Introduction
Trigger Finger and Trigger Thumb, known medically as Stenosing Tenosynovitis, are prevalent conditions affecting the hand. These issues arise when the tendons in the fingers and thumb fail to glide smoothly, leading to symptoms that can cause discomfort. Tendons are robust tissues connecting muscles to bones, and in this condition, they may catch or become stuck during finger or thumb movement. This makes it challenging to fully extend the fingers or thumb and can lead to pain, swelling, and discomfort. Trigger Finger and Thumb can affect multiple fingers or the thumb simultaneously or occur in different fingers at various times.
Anatomy
The tendons responsible for finger and thumb movement are attached to the bones of the hand. They pass through a protective tunnel known as the tendon sheath, connecting to the forearm muscles that facilitate finger extension. Typically, these tendons glide effortlessly through the sheath, enabling smooth hand movements. However, swelling or the formation of a nodule—a small round mass—can hinder this movement. Swelling in the tendon sheath can narrow the opening, causing the tendon to catch, which results in pain, swelling, and a characteristic popping sensation. This may lead to fingers or thumbs getting stuck, making bending or straightening difficult.
Causes
The precise cause of Trigger Finger and Trigger Thumb remains unclear, although these conditions are more frequently observed in women and individuals aged 40 to 60. Certain medical conditions, including diabetes, rheumatoid arthritis, autoimmune disorders, and gout, can increase the likelihood of developing Trigger Finger or Thumb. Some individuals may be born with nodules on their tendons, and repetitive gripping actions, such as using tools, may irritate the tendons.
Symptoms
Initial symptoms of Trigger Finger and Trigger Thumb typically include pain and discomfort at the base of the affected finger or thumb, along with potential pain in the palm. Swelling and the presence of a small lump in the area may also occur. Affected individuals often struggle to bend or straighten their fingers or thumb, which may catch or become stuck during movement. Symptoms may worsen in the morning or after periods of inactivity, but movement can often help loosen the fingers or thumb. Severe cases may lead to fingers or thumbs becoming completely immobile.
Diagnosis
A doctor can diagnose Trigger Finger or Trigger Thumb through a physical examination of the hand. They will inquire about symptoms and pain levels, checking for any clicking or popping sounds during movement and assessing any limitations in motion. A locked finger or thumb is a key indicator for diagnosis.
Treatment
For mild cases, rest and pain relief are often sufficient to alleviate symptoms. A doctor may recommend using a splint for support and healing. Over-the-counter pain medications can help reduce discomfort and swelling. In some instances, a physician may opt to inject an anti-inflammatory cortisone medication directly into the affected area.
Surgery
Surgery may be considered when other treatments fail or if the finger or thumb remains bent. There are several surgical options available, which your doctor will help you evaluate. One outpatient procedure involves numbing the area and making a small incision on the palm side of the hand to open the tendon sheath, creating a larger tunnel for the tendons. Another option can be performed in a doctor's office, where the sheath can be opened with a needle, also facilitating smoother tendon movement.
Recovery
Recovery times can vary based on the severity of the condition and the surgical approach taken. Your doctor will provide guidance on what to expect post-surgery. Most individuals can start moving their fingers or thumb right after the procedure. While some may experience temporary discomfort or swelling, most achieve full recovery within weeks. In certain cases, hand therapy may be necessary to restore movement.
