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Home Health Trigger finger – what’s the catch?
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Trigger finger – what’s the catch?
Written by Ken Chisholm, RN; BS; CNOR; CRNFA; OPA   
Thursday, 04 June 2009 13:46

I received a semi-panic-stricken phone call from a friend one morning not too long ago. She was upset about awakening to find that her left ring finger was “stuck” in a bent position and she couldn’t straighten it. She didn’t know how it got that way and didn’t remember injuring it in any way in the recent past. She also complained of pain in the knuckle joint that was bent.

“What’s going on?” she asked. “What’s happening to my finger?”

The condition that this person was so concerned about is call “trigger finger.” This condition can affect any of the fingers, including the thumb. The surprising thing is; the “problem” really doesn’t involve the finger at all.

The main trouble with this condition lies in the portion of the hand where the flexor tendons, those that cause the segments of the finger to bend, pass through a tunnel-type affair known as a “pulley.” This pulley serves as a control mechanism, or bridge, for tendons that pass over the metacarpo-phalangeal joint (where the finger meets the hand), on the palm side of the hand.

 For any number of reasons, these tendons can become inflamed and ultimately swollen, forming a small “nodule” on the portion that “slides” through the pulley. This area of enlargement now becomes the source of “catching” on either side of the pulley. Consequently, the finger can become stuck in the bent or flexed position, or there can be a lot of difficulty in bending the joint beyond the nodular area. The nodular area can also be quite sore to the touch or with any pressure applied to it. Many people have reported waking up in the morning to a stuck finger, and not being aware of what happened while they are sleeping.

As was mentioned in the beginning, many people complain of the knuckle hurting when the finger is stuck, which can be a combination of prolonged pressure on the joint cartilage while stuck in the flexed position and radiant pain from the real problem area in the hand.

So, now that it’s “stuck,” what can be done about it?

In some instances, if the problem is detected early, treatment can include one or two cortisone injections into the area of inflammation over time, and occasionally this can be curative. For the most part, however, people typically seek treatment when the finger(s) catch regularly. Care must be taken to limit the number of cortisone injections, because the steroid itself can ultimately have negative effects on the tendon by weakening the tissue, setting the table for possible tendon rupture.

Surgical intervention becomes necessary if lesser treatment options fail, or if the catching is severe enough to make surgery the first line of treatment. The procedure is normally known as a trigger finger release.

The procedure is relatively minor, as procedures go, and is typically performed as an outpatient. Anesthetic choices include a general anesthetic (going to sleep), or a “regional” block, where the affected arm is made numb for the procedure and the patient receives intravenous sedation.

Anesthesia is usually preferred over a “local” because of the need to use a pneumatic “tourniquet” which is similar to a blood pressure cuff in that it is inflated just before the procedure to a pressure level sufficient to occlude the blood supply to the arm and hand. The tourniquet remains inflated for the duration of the procedure, which is typically between 15-30 minutes. The pressure from the tourniquet can be quite painful under local anesthetics.

The incision is usually very small, and only a few sutures are necessary. The wound is kept clean and dry for 10-14 days until the sutures are removed. Activity is usually allowed “as tolerated” by then.

If you suffer from this annoying condition, don’t get “caught.” Call your doctor.
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care.

 
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