the tendon to glide easily through when bending and straightening the finger.

When there is a problem with the tunnel/ sheath or a problem with the tendon such as swelling/inflammation it means that the tendon cannot glide through properly. This means that the finger cannot bend properly. Sometimes the tendon gets caught in the sheath and when it pops through can give a ‘click’ like a trigger being released – this can be very painful. In severe cases, the finger can become locked down permanently.

Why does it occur?

Because of the position of the ligaments at the bottom of your finger they are exposed to pressure when gripping on to things. Over time the ligaments can become swollen/ inflamed and thicken.

This thickening can partially block the opening of the tunnel/sheath that the tendon glides through.

The condition is more common:

  • In women

  • In adults over the age of 40+

  • If you have injured the base of the finger/ palm

  • In people with other health problems such as diabetes, of inflammatory conditions such as Rheumatoid arthritis/gout, thyroid problems, Carpal Tunnel, Dupuytren’s Disease. Patients with diabetes may experience multiple fingers triggering over a period of time

 

What are the symptoms?

Symptoms include:

  • Pain at the bottom of the affected finger/ thumb on movement/pressure

  • A nodule/lump at the base of the affected finger/ thumb

  • Stiffness when moving the affected finger/thumb

  • “Clicking”/ “Popping” when moving the affected finger/thumb – often worse in the morning

  • In severe cases the affected finger/ thumb becoming stuck in a bent position

 

What tests might be done?

A doctor/orthopaedic consultant will be able to diagnose trigger finger through examination and asking the patient about their symptoms.

On occasions, X-Rays may be required to check there are no problems with the bones or joints in the hand.

 

What is the treatment?

Non-Surgical Treatment

  • Medication: often doctors will prescribe anti-inflammatory medication like ibuprofen to help relieve swelling around the tendon and reduce ‘triggering’ as well as helping with the pain

  • Advice: sometimes advice about avoiding certain activities that can aggravate the condition can help to relieve symptoms

  • Splinting: Splints can be used which hold the affected finger straight in order to prevent the tendon from becoming irritated. This may in turn help to reduce swelling

  • Injections: Steroids can be injected into the tendon sheath (the protective layer surrounding the tendons) to help reduce swelling of the tendon and allow it to move more freely and prevent triggering

 

Surgical Treatment

Trigger Finger Release: If the above treatments do not work surgery may be required to release the thickened ligament/ arch surrounding the tendon to allow it to move more freely.

 

What to expect after a Trigger Finger Release

Trigger Finger Release surgery is normally done under local anaesthetic therefore you will not have to stay in hospital overnight.

You will be sent home with dressings over the wound and a practice or district nurse will reduce the dressings between 3-5 days. You will have your stitches removed within 10-14 days.

You may be referred to a hand therapist who will give you information and advice about exercising the affected finger and may provide a splint to ensure that it stays straight following your surgery.

Things to consider before having a Trigger Finger Release:

As with all surgery, there is a small risk of

  • infection

  • Bleeding

  • Nerve or vessel damage 

  • Risk of Reflex Sympathetic Disorder (RSD). Can also be known as Chronic Regional Pain Syndrome (a malfunction of the nervous system that controls your pain).

  • Risk of problematic scar tissue. After the operation there is a risk that you may have problems with scarring including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement.

  • Recurrence