Q & A: TRIGGER FINGERS

by Lorenzo G. Walker, M.D.

Surgery of the Hand and Upper Extremity

QUESTION: I have noticed a painful catching and locking of the middle finger of my right hand when I attempt to bend and unbend it. It is most severe in the morning, and at times requires me to painfully snap it back into place. Why is this happening and what can be done about it?

ANSWER: Trigger thumb and trigger fingers are caused by inflammation of the tendon sheaths within the hand. Although this can occur in any digit, it most commonly occurs in the ring and middle fingers. The tendons which flex the digits must be held closely against the finger bones in order to prevent a "bowstringing" effect when the fingers and wrist are flexed. At times, these tendon sheaths become inflamed and swollen, often due to repetitive trauma or repetitive stress. This effect is seen frequently in the workplace. Occasionally, this inflammation can occur because of an underlying disease process such as rheumatoid arthritis or gout.

When examined, there is significant pain on the palm side of the hand, at the level of the blockage. As the process progresses, the involved finger becomes extremely stiff, eventually causing stiffness to the adjacent digits in the affected hand.

Treatment is first directed towards decreasing the inflammation within this tendon sheath. Sometimes this can be done with oral anti-inflammatory agents. Splinting is not recommended, as it worsens the stiffness already present in the fingers. A steroid injection can be given into the tendon sheath locally in an attempt to decrease the inflammation. If these measures fail to alleviate symptoms, surgical release of the tendon sheath can be performed as an outpatient procedure under local anesthesia and relief is immediate and permanent. Recovery takes approximately two weeks, during which the patient has free motion of all digits within a soft, bulky dressing.