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What is trigger finger/thumb?

A trigger finger or trigger thumb is a condition, which involved the pulleys and the tendons in the hand.  These tendons are used in flexing our fingers.  The tendons work like long strings that connect the muscles of the forearm with the bones of the finger and thumb.

Trigger finger

In the finger, the pulleys are a series of rings that form a tunnel through which the tendons must glide, much like the guides on a fishing rod through which the line (or tendon) must pass. These pulleys hold the tendons close against the bone.

Trigger finger/thumb occurs when the pulley at the base of the finger (A1 pulley) is too thick and constricting around the tendon, making it hard for the tendon to move freely through the pulley. Sometimes the tendon develops a nodule (knot) or swelling of its lining. Because of the size discrepancy between the tendon and the pulley, one may feel pain, popping, or a catching feeling in the finger or thumb.  When the tendon catches, it produces inflammation and more swelling. This causes a vicious cycle of triggering, inflammation, and swelling. Sometimes the finger becomes stuck or locked, and is hard to straighten or bend.

Causes of Trigger Finger

The causes of trigger finger are not always clear.  Some trigger fingers are associated with medical conditions such as rheumatoid arthritis, gout, and diabetes. Local trauma to the palm/base of the finger may be a factor on occasion, but in most cases there is not a clear cause.

Presentation of Trigger Finger

Patients with trigger finger/thumb may experience discomfort felt at the base of the finger or thumb, where they join the palm.  There may be tenderness noted at this area.  A nodule may sometimes be felt in this area. When the finger begins to trigger or lock, the patient may think the problem is at the middle knuckle of the finger or the tip knuckle of the thumb, since the tendon that is sticking is the one that moves these joints.

Treatment of Trigger finger

The goal of treatment in trigger finger/thumb is to eliminate the catching or locking and allow full movement of the finger or thumb without discomfort.   There are nonoperative ways to approach the trigger finger/thumb.  Antiinflammatory medications may be effective in some cases.  Often times, wearing a night splint (which we can provide you with) can decrease some of the symptoms of trigger fingers.  A cortisone injection into the hand can also help decrease or eliminate the symptoms of trigger finger/thumb. 
If non-surgical forms of treatment do not relieve the symptoms, surgery may be recommended.  We perform these surgeries as an outpatient.  The anesthesia is local anesthesia with some intravenous sedation.  The surgery takes less than 30 minutes to complete.  During surgery, a small incision is made over the A1 pulley (in the palm of the hand).  The pulley is released.  Immediately after surgery, active range of motion of the fingers is initiated.  Normal use of the hand can usually be resumed once comfort permits. Some patients may feel tenderness, discomfort, and swelling about the area of their surgery longer than others. Occasionally, hand therapy is required after surgery to regain better use.  A consultation with your treating surgeon can help decide the best options for you.