What is Trigger Finger / Stenosing Tenosynovitis?
Trigger finger, also known as Stenosing Tenosynovitis, is one of the most common conditions causing hand pain and loss of function. Trigger finger occurs when a flexor tendon (tendon of a muscle that bends a finger) or other part of the flexor mechanism of the fingers becomes irritated and thickened, causing the finger to eventually become “stuck” in a flexed (bent) position. This can happen to only one finger or multiple fingers simultaneously. This happens due to an irritation of the flexor tendon and subsequent thickening of it, causing a feeling of catching or snapping when bending and straightening the finger. In the most advanced cases of Trigger Finger, the finger will become permanently flexed with the patient completely having lost the ability to straighten out the finger.
What Causes Trigger Finger?
What causes Trigger Finger to occur is not known. The mechanics of what happens are well known, however. At the base of each finger, is a tendon sheath that secures the flexor tendons of the fingers close to the hand. At the opening of each tendon sheath is a pulley. This is a band of connective tissue called the A1 pulley. Through this pulley and sheath run the flexor tendons of the finger.
At the beginning of this condition, it is this pulley that usually causes the problem. Generally, the pulley is the first structure to become irritated and thickened, disrupting the smooth gliding motion of the flexor tendon when bending and straightening the fingers. Over time, as the condition progresses, the tendon itself will become irritated as well, leading to a worsening of the condition and more pain. While the exact cause of this condition is not known, there are risk factors and other conditions that are known to make an individual more susceptible to Stenosing Tenosynovitis. These are:
- Medical conditions such Diabetes and Rheumatoid Arthritis, and Gout
- Repetitive motions of the fingers including frequent gripping and grasping
- Rarely, traumatic injuries can cause Trigger Finger
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What are Symptoms of Trigger Finger?
At first, the symptoms will be mild usually with no pain but an uncomfortable feeling of catching when straightening the fingers. Other symptoms may be:
- Snapping, catching, or locking when bending and straightening the finger(s)
- Pain and stiffness felt when moving the fingers
- The formation of tender nodules, or lumps, at the base of the fingers near the location of the tendon sheath
- The symptoms of stiffness with movement are usually worse upon waking and lessen as the day goes on
- In advanced cases, a complete loss of ability of straightening the finger and a fixed position of the finger in a bent position
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Treatment for Trigger Finger
The treatment for this condition depends entirely on how far the disease has progressed, so seeking an early diagnosis and treatment is key. Treatments include:
- Discontinuation of any known activities that may be contributing to progression
- Steroid injections
- Custom splinting of the fingers
- NSAIDs (non-steroidal anti-inflammatory drugs)
If non-surgical methods fail to relieve pain, you may opt to have surgery in order to help this condition. The surgery for this condition is called a Trigger Finger Release. During surgery, a minor incision will be made in the palm and a small cut to the tendon sheath in order to allow smoother motion of the flexor tendons.