Trigger finger, or stenosing tenosynovitis, occurs when the thumb or fingers experience impaired motion. This results in pain, stiffness, and a characteristic locking or catching sensation when moved. Trigger finger results from inflammation of the sheath of the finger tendon, thus impacting daily activities.

This blog post summarises the causes, symptoms, risk factors, and diagnostic tests for trigger fingers. It also provides an overview of treatment and prevention, which will help you if  you are an aspiring medical student preparing for the NEET PG exam understand the clinical picture of this disabling hand condition.

Keep reading for a detailed insight. 

What is Trigger Finger?

The development of trigger finger is characterised by inflammation and narrowing of the tendon sheath in the affected finger. The tendons travel through a covering sheath, but when it becomes thickened or inflamed, it impedes free gliding.

A persistent flexion of the finger can develop over time, requiring external effort to extend it. Although the thumb and ring finger are typically involved, any finger is susceptible. In later stages, the finger might become immobile in a bent posture.

What are the Causes of Trigger Finger?

Here’s a breakdown of the trigger finger causes:

• Repetitive Grip or Strain

Through activities such as typing, sewing, or excessive hand tool use, the tendons, resulting in the build-up of inflammation over time.

• Overuse of the Tendons

The risk of tendon sheath thickening can be elevated by jobs involving manual labour or repeated finger movements.

• Post-traumatic Inflammation

Injury to the palm or heel of the finger after direct injury could produce inflammation, local oedema, and impair tendon movement.

• Degenerative Diseases

Chronic inflammatory diseases like rheumatoid arthritis will create chronic tendon sheath inflammation and develop trigger fingers.

What are the Risk Factors of Trigger Finger?

Here are some of the common risk factors that contribute to the development of trigger finger:

• Diabetes Mellitus

Particularly in long-standing Type 1 or Type 2 diabetes, it is secondary to glycosylation of tendon tissue and a deranged healing response. 

• Rheumatoid Arthritis and Gout

They are both inflammatory diseases that may involve the sheaths and covering tissues of the tendons. 

• Hypothyroidism

Where a reduced metabolic rate can result in the deposition of mucopolysaccharides in connective tissues, inducing stiffness.

• Gender

Women are more commonly affected, especially during the postmenopausal age group, possibly secondary to hormonal effects on connective tissue.

• Age Group (40–60 Years)

This is a more common age group to see a higher incidence, perhaps due to cumulative wear and tear on tendons over the years.

• Carpal Tunnel Release Surgery

Some patients develop trigger finger postoperatively, possibly due to tendon tension and alignment changes.

What are the Symptoms of Trigger Finger?

Trigger finger symptoms vary from minor pain to intense stiffness or locking. Here are some of the significant symptoms of trigger finger:

• Popping or Clicking

Catching sensation with a snapping sound when the tendon glides over the tightened tendon sheath during movement of the finger.

• Pain or Tenderness

Movement or gripping intensifies the pain typically felt at the base of the affected thumb or finger.

• Finger Stiffness

It happens in the morning or when one is at rest, and the finger can no longer be extended or bent smoothly.

• Bump (Nodule)

A palpable nodule near the palm indicates a thickened tendon causing obstruction.

• Inability to Extend the Finger Fully Straight

The finger tends to catch or lock, and the other hand has to be used to assist in extending it fully.

• Permanent Locking

In sporadic cases, the finger can become permanently curled and will not straighten without surgery.

What is the Diagnosis of Trigger Finger?

Trigger finger is most often diagnosed with a complete physical examination by the doctor. The diagnostic process generally includes the following trigger finger tests:

• Examination of Symptoms and Hand Activities

The physician asks the patient about the development, duration, and character of stiffness, pain, or locking of the finger, activities with the hands, and whether there are repetitive activities that may provoke symptoms.

• Test for Click, Lock, or Bump over the Tendons

Palpation of the involved finger’s tendon sheath identifies tenderness or nodules, and the examiner is attuned to the clicking or locking feel on finger movement.

• Assessment of Finger Movement and Flexibility

The doctor does active and passive extension and flexion of the finger to find any restriction, catching, or pain that confirms the diagnosis.

• Imaging Studies (If Necessary)

While imaging is rarely necessary in most cases, in cases of suspicion, ultrasound or MRI (magnetic resonance imaging) may be utilised to view the thickening of the tendon sheath or rule out other causes, such as cysts or arthritis.

What are the Treatment Options for Trigger Finger?

The course of treatment varies with the intensity of the symptoms. In mild cases, simple lifestyle changes can improve them, but in serious cases, surgical or medical intervention is required. 

Here are some of the trigger finger treatment options: 

• Home Remedies and Lifestyle Changes

Resting the finger and avoiding repetitive gripping significantly helps. Warm compresses relax stiffness, and stretching gently increases tendon movement.

• Non-Surgical Medical Treatment

During the night, splinting the finger lowers tension on the tendon. Pain and swelling decrease with NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen. Corticosteroid injections reduce swelling and can provide long-lasting relief.

• Surgical Treatment

A small surgery releases the contracted tendon sheath so that it moves freely if other treatments are ineffective. Recovery is usually speedy with improved hand function.

Can Trigger Finger Be Prevented?

Although not entirely avoidable, one can largely lower their chance of getting trigger finger by following these practices:

• Preventing repetitive straining of the hands, particularly while engaging in activities that involve repetitive gripping, pinching, or bending of the fingers. All these movements result in tendon inflammation over time.

• Regular break-taking when engaging in activities that involve the hands to give tendons and tissues enough resting and recovery time, thus preventing inflammation.

• Wearing protective gloves when using hand tools or applying direct pressure or stress on the fingers can help avoid friction and possible injury.

• Successful control of underlying related medical conditions, such as diabetes or arthritis, with proper medication and lifestyle modification, can reduce inflammation and susceptibility to trigger fingers.

FAQs About Trigger Fingers

1. Is trigger finger a permanent condition?

No, not necessarily. Conservative management commonly results in improvements in mild to moderate cases. However, if left untreated, trigger finger can become permanent.

2. Can trigger finger heal on its own?

In some cases, especially when caused by temporary overuse, it may resolve on its own. However, persistent cases often need medical treatment.

3. Are steroid injections safe for the trigger finger?

Corticosteroid injections are frequently administered and typically yield positive results. However, repeated injections are not usually recommended due to potential side effects.

4. How long does it take to recover from trigger finger surgery?

Recovery can usually take a few weeks. Typically, individuals recover full finger movement in about two to six weeks following their surgical operation.

5. Is trigger finger linked to other health conditions?

Yes, a higher risk of trigger finger is observed in those people with diabetes, rheumatoid arthritis, or thyroid disorders.

Conclusion

Trigger finger is a commonly encountered condition with well-defined anatomical and pathological underpinnings. It is crucial to understand trigger finger causes, symptoms, and treatment, especially for medical students appearing for exams such as NEET PG. 

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