Trigger Finger

What is it?

Also known as Stenosing Tenosynovitis, trigger finger/trigger thumb; i.e. trigger digit, is the thickening of the tissues surrounding the tendons that allow bending movements of the fingers and thumb.

Muscles in the forearm are connected to the fingers with tendons. These tendons are surrounded by a sheath and are enclosed by pulleys (short tunnels) that maintain a close relationship between the tendon and bone.

In trigger finger the sheath and pulley become thickened from friction and the tendon may also form a nodule within it. As a result, the finger tendon experiences a high resistance to movement and may become stuck, leading to catching or locking of the finger whilst trying to straighten and extend it. Repeated locking may exacerbate the condition and worsen the symptoms.

Who gets it and what causes it?

There is no clear cause but there are associations with rheumatoid arthritis, gout and diabetes and occupations that involve heavy or prolonged gripping.

What are the signs and symptoms?

You may experience stiffness or difficulty in straightening and bending your finger (or thumb), and it may become locked or trapped in a certain position. Patients often experience painful 'clicking' and tenderness at the base of the finger or thumb, and may feel a small lump at that site.

What tests will I need?

The diagnosis can usually be made with a consultation, involving a medical history and clinical examination. Usually, no specialised tests are needed though sometimes an ultrasound scan is helpful to confirm the diagnosis.

What is the treatment?

Nonoperative treatment measures include wearing a splint, modification of normal activities and taking oral anti-inflammatory medications.

Steroid injections around the tendon/pulley at the point of triggering are usually the next line of treatment. They help to reduce swelling and friction and restore some of the freedom of movement of the tendon through its sheath and pulley. The steroid may take a few days or weeks to take full effect. Persistent or severe symptoms are likely to require surgical treatment.

What does the surgical treatment involve?

Surgery aims to release the tendon from the thickened sheath and pulley by making a small cut either with a needle or with a very small surgical incision.

Mr Miller performs trigger digit release surgery at Claremont Private Hospital. The surgery usually lasts 15 to 20 minutes and is usually a day case procedure requiring only local anaesthetic. 

What happens after the surgery?

Taking simple painkillers regularly for the first few days after the operation will help to relieve any post-operative pain. Stitches, if required, are of the resorbable (dissolving) kind so will not need removal. A wound check will be organised either at your GP surgery or at the Claremont Hospital 5-7 days after your operation and a follow-up appointment to see Mr Miller 1-2 weeks after that.

When I can return to normal activity?

A period of 2-3 weeks off work is recommended to allow you to recover.

You are advised not to drive for 1 week after surgery.

What are the complications of surgery?

Complications are unlikely. There are small risks of infection (~2%), nerve or tendon injury (<1%) and recurrence of symptoms. A small percentage of patients (1% or less) will develop a severe reaction after hand surgery (called CRPS), with long-standing pain and loss of use in the hand which is something that is difficult to treat. If you are concerned about any of these risks, or have any further queries, please speak to Mr Miller.