A common condition affecting the hand, trigger finger, formally known as stenosing tenosynovitis, can make it difficult to bend or straighten a finger or thumb. It can impact any digit, though it frequently occurs in the ring finger or thumb.
Understanding Trigger Finger
Trigger finger develops when irritation causes swelling or thickening in the tendons of the fingers or their protective sheaths. Tendons are strong, cord-like tissues connecting muscles to bones, enabling movement. Each tendon is surrounded by a sheath, which helps it slide smoothly as the finger bends and straightens.
When inflammation occurs, the tendon or its sheath can swell, making it difficult for the tendon to glide freely. Sometimes, a small lump, or nodule, can form on the tendon, further obstructing its movement. This interference causes the characteristic “catching” or “locking” sensation. The finger might get stuck in a bent position, sometimes requiring the other hand to straighten it. Symptoms often include pain at the base of the affected finger or thumb, particularly when gripping, and stiffness, especially in the morning.
The Likelihood of Self-Resolution
Trigger finger can resolve on its own, but this is often unlikely, especially in more severe or long-standing cases. Mild instances might improve with rest or by avoiding aggravating activities. If symptoms persist or worsen, medical evaluation is recommended.
Factors influencing self-resolution include symptom severity and duration. Conditions like diabetes and rheumatoid arthritis can reduce the chances of spontaneous improvement. In children, trigger finger is uncommon and often resolves by age three without specific treatment. For adults, waiting for the condition to resolve without intervention may lead to increased pain and stiffness, making daily tasks more challenging.
Non-Surgical Management
When trigger finger does not resolve spontaneously, several non-surgical approaches can help manage symptoms and promote healing. Rest and activity modification are common recommendations, involving avoiding repetitive gripping or activities that worsen the condition to allow the tendon to heal. Splinting, particularly a metacarpophalangeal (MCP) joint blocking splint, can immobilize the affected finger in a straightened position to prevent irritation and reduce inflammation. Wearing a splint, especially at night, can alleviate morning stiffness.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, help reduce pain and inflammation. Corticosteroid injections, delivered directly into the tendon sheath, are a frequently used treatment option. These injections reduce inflammation around the tendon, allowing it to glide more freely. Corticosteroid injections are effective for 50% to 70% of individuals, though effectiveness may be lower in those with underlying conditions like diabetes.
Physical therapy exercises, such as tendon gliding and finger stretches, can improve mobility and strengthen muscles around the tendons.
Surgical Interventions
If non-surgical treatments do not provide adequate relief, or if symptoms are severe and persistent, surgical intervention may be considered. This is an option when the finger remains locked, pain is significant, or conservative methods have failed over several months. The most common surgical procedure is a trigger finger release, also known as A1 pulley release.
During the surgery, a small incision is made in the palm at the base of the affected finger. The surgeon cuts through the tightened portion of the tendon sheath (the A1 pulley) to create more space. This allows the tendon to glide without catching or locking. Recovery involves soreness and swelling for a few days, with initial difficulty moving the finger. Full movement usually improves within a few weeks, though mild stiffness and swelling can persist for up to six months.