Question and Answer with a Hand Surgeon
Has your finger ever felt stuck in a bent position? Is your thumb or ring finger stiff when you wake up in the morning? Does your finger make a popping or snapping sound when you try to straighten it?
These are all signs that you may have a trigger finger — a condition that causes pain and swelling in the tendon tissue that holds the muscle and bone in your finger together. A trigger finger causes the finger to feel stiff or as though it is caught on something. In severe cases, the finger gets stuck and can’t bend at all.
Nearly two percent of people in the U.S. will experience trigger finger at some point in their lifetime. Joseph Said, MD, a hand surgeon at Summit Health, helps diagnose and treat many patients with trigger finger. He answers common questions about the condition and explains how hand specialists work with patients to improve their symptoms and get them back to the activities they enjoy.
Q. Why does trigger finger happen?
A. Trigger finger occurs when there is a mismatch in size between the finger tendons and the space for the tendons. The tunnel for the tendons becomes rigid, or the tendons that pass into the tunnel become too swollen for the tunnel. This is like the islets of a fishing pole. If there is a knot in the fishing line, it does not pass smoothly through the islets. The tendons must squeeze into a tighter space in the hand, and sometimes the finger gets stuck and snaps.
Q. What are the most common symptoms?
A. Trigger finger usually manifests as pain in the palm of the hand. The finger may also get stuck and be unable to straighten. Generally, the condition is worse in the morning.
Q. What fingers are likely to be affected?
A. The ring finger and the thumb are the most common trigger fingers.
Q. Is trigger finger like arthritis?
A. No, this problem is different from arthritis. In arthritis, there is a loss of cartilage that causes pain to develop in the joints. Since the tendons are affected in trigger finger, the discomfort develops in the palm.
Q. Does the weather affect trigger finger?
A. Unlike joint pain, weather does not typically affect a trigger finger. Laying down at night can make symptoms worse in the morning because more swelling develops in the hand.
Q. How is trigger finger diagnosed?
A. A history of a painful, catching finger and tenderness in the palm is usually enough to diagnose a person with a trigger finger. No imaging is required.
Q. What type of specialist can help?
A. Most primary care physicians can diagnose a trigger finger. But a hand surgeon is best qualified to evaluate and treat the condition. There are other problems like arthritis or snapping tendons on the back of the hand that can imitate a trigger finger.
Q. How is the condition treated?
A. If a specific activity is associated with the onset of symptoms, then avoidance of that activity may help resolve the triggering in the early stages. In addition, anti-inflammatory medications and splinting the finger for a few weeks can help.
Corticosteroid injections are typically the mainstay of treatment for painful triggering. But if that is not working well, then surgery should be considered.
Q. When should I think about surgical options?
A. Trigger finger surgery should be considered if other options are not working, or if the finger is locked and cannot move. When the finger remains locked over time, there is a risk that the finger could lose motion.
Q. How is the surgery performed?
A. Trigger finger release surgery is a relatively simple procedure. The tunnel sheath is opened to allow the tendon to pass through it more easily. The surgery can be performed under local anesthesia with the patient awake or under general anesthesia while the individual is asleep. The procedure, which only takes a few minutes, can be performed in the office.
Q. Can physical therapy help?
A. A hand or occupational therapist can create a custom-molded trigger finger splint and provide exercise instructions for patients. Therapy may not be enough to cure the problem completely.
Q. Who is most likely to develop trigger finger?
A. Anyone can develop trigger finger, but certain individuals are more at risk. Women are six times more likely to develop trigger finger than men. Some risk factors for trigger finger include a history of diabetes, hypothyroidism, inflammatory disorders like rheumatoid arthritis, and taking certain medications such as Anastrozole (Arimidex) and Exemestane (Femara). Nearly 10% of diabetics will develop trigger finger.
In patients who do not have a clear risk factor, the most likely cause is repetitive gripping activities. These repetitive motions cause the tendon to swell and thicken from too much friction, like a thread passed too many times through a sewing needle.