Trigger Finger and Trigger Thumb
A tendon is a thick band of connective tissue connecting bone to muscle. Tendons in the forearm connect the muscles of the forearm to the end of our fingers, helping us to move them.
These tendons are held firmly in position on the bone by thin bands of connective tissue, known as tendons sheath or pulleys. When our fingers move, the tendons pass smoothly through these thin bands. Occasionally, repetitive use or disease such as rheumatoid arthritis can cause a nodule to develop on the tendon. When this thickening restricts the regular smooth movement of the tendon through the tendon sheath it is known as trigger finger (or trigger thumb).
This can be best imagined as the tendon being a bit like a rope passing through a pulley. Should a knot be tied in the rope, its passage through the pulley will not be as smooth or may be prevented entirely.
The severity of symptoms you may experience with trigger finger will depend upon a number of factors, including the location and size of the tendon nodule. Generally, the larger the nodule, the more pronounced the symptoms will be, although this is not an absolute rule.
You can have trigger finger in more than one finger, and in one hand or both. Depending on the size of the tendon nodule, you may be able to feel a hard lump when you press on the part of your finger that is painful.
Many people find that it becomes harder to bend the affected finger or thumb, often saying that it feels much stiffer than usual. It can make you feel clumsy, as you may drop things more frequently as a result of your finger(s) locking.
You may have a regular clicking and/or locking in your finger several times each day. This often happens when you have been gripping something tightly,
Sometimes the finger can only be moved back into position with the help of the other hand. When the condition is more severe, your finger may become locked in a bent position which can be quite unnerving to experience.
Trigger finger is one of those frustrating medical conditions where symptoms can vary dramatically from day to day. Some days it may be a real problem, while other days the issues are only minor. This means that sometimes when people come to see me, they won’t have any symptoms of triggering or only have very mild triggering.
The first thing I always tell people (and this is often a big relief for them to hear) is that trigger finger or trigger thumb can often be treated very effectively without the need for surgery. Although I am a hand surgeon, I only ever advise surgery when all other treatment options have been exhausted. In fact, I often advise people not to have surgery!
Most people will have gone to their GP to get some advice before coming to see me. Non-surgical treatment they may have suggested often include avoiding tight gripping and flexing the hand as much as possible (although I appreciate this is easier said than done).
A cortisone injection will alleviate symptoms in most cases, although the effects of this may wear off over time.
If you have had one or more cortisone injections and are still having symptoms of trigger finger, I would advise surgery to settle the problem. Also, when the tendon surfaces could have become damaged, surgery would be needed to prevent further deterioration.
This operation is usually done under local anaesthetic, meaning you will be awake but unable to feel anything in your hand while I operate. I will make a small cut in your palm (usually 1.5 - 2 cm) and carefully inspect the tendon to determine the extent of the problem. I’ll then split or ‘release’ the tendon sheath to enable the tendons to move freely. As you are awake, you will be able to test and confirm that the problem has been eliminated before we even stitch up the skin.
We will carry out what is known as an ‘active test’ during the operation, where I will ask you to move your finger. This helps to check that you are able to move your finger freely once more, allowing you to see the result of the operation pretty much immediately.
Your hand may be sore especially with tight gripping around 2-3 weeks after the operation, so you may need some time off work if you have a manual job. I will see you again in clinic for a check-up around 4-6 weeks after your operation.
- Dupuytren's contracture
- Finger joint replacement surgery
- Hand and lower arm arthritis treatment
- Ganglion removal (hand)
- Hand and wrist ligament reconstruction
- Carpal tunnel syndrome surgery
- Trigger finger release surgery
- Trigger finger & thumb
- De Quervain’s Tenosynovitis
- Ulnar nerve release surgery
- Wrist arthroscopy
- Tennis elbow treatment
- Golfer's elbow treatment
- Cubital tunnel syndrome treatment
- Peripheral neuropathies
- Osteoarthritis Base Thumb (CMC joint osteoarthritis)
- Wrist joint osteoarthritis