Trigger Finger – What is it?
Trigger finger (also known as stenosing tenosynovitis) is probably the most common condition I see in my clinic. If your fingers “clicks” or gets stuck in the bent position, it is most likely a trigger finger. Most patients believe this clicking and sticking are related to arthritis, but this is generally not the case. Much as a fishing pole has eyelets that help hold the fishing line next to the fishing pole as it bends, your finger has pulleys that help to hold your tendon (which is responsible for bending your finger) next to your bone as you bend your finger. If one of these pulleys gets inflamed, the tendon can get stuck in the pulley and the finger will click and get stuck as it moves in and out of the inflamed pulley.
How did this happen?
The short answer is that we don’t know. Trigger finger is a little more common in diabetics and in people with inflammatory arthritis, but for the most part we don’t know why people develop a trigger finger. Because your hands swell a little at night, triggering tends to be a bit worse first thing in the morning.
What can I do for my trigger finger?
First of all, no damage is being done, so no treatment is absolutely necessary. Wearing a splint at night to keep the finger straight, taking anti-inflammatory medications (such as Advil or Aleve), and avoiding activities which cause triggering is the first line of treatment. However, by the time most patients make it to my office they are ready to get rid of the triggering and are looking for relief. For most patients we recommend a cortisone injection. While a little uncomfortable, these injections will cure the majority of patients (67-90% depending on the study). Sometimes a 2nd (and rarely a 3rd) injection will be recommended. If 2-3 injections fail to relieve the triggering, some patients will request a surgical release of the inflamed pulley. Luckily, the majority of patients can be treated without an operation.
What is the new treatment?
Surgery is still the gold standard for treatment of trigger finger that does not respond to cortisone injections. This generally involves a trip to the operating room for a short 5-10 minutes, low risk operation. However, for some patients, an in-office treatment under a local anesthetic may be appropriate. This treatment uses a needle to gently release the inflamed pulley. The procedure is pain free after the initial injection of local anesthetic and usually takes about 10-15 minutes total (mostly setup time but may require a dedicated appointment). Also, not all fingers are appropriate for the needle treatment (i.e. the thumb) and the finger must actively be triggering at the time of release so we know whether or not the treatment has worked. For some patients who fail to respond to all traditional non-operative treatments, this new minimally invasive in-office treatment may help to prevent the need for an operation.