Trigger finger, also known as stenosing tenosynovitis, occurs when any finger, including the thumb, becomes stuck in a bent position as if holding onto a trigger. After becoming stuck, the finger may snap into a straight position as if a trigger is being released. This condition is the result of a narrowed space around the tendon caused by inflammation. The tendon cannot move as freely in the narrowed area and can become stuck. Trigger finger can recur but the condition generally corrects itself after a short while. More severe cases may become locked in the bent position and require surgery to correct it.
When the condition occurs in children as young by the time they are one year of age, the condition is known as congenital trigger finger. In these cases, the affected finger is most commonly the thumb and the condition is therefore often referred to as congenital trigger thumb.
The most common symptom of trigger finger is stiffness in the joints of the finger, especially in the morning. Other symptoms may include:
- Popping or clicking is felt when moving the finger
- Tenderness, sometimes accompanied by a lump in the palm of the hand at the base of the affected finger
- Finger is locked in a bent position and is unable to straighten
Symptoms are usually worse in the morning and after periods of inactivity. Maintaining mobility and activity in the fingers will keep them from becoming too stiff. In some cases, more than one finger may be affected.
In children with the congenital form of the condition, there is often no pain associated with the bent finger position and there is generally no history of trauma or repeated use of the joint. In about one fourth of all congenital cases, the condition occurs in both hands.
To diagnose trigger finger, a doctor will perform a physical examination and discuss the symptoms. This may include feeling for lumps in the palm, checking for how smooth mobility is in the affected finger, and looking for areas of pain. Usually a physical exam is enough to make a diagnosis, however, further tests to determine any underlying conditions, such as arthritis, may be used. This may include blood tests to look for certain indicators of underlying conditions or magnetic resonance imaging to see the structure of the finger or hand.
Depending on the severity of the condition, the condition may be treated with nonsurgical methods including anti-inflammatory medications or local injections of a steroid into the joint. Splinting the affected finger or "buddy taping" it to the finger directly next to it can allow the finger to rest and heal.
If the condition is unable to be successfully treated with nonsurgical methods and is affecting the patient’s quality of life, surgical treatments may be needed. Surgical treatment is usually an outpatient procedure that uses only local anesthetic and may be done either in the doctor’s office or in an operating room. Surgery will focus on removing or breaking up the constricting material that is causing the tendon to catch and lock in place.
For children with congenital trigger finger, the condition may spontaneously correct itself before one year of age in many cases. If the condition does not correct itself, surgery is often performed to release the finger when the child is between the ages of 1 and 3 years old.
The knowledgeable and highly trained staff at the Cedars-Sinai Department of Rheumatology and the Hand Surgery Program will work with each patient to determine the best treatment option.