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“I am the Walrus” by the Beatles
Carpal tunnel syndrome is the most common hand condition that hand surgeons treat, but a problem known as the “trigger finger” probably runs a close second. The trigger finger is a condition where the tendons that bend the finger get stuck. The finger can bend down (this is called flexion) but when you try and straighten the finger up the finger has to be pushed up, sometimes with a pop or catch. The problem occurs because the tendon which bends the finger runs through a sheath which begins in the base of the hand. Usually the tendon or it’s lining gets thick and that causes the tendon to get stuck. In some people the sheath gets too thick, which cause the sheath to be too narrow to allow the tendon to glide. In some people both things probably occur. Since the tendon is actually getting stuck in the palm of the hand, this is the area that is usually the most tender. However the joint that gets stuck is the first joint of the finger known as the proximal interphalangeal joint. Sometimes it takes some time to convince people that the tendon is actually catching in their hand and that’s there’s nothing actually wrong with the joint.
Trigger fingers can occur in almost any age group, but the highest incidence is seen in middle aged women who are usually otherwise healthy. Plenty of men get trigger fingers as well, but women have the problem 2-3 times more frequently. Sometimes more than one finger may catch, and it can occur in both hands. For some reason I often see patients who get the same trigger finger in both hands and I really have no explanation for that. Other patients will have swelling in their finger and tenderness over their tendon sheath without actually locking. This is probably the same problem as the trigger finger but in an earlier stage.
Trigger fingers can be seen in patients who have carpal tunnel syndrome as well. Patients who are predisposed to have carpal tunnel syndrome, such as patients with diabetes and thyroid disease, also seem to have an increased incidence of trigger finger. The thumb is the most common digit to trigger although any finger may develop trigger finger.
Most people try some form of non-surgical treatment for this problem. Sometimes the problem just goes away. If the finger is still locking after 4 to 6 weeks then it probably won’t get better on it’s own. I’ve had patients try splinting their finger out straight to keep it from bending, especially when they sleep since the trigger seems to be worse in the morning. Medicines such as NSAID’s (advil and aleve) don’t seem to have much affect on the problem. If the triggering is causing problems such as pain or is interfering with activities, then most of my patients try at least one cortisone shot. The shot is placed into the tendon sheath and seems to both shrink the tendon and enlarge the pulley to allow the tendon to glide without catching. Although the results are variable I think that usually at least 65-70% of patients will have their trigger finger go away with a single injection. A second injection can be done if the first one wears off but any further injections don’t seem to do much good. The injections hurt for a short period of time and can sometimes cause the finger to temporarily go numb because of the local anesthetic that is injected along with the cortisone, but other than that it is very rare to have any complications from the injections. Patients with diabetes have to keep a close eye on their blood sugar because the cortisone can send the levels of pretty high for several days in some patients.
If the shots don’t work then surgery is an effective way of getting rid of the problem. The surgery can be done with a local anesthetic or with sedation, and consists of making a small incision over the sheath where the tendon is catching. A small portion of the sheath is then opened to allow the tendon to glide. If there is a lot of swollen tissue around the tendon this can be removed at surgery as well. The whole procedure usually only takes about 5 minutes. The biggest risks of surgery are for the finger to re-lock or for an infection to recur, and fortunately both of those complications are rare.
If the trigger finger is only an annoyance nothing has to be done. No damage will occur from leaving the problem untreated. If you are having problems then a cortisone shot will often relieve the problem, and if that doesn’t work a simple surgery can often take care of the problem once and for all.