What is a trigger finger?
The trigger finger is a very common condition. It begins with painful discomfort in the palm during flexion and extension of a finger. Typically finger extension occurs abruptly. The diagnosis is obvious .
The discomfort is usually greater in the morning.
At a later stage, it may become necessary to use the other hand to extend the blocked finger. The passage is often very painful; the finger is sometimes completely blocked in flexion.
What is the origin of the trigger finger?
Understanding the origin of the trigger finger needs some anatomical knowledge. Finger flexion is activated by muscles located in the forearm. These muscles terminate as tendons that cross the palm and end at the fingertips. Contraction of the muscles in the forearm pulls the tendons and flexes the fingers. If you look at your hand, you will notice that when you bend your fingers, there is no bow stringing of the flexor tendons. This is because the tendons are maintained against the phalanges by a “pulley reflection ” system. This system of tendon and pulley is extremely adjusted and just a little thickening of the tendon may cause a triggering effect. This is what happens in a trigger finger: The tendon thickens locally and passes with difficulty under the pulley at the base of the finger.
What causes thickening of the tendon?
The thickening of the tendon most often occurs without any specific cause. Sometimes there seems to be a relationship with a repetitive manual gesture, but this is not always the case. Most often it is a chronic inflammation, which sets a vicious circle: the friction of the tendon worsens the thickening of the tendon, increasing friction.
Who is affected?
Everyone can have a trigger finger, even babies, but middle-aged women are most often affected. Diabetes is a risk factor for trigger finger.
How to treat it?
The diagnosis is made by clinical examination and usually no further examination is required. X-Rays, Ultra sound or MRI should not be prescribed in a typical clinical presentation.
Several treatments are available:
Rest: for mild and moderate cases, putting the finger at rest may be enough to relieve symptoms. Resting is avoiding manual and repetitive work and generally, anything that reproduces the triggering or the pain. A splint may be used for temporary immobilisation.
Steroid injection: Steroids are anti-inflammatory drugs that reduce local inflammation and thus deflate tendon thickening. The onset of action of an injection is usually delayed for a few days. Definitive healing may be obtained following a single injection.
Surgery: Surgery should be considered if other treatments are ineffective. The pulley release is usually performed under local anaesthesia as a day case procedure. The surgical procedure is to release the pulley at the base of the finger to facilitate the passage of the tendon. After surgery, there is no splint or rehabilitation; a simple bandage is kept for a few days. Daily activities are possible immediately. Recovery is generally complete within three to six weeks.
An informed consent form will be given before surgery. We hope to inform you as objectively as possible the principles of intervention, but also the risk of complications.