Trigger Finger Treatment
Trigger finger is a mechanical problem with a mechanical explanation, and understanding it removes most of the alarm it causes. A tendon that normally glides smoothly through a tunnel of pulleys develops a thickening, that thickening catches at the entrance to the first pulley, and the finger locks. The catch releases with a snap, which is where the name comes from.
Steven Struhl, MD is board certified in orthopedic surgery and separately in sports medicine and arthroscopic surgery, has practiced in New York since 1991, and serves on the faculty of NYU School of Medicine. Trigger finger responds to a small number of treatments reliably, and most patients never need an operation.
Trigger Finger Symptoms
- Catching or Locking: the finger sticking in a bent position and releasing with a snap.
- Worse in the Morning: stiffness and locking most pronounced on waking, easing through the day.
- A Tender Nodule in the Palm: felt at the base of the affected finger, over the tendon.
- Pain at the Base of the Finger: rather than at the joint that appears to be stuck, which surprises patients.
- A Finger Locked in Flexion: in advanced cases, requiring the other hand to straighten it.
- Multiple Fingers: affected in some patients, particularly those with diabetes.
The ring finger and thumb are most commonly affected, and the pain is felt in the palm even though the problem appears to be at the finger joint.
What Causes Trigger Finger
- Repetitive Gripping: particularly forceful gripping of tools, which is the most common association.
- Diabetes: a strong risk factor, and patients with diabetes are more likely to have multiple fingers involved and to respond less well to injection.
- Rheumatoid Arthritis: inflaming the tendon sheath.
- Thyroid Disease and Gout: both associated.
- Prior Carpal Tunnel Release: trigger finger appears in some patients afterward.
- Age and Sex: most common between fifty and sixty, and more frequent in women.
In many patients no cause is identifiable, and that is a normal finding rather than an incomplete evaluation.
Diagnosis
Trigger finger is diagnosed by examination alone. A tender nodule at the base of the finger, with catching reproduced when the patient makes a fist and opens the hand, establishes it. Imaging is not required. Radiographs are taken only where arthritis or another problem in the joint is suspected, and where the finger is genuinely stuck rather than catching, other causes are considered.
Trigger Finger Treatment
- Activity Modification: reducing forceful repetitive gripping.
- Splinting: holding the affected finger straight, particularly overnight, which resolves a proportion of early cases.
- Anti Inflammatory Medication: for symptom control.
- Stretching and Tendon Gliding: gentle exercises maintaining motion.
- Corticosteroid Injection: placed into the tendon sheath, which is the mainstay of treatment and resolves symptoms in a substantial majority after one or two injections.
Injection works well and it works less well in patients with diabetes and in fingers that have been locking for a long time. A second injection is reasonable where the first helped and the symptoms returned. A third rarely adds much.
Trigger Finger Release Surgery
For fingers that continue to catch after injection, or that are locked, Dr. Struhl performs a trigger finger release as an outpatient procedure under local anesthesia.
- What Is Done: a small incision in the palm, through which the A1 pulley is divided, giving the thickened tendon room to glide.
- Duration: the procedure itself takes a matter of minutes.
- Immediate Motion: the finger is moved on the table to confirm the catching has resolved.
- Success Rate: very high, with recurrence uncommon.
- Percutaneous Release: performed through a needle rather than an incision in selected cases.
Recovery
- First Few Days: a light dressing, with finger motion started immediately, which matters because stiffness is the main thing to avoid.
- Weeks One to Two: light use resumed, with the sutures removed around ten days.
- Weeks Two to Six: grip strength rebuilding, with palm tenderness at the incision settling gradually.
- Weeks Four to Six: return to full activity including manual work.
The catching resolves immediately. Palm soreness at the incision is the part that lingers, and it typically settles over four to six weeks.
Schedule a Trigger Finger Consultation in New York City
A finger that locks in the morning and has to be straightened with the other hand is worth treating rather than working around, since the joint stiffens the longer it stays in that position. Dr. Struhl evaluates wrist and hand conditions at his Manhattan and Westchester offices. Contact us to schedule an appointment.
