Flexor tendons attach to muscles in the forearm, wrist and hand. The tendons run through small tunnels in the palm and fingers called tendon sheaths.
The tendon sheaths have “pulleys,” which are bands of tissue that hold the flexor tendons close to the finger bones. Normally, the tendons pass through the pulleys as you move your finger.
The most common pulley to be involved in trigger finger is known as the A1 pulley. When it becomes irritated, thickened or inflamed, it may develop a small nodule on its surface.
When flexing your finger, the inflamed tendon moves out of the sheath, but the nodule prevents it from moving smoothly back in as the finger tries to straighten, and the finger locks. Forcing the swollen area into the sheath causes a sudden release, and you may feel a popping sensation similar to that felt when pulling a trigger.
The condition is known as stenosing tenosynovitis, aka trigger finger.
People at the highest risk for trigger finger are women and people who:
- Work in jobs that require repetitive gripping and grasping and forcefully using the fingers or thumb.
- Typists and writers.
- Musicians and painters.
- Construction workers and manual laborers.
- Assembly line workers.
- Have arthritis, gout or diabetes.
- Are between the ages of 40 and 60.
However, the exact cause of trigger finger is unknown.
You may notice the symptoms of trigger finger after prolonged and active hand use where you have repeatedly been pinching and grasping.
There may be pain, stiffness and your finger may pop, catch or “lock” when you bend and straighten your finger.
Any of your fingers can be affected by trigger finger, but the ring finger and thumb are most often affected, although more than one finger can be involved.
You may also notice a painful or tender lump at the base of the affected finger on the palm side of your hand. Stiffness and pain may be worse after a long period of inactivity or when you wake up in the morning.
Diagnosing trigger finger is straightforward. Your doctor will review your medical history, ask about the symptoms you’re experiencing and examine your hand. X-rays and other tests are not usually necessary.
Your doctor will have you open and close your hand, checking for pain and the locking sensation typical of trigger finger. They will also look for thickening or swelling of the tendon sheath.
In most cases, treatment of trigger finger doesn’t include surgery. Instead, your doctor may prescribe rest, splinting, hand exercises, anti-inflammatories (such as ibuprofen or naproxen) or a steroid injection.
If symptoms don’t improve, you may get a second steroid injection. However, if the condition persists, your doctor may recommend surgery.
The surgery for trigger finger is an outpatient procedure known as tenolysis or trigger finger release. Through a small incision or with the tip of a needle, your surgeon will release the A1 pulley blocking tendon movement so the tendon can move smoothly through the tendon sheath and function normally again.
It may take several months for swelling and stiffness to subside after surgery. If it continues, your doctor may recommend hand therapy.
If you have any of the symptoms of trigger finger, call our office at (978) 794-1946 or (603) 898-2244 for a consultation, or take advantage of our walk-in clinic in Haverhill and Andover Monday–Friday, 8am–12pm and 1–3pm.