Trigger Finger

Trigger finger also known as stenosing tenosynovitis, is a condition where there is difficulty in the free movement of the finger There occurs thickening and constriction of the sheath, i.e. the covering of the flexor tendon of the finger at the base of the finger. All this results in narrowing of the space within the sheath surrounding the tendon that affects the free movement of the tendon and there is a snap during these movements The exact cause of trigger finger is not known. It is supposed to be due to some chronic inflammation of the tendon sheath.

Clinical features: The patient complains of difficulty in bending and straightening of the finger There is pain and catching during movement of the finger. The patient notices a click as the finger is bent and active straightening is not possible. However it can be straightened passively with force and the straightening is sudden with a snap and severe pain. In short, the finger is bent and straightened with a snap like a trigger being pulled and released. In severe cases we cannot straighten the finger even with force and the finger gets locked in a bent position. In late stages we can also feel a thickening or a nodule at the base of the finger. There is tenderness, le pain on pressure of the nodule and tendon sheath Trigger finger can affect any finger including thumb However, ring finger, thumb and middle finger are more commonly involved. At times several fingers may get affected at the same time and both hands can also be involved. It occurs more often in the middle age and women are more frequently affected as compared to males. Recurrent triggering can occur in some of the patients, especially in younger ones and those with diabetes. It is also known that spontaneous resolution of the triggering without any treatment occurs in some of the patients over a period of some months or so

Risk factors: Certain factors that increase the risk of having a trigger finger are People involved in work or hobbies that require repetitive gripping actions are certainly at a higher risk of developing trigger finger ) Medical conditions Trigger finger is more common in patients with diabetes or rheumatoid arthritis i) Trigger finger can also happen after a forceful activity of the hand iv) Sex- It is more common in women, Diagnosis is made on the basis of history and clinical examination Normally x-rays or other tests are usually not needed Relevant lab tests may be done to rule out diabetes, any specific cause like rheumatoid arthritis etc.

Management

Nonsurgical - Rest to the hand and avoiding activities that worsen the problem do help in early cases. Gentle stretching exercises help in relieving stiffness and improving the movement of the finger Anti-inflammatory drugs - NSAIDS help in reducing inflammation and pain local injection of hydrocortisone mixed with a local anesthetics, carefully given into the tendon sheath and near the nodule gives relief in majority of patients by reducing inflammation and constriction. We have to be careful that the corticosteroid is not injected directly into the tendon, as this increases the risk of tendon rupture If symptoms do not resolve within a reasonable time second injection may be given,

Surgical release is done in patients that are refractory to nonsurgical treatment, when the constriction is very tight. Surgery is done when the finger is locked and is not reducible. The surgery is usually done under local anesthesia that numbs the area for surgery. We do release of the constricted sheath and it can be done by an open or percutaneous method. Surgical open release is the "gold standard" of the treatment of the trigger finger as we can very well see the surgical area and it is highly effective with low complication rates, however percutaneous release is getting popular as procedure time is shorter and recovery of function is quicker. Patients certainly get significant relief from the pain and improvement in function after the surgical release.

Infantile trigger finger: As the name suggests it occurs in infants and parents sometimes notice that the baby cannot straighten the thumb tip. Very often the condition is missed or is wrongly taken for a dislocation. On examination we find that we cannot extend- straighten the thumb tip or it may be straightened passively with some force. Good thing is that this condition resolves itself and spontaneous recovery occurs in most of the cases. It is good to wait until the child is about 3 years old and if there is no recovery, then surgical release can be done. As such parents of the affected child have to be inormed and reassured accordingly.

 (The writer is the former Vice Principal, Professor. & Head of Orthopedics’, Christian Medical College, Ludhiana, past President, North Zone Orthopedics’ Association)

DISCLAIMER:

The views expressed in the Article above are Dr M K Mam’s personal views and kashmiribhatta.in is not in any way responsible for the opinions expressed in the above article.                                                     

Courtesy: Dr M K Mam  and Koshur Samachar:   October, 2019