Trigger Fingers

If your finger gets stuck in flexion such that you have to use your other hand to straighten it, or you get a painful snapping when you straighten your finger, you may have ‘stenosing tenosynovitis’, otherwise known as a trigger finger. The flexor tendons that bend your fingers run in tunnels, called flexor sheathes, on the front of your fingers. The entrances to the tunnels are in the palms at the base of the fingers. If the entrance to one of these flexor sheathes becomes too tight or swollen, it causes a thickening in the tendon which causes the tendon to get stuck.

Trigger fingers are not dangerous but can be a nuisance. They are more common in diabetics and older people but can occur in anyone, particularly after an episode of unaccustomed use of the hand.

If you have a trigger finger, your first option is to live with it, there is a chance it will get better by itself with rest. Your second option is a steroid injection which can be curative, but in about 50% of cases the triggering comes back. Before giving you a steroid injection, I will inject local anaesthetic first which makes the procedure less uncomfortable and provides pain relief for several hours afterwards. It also means the finger will be temporarily numb so you need to be careful not to burn or injure the finger inadvertently. The steroid may take up to two weeks to take effect. The risks of a steroid injection are bruising, infection, nerve or tendon injury and there is a theoretical increased risk of becoming more unwell with coronavirus should you catch it.

Your last option is surgery to divide the swollen entrance to the sheath (A1 pulley). This surgery can either be with a needle (percutaneous release) or an open procedure and is performed under local anaesthetic. A percutaneous needle release avoids a scar. The sharp end of the needle is used to divide the entrance to the sheath. The disadvantage is that it because the tunnel is not visualised, the outcome of surgery is less predictable. An open procedure involves making an incision in the palm at the base of the finger. The risks of surgery are a permanent scar which can be tender, delayed healing, infection, problems with ongoing pain, injury to the nerves that supply sensation in the finger, swelling and stiffness of the hand and a very small risk of the problem coming back. Most patients have an excellent outcome.

You will have a sticky dressing on the wound which you can remove at five to seven days. I use dissolving stitches which generally dissolve over 2 weeks. Once you have removed the dressing, you should gently rub any visible stitches to encourage them to come away. You should work to regain the full range of motion of the finger from day 1 by repeatedly closing and opening your hand. I recommend taking a few days off work and driving, particularly if you a manual worker. Most patients do not need any physiotherapy, but if you find yourself struggling with pain or movement, please let me know and I will make this referral.