Trigger Finger / Trigger Thumb.

Trigger finger or trigger thumb, is a condition affecting the normal movement of the finger causing it to "jam"  in a flexed (bent) position and then "snap" or "click" open when trying to straighten it. This is usually painful.

Anatomy.

The tendons that pull on and move the fingers are held in place on the  bones by loops of tissue called pulleys.  These pulleys form a series of  tunnels which hold the tendons onto the surface of  the finger bones.   To keep the tendons lubricated in these tunnels they are covered in a  slippery covering called the synovium.

Causes.

Triggering occurs when a nodule forms on the surface of the otherwise smooth tendon.  There are a number of conditions which can cause  swelling of the tendons or the formation of nodules. These include:

• Rheumatoid arthritis.
• Partial tendon lacerations.
• Repetitive trauma or injury.
• Or simply wear and tear or ageing of the tendon.

Triggering in young children can also be caused by a congenital abnormality which forms a nodule  in the tendon.

Symptoms.

The symptoms of trigger finger or thumb are those of pain  and a  clicking when trying to straighten or bend the finger  or thumb. This is often painful, the pain is often referred to  the knuckle of the finger.  Tenderness can also occur over the  area of the nodule at the base of the finger in the palm. The  clicking feeling occurs when the nodule clicks back and forth under the first pulley of the finger.

If the nodule becomes too large it may  become stuck and the finger is then jammed in a bent position  and may need to be forced straight by the other hand.

Diagnosis.

The diagnosis of trigger finger and thumb is usually made on the history of the condition and the  clinical examination. One can often feel a click over the first pulley as the nodule in the tendon  passes below it. No x-rays or other tests are needed to make the diagnosis.

Treatment.

Definitive treatment is usually surgical.  A cortisone (steroid) injection into the sheath may decrease  the inflammation and shrink the nodule to relieve the triggering, but its effect is only temporary. Oral anti-inflammatory tablets may also give temporary relief but ultimately surgery is required to split the pulley and allow the nodule and the tendon to glide beneath it.

This is usually day-case surgery. A small cut is made in the palm of the hand and the pulley released under direct division. The tendon is then inspected and the pulley left open to heal in the enlarged  state so that the triggering is relieved.

After Surgery.

Once you have recovered from the anaesthetic you will be allowed home. You should have someone available to bring you home after the surgery as you will not be able to safely drive yourself.

You will have a bulky dressing on you hand which you will be able to remove in 2 days, but you  should leave the smaller dressing underneath intact if possible. If necessary, however, this too can  be changed after a few days and should be replaced by a similar dressing.

You will need to keep the hand clean and dry.

You are encouraged to start moving the finger as soon after the operation as possible, even with the dressings intact.

Sutures will usually be removed in 10 to 14 days.

If you develop any increasing pain, swelling, heat or redness in the wound, you should have it  reviewed by you GP as soon as possible.

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The information on these pages is presented as a rough guide to help you understand your condition better. The information is in no way intended to be a comprehensive coverage of the subject. As all patients and their conditions are different, the treatment may vary from time to time. All patients are encouraged to take steps to ensure that they are as well educated about their conditions as possible. Other sources of information inc

Philip Allen Orthopaedic
P PO Box 1089, Coolangatta, QLD, 4225, Australia
T +61 7 55980977  F +61 7 55980016 E allen@bonedoctor.com.au
www.bonedoctor.com.au