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Trigger finger


Trigger finger or trigger thumb are common problems affecting the hand. The technical name for the condition is stenosing tenovaginitis but it is a lot easier to say 'trigger finger'! It is totally a benign problem and whilst it can be associted with some generalised conditions, it is extremely rare for it to be a presenting symptom. It is seen in young children, almost never in teenagers and then throughout adulthood, even into the 90s.

trigger finger

The cause of the condition is not fully understood and yet we know the mechanics. Occasionally it is associated with tenosynovitis. The tendons to the fingers and the thumb pass through a series of small tunnels, starting in the palm and extending up to their insertions into the finger bones. These tunnels are referred to as pulleys and they work by holding the tendon in place and giving it a smooth tunnel to glide in. A tightening or constriction occurs in the first puley and this seems to cause a nodule on the tendon which then catches, a bit like a thread bunching up as you are trying to pull it through the eye of a needle.

Symptoms include pain (sometimes out of proportion to what can be seen or felt in the hand) and a catching or locking of the digit in flexion.

In babies it may not be immediately obvious especially if it is the thumb. When it is noticed, it is usually by the fact that the thumb will not straighten out properly and there is a lump at the base of the thumb on the palmar aspect. It does not need immediate treatment as in a proportion of cases it will spontaneously resolve. The only effective treatment in children is surgery and as this would have to be performed under a general anaesthetic, CP does not believe it is worth taking the risk until the child is considerably older (around 4 to 5 years).

In adults there are a number of treatment options

  • Do nothing, if the symptoms are very mild and not functionally interfering.
  • Nocturnal splint for those cases where symptoms only occur at night or first thing in the morning.
  • Cortisone injection - the mainstay of treatment with a success rate of around 75% (when given by me).
  • Surgical release - the definitive solution but it is an operation and there are always small risks and inconveniences.

  • Surgery

    The operation is performed as a daycase under local anaesthesia. The incision is not much more than one centimetre in length in the palm as shown. Performing the operation under local anaesthesia is important as it allows active assessment that the triggering has been cured as after releasing the tendon you will be asked to make a fist to prove that there is no more triggering. Usually only one or two stitches are needed and the hand is bandaged with a non-waterproof dressing and a bulky bandage. This should stay on for 48 hours after which it can be removed and a waterproof dressing of your choice applied. During that first 48 hours driving is not recommend as you are probably not safe (See Driving in General Advice). Then it is a matter of using the hand sensibly whilst the hand heals. Dissolvable stiches are used so nothing needs to be removed. It is common for the scar area to be a little thickened and sensitive to begin with but it usually settles within a month. Gentle massage can help settle it down.

    Further information can be obtained at the following links:

  • British Society for Surgery of the Hand
  • American Society for Surgery of the Hand