Trigger Finger

Question 1

Causes of trigger finger

Answer 1

• Overuse or idiopathic injury
• Occurs due to chronic inflammation and hypertrophy of the sheath that disrupts the ability of flexor tendons to glide properly
• Since these sheaths act as pulleys, the repeated motion of the tendon rubbing on the sheath leads to inflammation and pain
• Once the finger is flexed, the swollen tendon can get stuck in the tendon sheath surrounding it
• When trying to force the finger into extension, extreme pain is usually felt
• Swelling of the tendon can also occur which will interfere with the slidingmotion when an individual attempts to flex their finger

Question 2

Signs and symptoms of trigger finger

Answer 2

• Stiffness of finger(s) in the morning
• Initial painless clicking
• Painful Popping as the finger is flexed and extended
• Loss of ROM during flexion or extension without developing the“locking” feeling
• Formation of a nodule on the palmar side of affected finger
• Finger becoming stuck in the flexed position and “snapping” back straight when passively moved into flexion
• Inability to straighten affected finger

Question 3

Pediatric trigger finger

Answer 3

• May be linked to trauma, genetic abnormalities, or anatomic anomalies
• Different than in adults, pediatric cases include widening of the long finger flexor muscles (FDS and FDP)
• Similar to adults, nodules can also form
• Not common; only 0.05% of children
• Of those children, 90% of cases involvethe thumb instead of fingers 2-5

Question 4

Non surgical treatment for trigger finger

Answer 4

• Rest - Avoiding activity can promote the healing process
• Splinting - It is common to wear a splint at night to keep the affected finger in a straight position while sleeping
• Exercise - Gentle stretching can help decrease stiffness and increase ROM
• Medication - Over the counter medications including acetaminophen and NSAID’s can decrease pain and inflammation
• Steroid injections - Corticosteroid, or cortisone which is a anti-inflammatory that can be injected into the tendon sheath at the base of the affect finger

Question 5

Surgical treatment of trigger finger

Answer 5

• If the symptoms do not get better with the nonsurgical route then it is time to take the surgical approach
• The surgical intervention is a procedure for trigger finger release
• The goal is to release the A1 pulley, whichis responsible for limiting the tendonmovement. This can be performed without sedation and done in an outpatient setting
• Usually performed through a small openincision in the palm or with the tip of a needle

Question 6

Recovery from surgical treatment for trigger finger

Answer 6

• Incision may take 4-6 months. For the swelling and stiffness to go away completely
• Patients are prompted to move their finger immediately after surgery
• If the patient had limited AROM prior to surgery they may not regainfull ROM after the surgery