Anatomy:bigstock-man-with-sore-finger-31629524._01jpg

  • Each hand and wrist is made of 29 bones: 2 in the forearm, 8 in the wrist, 19 in the hand and fingers.
  • Joints allow movement where 2 or more bones connect, held together with strong bands called ligaments.
  • Cartilage covers the ends of the bones and provides a strong, smooth bearing surface.
  • Most of the muscles that stabilize and move the hand are located in the forearm, attached to the bones by long, cord-like tendons. Muscles on the back of the forearm extend (straighten) the wrist and fingers; those on the palm side cause flexion (bending).
  • The joints and tendons are lined with synovium, a thin slippery membrane that lets moving parts glide easily.
  • Bands of tissue across the back of the wrist and palm side of the fingers form sheaths to stabilize the tendons that pass under them.
  • Each hand has 3 main nerves that power the muscles and provide sensation.

What causes it?

  • Overuse, misuse or an injury can cause trigger fingers.
  • Tendonitis (aka “tenosynovitis”) occurs when friction on the tendon within the sheath causes inflammation in the synovium or fraying of the tendon, making it painful to grasp or lift anything.
  • Trigger fingers occur when an inflamed nodule on the flexor tendon of a finger or thumb gets trapped in the tendon sheath, causing it to click, lock or just hurt.
      • Trigger fingers are more common in diabetic patients.
      • You could have one trigger finger, or develop symptoms in more than one finger over time.
  • As the tendon sheath gets more inflamed, it gets more swollen and narrowed, increasing friction and locking in a vicious cycle.
  • The goal of treatment is to quiet inflammation around the tendon, restore smoothly-gliding tendons and preserve hand function.

Evaluation

  • History: What are your symptoms, any prior injury, pain patterns, activities that aggravate the problem? Is it your dominant or non-dominant hand? How does it affect your job or other important tasks? Treatments you’ve already tried, and if they helped? Your general health and medicines you take?
  • Physical Exam: How do you and your arms, wrists and hands look and move? Tenderness, swelling, deformity or discoloration in a specific structure?
  • Tests: X-rays define the bony structures and condition of the joints. You may need a consultation with a neurologist and a nerve test/electromyogram (EMG) if your hands are also numb, or other symptoms to suggest a nerve problem in addition to the tendonitis.

Treatment

  • There are different treatments available to help relieve trigger fingers. Each is designed to correct the cause: quiet inflammation around the tendons.
  • Start simple, and then add something else if needed. You can cut back when you start to feel better.
  • Exercises: keep your wrists/hands limber and move excess fluid out
      • Adjust your work area to avoid strain on your body
      • Take breaks for 1-2 minutes; get up every 30 minutes to rest, change positions and stretch
      • Roll your neck and shoulders; bend and straighten your elbows
      • Squeeze a soft rubber ball and release, 20 times, 3 times a day
      • Elevate your hands above shoulder level so swelling drains out
  • Wear a splint to support the painful finger.
      • At night so you don’t clench your fists while you sleep.
      • While doing heavy or repetitive work.
      • There are a lot of styles on the market; big drugstores and Wal-Mart have a good selection. Any one that’s comfortable and supports the painful area is a good one.
      • Buy several: one for the car, workshop, nightstand and sewing basket so it’s there when you need it.
  • Medicine:
      • Anti-inflammatory pills like Advil (ibuprofen) OR Aleve (naproxen) as needed, if you can take them.
      • Tylenol (acetaminophen) is not an anti-inflammatory, but relieves pain and does not cause stomach, kidney or blood-pressure problems.
  • Cortisone Shot: shrinks inflamed tissue that’s crowding the tendon sheath.
      • Works best if you’ve suddenly developed tendonitis from an unusually busy project.
      • Better than 50/50 chance of curing the problem.
      • You could have 1 or 2 shots in a particular tendon sheath, but if pain or locking keep coming back, you need surgery to decompress the sheath and solve the problem.
  • Surgery
      • If your pain/locking continues despite the brace and a shot, especially if you have multiple trigger fingers.
      • Outpatient, with local anesthesia; takes about 10 minutes. Some patients need sedation; many do not. We’ll talk about what’s best for you.
      • A small incision in the crease of your palm or side of your wrist divides the tendon sheath and relieves friction.
      • If you have 2 or more trigger fingers, I might recommend that we release all 5 fingers on that hand.
      • Soreness around the scar resolves in a few weeks.
      • Recurrence after surgery is rare.
      • Time out of work after surgery depends on the type of work that you do. Patients with a desk job can go back to the office within a day or so, with minimal use of the hand at first. If you have a physically heavy job, or need to use your hand for repetitive work, you could be out for up to 6 weeks. Talk to your employer about this, and ask about returning to work with restrictions for the first few weeks.

Info from AAOS: