Definition of Stenosing tenosynovitis (Trigger finger)
In trigger finger, also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis), one of your fingers or your thumb gets stuck in a bent position and then straightens with a snap — like a trigger being pulled and released. If trigger finger is severe, your finger may become locked in a bent position.
Often painful, trigger finger is caused by a narrowing of the sheath that surrounds the tendon in the affected finger. People whose work or hobbies require repetitive gripping actions are more susceptible. Trigger finger is also more common in women and in anyone with diabetes.
Treatment of trigger finger varies depending on the severity.
Symptoms of Stenosing tenosynovitis (Trigger finger)
Signs and symptoms of trigger finger may progress from mild to severe and include:
- Finger stiffness, particularly in the morning
- A popping or clicking sensation as you move your finger
- Tenderness or a bump (nodule) at the base of the affected finger
- Finger catching or locking in a bent position, which suddenly pops straight
- Finger locked in a bent position, which you are unable to straighten
Trigger finger more commonly occurs in your dominant hand, and most often affects your thumb or your middle or ring finger. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.
Trigger finger is not the same as Dupuytren’s contracture — a condition that causes thickening and shortening of the connective tissue in the palm of the hand — though it may occur in conjunction with this disorder.
When to see a doctor
If you have any stiffness or catching in a finger joint, bring it to the attention of your doctor so that he or she may review your symptoms and perform a physical evaluation of your hand. If your finger joint is hot and inflamed, seek immediate medical care because these signs indicate a possible infection.
The cause of trigger finger is a narrowing of the sheath that surrounds the tendon in the affected finger. Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath — which, in turn, is lined with a substance called tenosynovium. The tenosynovium releases lubricating fluid that allows the tendon to glide smoothly within its protective sheath as you bend and straighten your finger — like a cord through a lubricated pipe.
But if the tenosynovium becomes inflamed frequently or for long periods, the space within the tendon sheath can become narrow and constricting. The tendon can’t glide through the sheath easily, at times catching the finger in a bent position before popping straight. With each catch, the tendon itself becomes more irritated and inflamed, worsening the problem. With prolonged inflammation, scarring and thickening (fibrosis) can occur and bumps (nodules) can form.
Factors that put you at risk of developing trigger finger include:
- Repeated gripping. If you routinely grip an item — such as a power tool or musical instrument — for extended periods of time, you may be more prone to developing a trigger finger.
- Certain health problems. You’re also at greater risk if you have certain medical conditions, including rheumatoid arthritis, diabetes, hypothyroidism, amyloidosis and certain infections, such as tuberculosis.
- Your sex. Trigger finger is more common in women.
Preparing for your appointment
You’ll probably start by seeing your family doctor or regular health care provider to determine what could be causing your symptoms.
Here’s some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance to prepare for your evaluation.
- Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of your key medical information, including any other conditions for which you’re being treated, and the names of any medications, vitamins or supplements you’re taking.
- Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.
For trigger finger, some basic questions to ask your doctor include:
- What are the possible causes of my symptoms?
- Is my condition temporary?
- Will I need treatment?
- What treatments are available?
- Do you have any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you’ve prepared, don’t hesitate to ask questions any time during your appointment if you don’t understand something.
What to expect from your doctor
Your doctor or health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over important information a second time.
Questions your doctor might ask include:
- What symptoms are you experiencing?
- How long have you been experiencing these symptoms?
- Do your symptoms seem to come and go or are they persistent?
- Does anything seem to make your symptoms better?
- Does anything seem to make your symptoms worse?
- Are your symptoms worse in the morning or at any particular time of the day?
- Do you perform repetitive tasks on the job or for hobbies?
- Have you recently experienced any injury to your hand?
Tests and diagnosis
Diagnosis of trigger finger doesn’t require any elaborate testing. Your doctor or health care provider makes the diagnosis based on your medical history and a physical exam. During the physical exam, your doctor will ask you to open and close your hand, checking for areas of pain, smoothness of motion and evidence of locking. Rarely, your doctor may inject a numbing medication (local anesthetic) to reduce pain so that he or she can proceed with the physical exam of your fingers and hand.
Treatments and drugs
Trigger finger treatment varies depending on its severity and duration.
Treatment of mild cases
For mild or infrequent symptoms, these approaches may be effective:
- Splinting. Your doctor may have you wear a splint to keep the affected finger in an extended position for up to six weeks. The splint helps to rest the joint. Splinting also helps prevent you from curling your fingers into a fist while sleeping, which can make it painful to move your fingers in the morning.
- Finger exercises. Your doctor may also suggest that you perform gentle exercises with the affected finger. This can help you maintain mobility in your finger.
- Avoiding repetitive gripping. For at least three to four weeks, avoid activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating hand-held machinery.
Treatment of serious cases
For more-serious symptoms, your doctor may recommend other approaches, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as nonsteroidal anti-inflammatory drugs — ibuprofen (Advil, Motrin, others), for example — may relieve the swelling constricting the tendon sheath and trapping the tendon. These medications can also relieve the pain associated with trigger finger.
- Steroids. An injection of a steroid medication, such as a glucocorticoid, near or into the tendon sheath also can be used to reduce inflammation of the sheath. This treatment is most effective if given soon after signs and symptoms begin. Injections can be repeated if necessary, though repeated injections may not be as effective as the initial injection. Steroid injections may not be as effective in people with other medical conditions, such as rheumatoid arthritis or diabetes.
- Percutaneous trigger finger release. In this procedure, which is performed with local anesthesia, doctors use a needle to release the locked finger. This procedure is most effective for the index, middle and ring fingers.
- Surgery. Though less common than other treatments, surgical release of the tendon may be necessary for troublesome locking that doesn’t respond to other treatments.
Lifestyle and home remedies
Certain self-care measures may alleviate trigger finger symptoms:
- Rest. Your stiff finger may relax somewhat if you rest your hand for four to six weeks. To prevent the overuse of your affected finger, you may need to change your routine to minimize repeated gripping actions.
- Soaking in warm water. Placing your affected hand in warm water, especially in the morning, may reduce the severity of the catching sensation during the day. If this helps, you can repeat the soaking several times throughout the day.
- Massage. Massaging your affected fingers may feel good and help relieve your pain, but it won’t affect the inflammation.