Trigger finger: Causes, Diagnosis and Treatment

by Johnny Jacks

Flexor tendonitis commonly starts with a strange pain in the palm of the hand when the finger’s movement is affected. Over time, there is a popping sound of the flexor tendon when the patient straightens or bends the finger. The condition typically affects the dominant hand, with the thumb being the most commonly affected finger. Traumatic forces lead to hypertrophy and narrowing of the tendon and its sheath, causing the tendon to no longer glide smoothly within the sheath, making the hand unable to function normally.

What is Trigger Finger?

Trigger Finger, also known as Flexor Tendonitis, is a common condition that can cause significant functional impairment. It is a form of tendonitis of the finger and thumb caused by repetitive use. Patients have constriction of the flexor tendon sheath combined with hypertrophy and inflammation, causing pain, snapping, catching, and restricted motion of the affected finger. Patients may have difficulty bending or straightening the finger, needing effort to extend the finger or forcibly pull the finger out like a trigger. The condition may cause nodules on the tendon. It usually occurs in the ring finger and thumb, but can occur in any finger. It can affect anyone, but is more common in people with diabetes and women, usually occurring in the age group of 50 to 60 years.

Symptoms of Trigger Finger

Symptoms of Trigger Finger.

Symptoms of Trigger Finger

Symptoms of trigger finger may start out mild but can worsen over time. Below are the symptoms that may be experienced when you have trigger finger inflammation:

  • A popping or clicking sensation accompanied by pain when bending or straightening your finger. Pain is more severe when the finger is at rest and improves when you move it.
  • Stiffness in the finger, particularly in the morning.
  • Aching pain or swelling at the base of the affected finger or thumb. This is known as a nodule.
  • A snapping sound when you move the affected finger.
  • The affected finger locks in a bent position, even if you try to straighten it unintentionally.

Causes of Trigger Finger Inflammation

Tendons are fibrous cords that attach muscles to bones. Each tendon is surrounded by a protective sheath. Trigger finger occurs when the tendon sheath in your finger becomes irritated and inflamed. This impedes the normal gliding motion of the tendon through the sheath.

Individuals at higher risk for developing trigger finger inflammation include farmers, teachers, craftsmen, and those with diabetes, carpal tunnel syndrome, gout, or rheumatoid arthritis.

Children can also develop this condition due to improper development of the size of the flexor tendon and its sheath. Proliferation of fibroblasts leads to differences in the size of the tendon and the A1 pulley.

The cause of infection in trigger finger inflammation is secondary infection, such as in tuberculosis or Mycobacterium kansasii infection.

How is trigger finger diagnosed?

Trigger finger is diagnosed based on clinical symptoms in the affected finger:

  • The affected finger has a swollen and stiff tendon that causes pain and difficulty in movement.
  • The affected finger can be locked in a bent or straightened position and cannot be easily moved back to its normal position.
  • The affected finger may also be swollen in addition to being painful.
  • Nodules of inflamed tissue may be felt on the flexor tendon at the finger joints, and these nodules may move when the finger is bent or straightened.
  • Ultrasound using a 7.5-20 MHz transducer can show a thickened and fluid-filled inflamed tendon sheath.
  • It is important to differentiate trigger finger from other conditions such as flexor tenosynovitis, gout, and psoriatic arthritis.
How is trigger finger treated?

How is trigger finger treated?

How is trigger finger treated?

In some cases, trigger finger may resolve without treatment. However, if left untreated, the affected finger or thumb may become permanently bent, making daily activities difficult.

Initial management of trigger finger involves careful preservation and modification of activities, non-steroidal anti-inflammatory drugs to control pain, immobilization, and corticosteroid injections. Treatment of trigger finger is usually non-surgical, especially if there are no complications and symptoms have only appeared for a short period of time. If the above treatment methods fail, surgery may be indicated for patients with trigger finger.

How is trigger finger treated?

How is trigger finger treated?

Medications used in trigger finger inflammation

For patients with trigger finger (TF), medications are primarily used to reduce pain and inflammation in combination with restorative treatment. Therefore, the most common medication treatment method is to inject corticosteroids locally at the site of pain or severe inflammation and use nonsteroidal anti-inflammatory drugs (NSAIDs).

Pain relief medications used for patients with trigger finger inflammation are acetaminophen-containing drugs taken orally at a dose of 500mg per time, 2-4 times daily within 24 hours. Alternatively, patients can use some topical or systemic NSAIDs such as Diclofenac, Ketoprofen, Naproxen, Indomethacin, Celecoxib…

In contrast to the widespread systemic distribution that occurs when taking oral anti-inflammatory drugs, injecting corticosteroids locally can achieve high concentrations of anti-inflammatory agents at the site of severe pain or inflammation. A range of corticosteroid preparations is available. Usually, corticosteroids are mixed with a local anesthetic before injection. The most common corticosteroid preparations used for patients with trigger finger inflammation include Methylprednisolone, Dexamethasone, and Triamcinolone… A maximum of 3 such corticosteroid treatments should be given per year.

Hydrocortisone acetate has a rapid effect and reduces inflammation by inhibiting the movement of neutrophils and reversing increased capillary permeability. The dosage varies depending on the degree of inflammation and the size of the affected area, ranging from 5-12.5mg per injection. No more than 3 injections should be given per treatment, with each injection spaced 3-4 days apart.

Methylprednisolone acetate has a long duration of action, with a dose of 8-20mg per injection depending on the location of the inflammation, with each treatment course lasting from 3-6 months.

Dexamethasone reduces inflammation by inhibiting the movement of neutrophils and reducing capillary permeability. The dosage varies depending on the degree of inflammation and the size of the affected area…

Corticosteroids should not be injected locally for inflammation caused by infection, fungus, or if infection cannot be ruled out at the injection site or nearby.

In addition, patients with trigger finger inflammation also use slow-acting joint degeneration medications such as Glucosamine sulfate, Hyaluronic acid, and Interleukin1 inhibitors…

Surgical method for treating trigger finger

Patients with trigger finger are recommended to undergo surgery when conservative treatment fails to relieve symptoms and pain. Surgery is performed to repair constrictions and remove inflamed nodules.

After surgery, patients should engage in active range of motion exercises to recover finger function. High-dose anti-inflammatory medications are used for 2 to 3 days after surgery. On the 10th postoperative day, the wounds will be removed.

In addition, patients should avoid traumatic injuries, treat low-grade joint inflammation, gout, adhesive spondylitis, joint degeneration, diabetes, and other conditions that can cause limb deformities. Furthermore, preventive measures should be taken to avoid and treat other anomalies that may cause deviation of the affected finger.

These are basic information about trigger finger that hopefully will be useful for readers to diagnose and treat appropriately.

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