By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

“TRIGGER FINGER” MAY NEED SIMPLE TRATEMENT OR SURGERY

Question: I have a friend who has a trigger finger. Could you tell me what this really is? What causes this problem? What can he do about it?

Answer: Most people don’t notice how well their fingers work until one gets stuck in a bent position. When this happens to one of your fingers or your thumb, it is called a trigger finger. The medical term for trigger finger is stenosing tenosynovitis.

The name “trigger finger” is somewhat of a misnomer, since any digit can be involved. The term derives from the fact that attempting to straighten out an affected finger will at first put it in a bent position similar to that of a finger around a trigger. Then, when enough force is applied, the finger may suddenly straighten out with a snap. Also, when you grip an object, instead of the normal smooth motion, your finger tends to catch and then suddenly bend to the proper position.

Trigger finger is usually painful and comes on gradually. It is caused by an inflammation of a tunnel-like sheath surrounding the involved tendon. Excessive use or a natural predisposition can cause inflammation in this tunnel. This can be because the tendon thickens or the wall of the tunnel narrows. Either way, the tendon no longer glides smoothly within the sheath and is prone to “catching.” This joint locking, as I described earlier, stops the finger in a bent position before it snaps into the desired position -- either straight or closed. You may experience this catching in just one finger joint or in the entire finger.

Trigger finger can become a cyclical problem. That is, each time your digit catches it can irritate the tendon and the sheath, and they can become even more inflamed. This, in turn, makes it more likely to catch the next time and cause further inflammation. In chronic cases, scarring and thickening can produce fibrosis and bumps.

Trigger finger is more common in women than men, and certain medical conditions -- like rheumatoid arthritis, diabetes, hypothyroidism and some infections -- can increase your likelihood of developing a trigger joint.

Treatment of a trigger finger depends on the severity and duration of the problem. In a case of mild trigger finger, when symptoms are infrequent, the treatment may be rather simple. You may be instructed to decrease the use of the finger, soak it in warm water, use a finger splint while sleeping, and engage in finger exercises and massage. Using anti-inflammatory drugs like ibuprofen can help as well.

In more severe cases, more potent anti-inflammatory drugs may be used. Sometimes the tendon sheath is injected with steroids to improve the function. This can bring prompt relief. If there is no response to two steroid injections, then surgery is usually indicated to release the trigger finger and repair the tendon.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.