Trigger finger/thumb

What is it?

Trigger finger is also known as stenosing tenovaginitis. It is a condition where the flexor tendons of the finger or thumb, which bends the digits, gets stuck as it glides in a tunnel created by a series of pulleys, in the palm of the hand. This can cause pain and catching when bending and straightening the finger and when severe, can cause the finger to become locked when bent into the palm. It is often caused by either a thickening of the pulley or swelling around the tendon.

How do I know if I have a trigger finger/thumb?

Trigger fingers or thumbs often start with a painful and sensitive area at the base of the finger or thumb. Common signs and symptoms of a trigger digit are:

  • Pain
  • Catching
  • Popping or clicking (see video below)
  • Limited movement of the finger
  • Tender lump at the base of the finger or thumb

What can I do to treat it?

  • Hand therapy and splinting
  • Anti-inflammatories
  • Corticosteroid injection
  • Surgery

For early onset symptoms, splinting and anti-inflammatory medications can be helpful. A cortisone injection around the flexor tendon can reduce swelling and can be an effective treatment.  Research studies have shown resolution in 69% of cases with no recurrence of symptoms for 3 years or more. The thumb responds even more favourably to a cortisone injection when compared with other digits with a response rate of more than 80%.(1) Injections can be performed in the clinic and normally well tolerated by patients.Surgery is a safe and effective solution in cases where trigger finger does not resolve or recurs after a cortisone injection. 

Surgery can be performed under local anaesthetic as a day procedure in hospital or the clinic, to release the pulley in the palm of the hand, to allow free movement of the tendon. This can be done by a percutaneous needle technique or with a small open cut in the palm with no recurrence in the operated finger.(2)

What are the risks of surgery?

  • ReInfection
  • Injury to the nerves and arteries of the finger – can cause numbness or cold insensitivity
  • Tendon bowstringing – can cause stiffness in the finger

What should I expect following surgery?

Dressings – The hand will be wrapped in a bandage following surgery. This dressing should be kept clean and dry until you are seen by your doctor within 5-7 days.

Pain management – Local anaesthetic can keep the site of surgery and finger numb for 4-6 hours following surgery. Ice, and keeping the hand elevated combined with regular simple paracetamol or anti-inflammatories for 2-3 days is usually adequate in keeping pain under control.

Movement – You are encouraged to keep the fingers moving following surgery to help reduce swelling and minimise stiffness.

Return to Activity – You can use your hand for simple activities such as driving, dressing, eating and typing when you feel comfortable after surgery.

Related Conditions

Carpal tunnel syndrome

References

  1. Castellanos, Juan, Ernesto Muñoz-Mahamud, Enric Domínguez, Pablo Del Amo, Oscar Izquierdo, and Pere Fillat. “Long-Term Effectiveness of Corticosteroid Injections for Trigger Finger and Thumb.” The Journal of Hand Surgery 40, no. 1 (January 2015): 121–26. https://doi.org/10.1016/j.jhsa.2014.09.006.
  2. Wang, Jia, Jia-Guo Zhao, and Cong-Cong Liang. “Percutaneous Release, Open Surgery, or Corticosteroid Injection, Which Is the Best Treatment Method for Trigger Digits?” Clinical Orthopaedics and Related Research 471, no. 6 (June 2013): 1879–86. https://doi.org/10.1007/s11999-012-2716-6.
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Dr Avanthi Mandaleson

Specialist Hand & Upper Limb Surgeon​
(BMedSci, MBBS, FRACS, FAOrthA)

For all appointments please call (03) 9456 9077