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Trigger Finger (Stenosis of Tenosynovitis)

The condition in which the fingers get stuck in a bent position and cause pain in the fingers is called trigger finger. When you make a fist and try to open your hand the finger gets stuck in a bent position and it is difficult to straighten it.
Trigger finger is one of the common problems within the scope of hand surgery.

How does Trigger Finger Occur?

The formation mechanism of trigger finger is still not fully known; however, the course of the disease is well-known. The tendons bending the fingers pass through the special pulleys in the palm. The thickening and narrowing of these pulleys or local thickening of the tendon lead to this disorder. The tendon gets stuck in the pulley and then the finger gets stuck in a bent position. The tendon stuck in the narrowed sheath is released by force, and then the finger pops straight. Using the finger after the beginning of this problem usually leads the structures there to swell more. And consequently, cause the condition to get worse. Sometimes the finger gets completely stuck and locked in the bent position.

What is the age range of Trigger Finger?

It can be seen in different age groups. Usually, its cause cannot be determined, but in adults, it can be associated with the characteristics way of using the finger and certain systemic diseases (Rheumatoid arthritis, gout, diabetes, and disorders that require dialysis).

How Can We Realize that We have a Trigger Finger Problem? 

First, suspicious pain begins in the palm or the base of the thumb. As its typical symptom, the finger gets stuck in a bent position when it is attempted to be opened; and when more power is exerted, the finger pops straight with a sound of “click”, it is triggered. The tendons become considerably soft when sleeping at night. The fingers are in the normal position; they are in the semi-bent position. In the course of time, the finger begins to get stuck in a bent position in the morning but it returns to normal after a while. With time  these sticking problems could become more obvious and painful.

Can’t it be Diagnosed with X-Ray? 

X-ray has no place in the diagnosis of this disorder. Your doctor examines the finger and detects the swelling, masses, and nodules that can be felt by hand. If it is not treated, it may even lead to tendon ruptures.

How to Treat Trigger Finger?

The treatment is intended to reduce the swelling and allow the tendons to move smoother.

Treatment in Acute Period 

Medications such as Aspirin or ibuprofen are given for eliminating the swelling, and finger splints are formed for enabling the finger to rest. This is suitable for sudden cases.

Treatment in Subacute Period 

At this stage (3 weeks to 3 months) usually certain complaints about pain and stiffens felt in the morning are reported but the finger may begin to get stuck in a bent position much later. If the complaints do not regress, local cortisone injection is performed in the thickened area of the tendon. The relaxation provided by this treatment varies from person to person, and takes a few weeks to a few months. However, steroid is not commonly used due to it long-term harms to the other structures. A temporary relief can be obtained with this application. But a permanent treatment cannot be given with local injections.

Treatment in Chronic Period 

In cases where no response can be achieved despite long-term (more than 3 months) medical treatments (due to diabetes, rheumatic diseases, conditions requiring dialysis, chronic cases), the pulley system that causes the jam should be surgically slackened. The treatment is intended to eliminate the discomfort felt during the movement, by preventing the finger from getting stuck in there.

How is Trigger Finger Surgery Done? 

* Closed (percutaneous) Technique 

Percutaneous surgical technique is a procedure that can be preferred in the treatment of trigger finger because it is fast and provides an efficient and easy relaxation and it has a low risk of complication. The intervention is made without tourniquet under local anesthesia. A local anesthetic substance is applied to the incision area by means of an insulin syringe. The pulleys are loosened by using the suitable needle. In all patients, the finger is controlled during the surgery to see if the function after the loosening process. The hand is wrapped in soft bandage, and after its removal, full movement of the finger is started. Theoretically, percutaneous surgery is considered to have a high risk of nerve damage.

* Open Technique 

The surgery is done under local anesthesia, through a small incision made in the palm. During the surgery, it is important to protect the blood vessels and neural structures close to the tendon sheath. The tunnel, in which the tendon gets stuck, is widened through a 1-2 cm incision made in the area of the disorder. A single suture is applied to the incision site, and then it is wrapped in a soft bandage. Patients can easily move their fingers after this surgical intervention.