Trigger finger by kids orthopedic

Trigger finger

by Kids Orthopedic

ABOUT THE DISEASE

Trigger finger is a painful condition that causes your fingers or thumb to catch or lock when you bend them. It can affect any finger, or more than one. When it affects your thumb, it’s called trigger thumb.

Trigger finger is also known as stenosing tenosynovitis (stuh-NO-sing ten-osin-o-VIE-tis). It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position.

Symptoms

Signs and symptoms of trigger finger may progress from mild to severe and include: 1.

Finger stiffness, particularly in the morning

2.

A popping or clicking sensation as you move your finger

3.

Tenderness or a bump (nodule) in the palm at the base of the affected finger

4.

Finger catching or locking in a bent position, which suddenly pops straight

5.

Finger locked in a bent position, which you are unable to straighten

Trigger finger can affect any finger, including the thumb. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

Causes

Most of the time, it comes from a repeated movement or forceful use of your finger or thumb. It can also happen when tendons -- tough bands of tissue that connect muscles and bones in your finger or thumb -- get inflamed.

Together, they and the muscles in your hands and arms bend and straighten your fingers and thumbs.

A tendon usually glides easily through the tissue that covers it (called a sheath) thanks to the synovium, a lubricating membrane that surrounds joints. Sometimes a tendon gets inflamed and swollen. Prolonged irritation of the tendon sheath can lead to scarring and thickening that affect the tendon's motion. When this happens, bending your finger or thumb pulls the inflamed tendon through a narrowed sheath and makes it snap or pop.

Risk factors

Factors that put you at risk of developing trigger finger include: Repeated gripping. Occupations and hobbies that involve repetitive hand use and prolonged gripping may increase your risk of trigger finger.

Certain health problems. People who have diabetes or rheumatoid arthritis are at higher risk of developing trigger finger.

Your sex. Trigger finger is more common in women.

Carpal tunnel syndrome surgery. Trigger finger may be a complication associated with surgery for carpal tunnel syndrome surgery, especially during the first six months after surgery.

Diagnosis

Diagnosis of trigger finger doesn't require any elaborate testing. Your doctor or health care provider makes the diagnosis based on your medical history and a physical exam. During the physical exam, your doctor will ask you to open and close your hand, checking for areas of pain, smoothness of motion and evidence of locking.

Treatment

Medications Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve) — may relieve the pain but are unlikely to relieve the swelling constricting the tendon sheath or trapping the tendon.

Therapy Conservative noninvasive treatments may include: Rest. Avoid activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating hand-held machinery until your symptoms improve. If you can't avoid these activities altogether, padded gloves may offer some protection.

A splint. Your doctor may have you wear a splint at night to keep the affected finger in an extended position for up to six weeks. The splint helps rest the tendon.

Stretching exercises. Your doctor may also suggest gentle exercises to help maintain mobility in your finger.

Surgical and other procedures

Steroid Injection An injection of a steroid medication near or into the tendon sheath may reduce inflammation and allow the tendon to glide freely again. This is the most common treatment, and it's usually effective for a year or more in most people treated. But sometimes it takes more than one injection.

For people with diabetes, steroid injections tend to be less effective.

Percutaneous Release After numbing your palm, your doctor inserts a sturdy needle into the tissue around your affected tendon. Moving the needle and your finger helps break apart the constriction that's blocking the smooth motion of the tendon.

This treatment may be done under ultrasound control, so the doctor can see where the tip of the needle is under the skin to be sure it opens the tendon sheath without damaging the tendon or nearby nerves. This procedure is usually done in the doctor's office or in an office procedure room.

Surgery Working through a small incision near the base of your affected finger, a surgeon can cut open the constricted section of tendon sheath. This procedure is usually done in an operating room.

Recovery

The time it takes to get better depends on how bad your condition is. The choice of treatment also affects recovery. For example, you may need to wear a splint for 6 weeks. But most patients with trigger finger recover within a few weeks by resting the finger and using anti-inflammatory drugs.

You should be able to move your finger just after surgery. Raising your hand above your heart can ease swelling and pain. Full recovery may take a few weeks, but swelling and stiffness may linger for 6 months. If your finger was super stiff before surgery, the doctor will probably suggest physical therapy to teach you exercises to help loosen it.

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