Trigger Finger (Stenosing Tenosynovitis)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Symptoms of Rheumatoid Arthritis

What is trigger finger?

Trigger finger is a "snapping" or "locking" condition of any of the digits of the hand when opened or closed. Trigger finger is medically termed stenosing tenosynovitis.

What causes trigger finger?

Trigger finger is caused by local swelling from inflammation or scarring of the tendon sheath around the flexor tendons. These are tendons that normally pull the affected digit inward toward the palm (flexion).

What are risk factors for trigger finger?

Usually, trigger finger occurs as an isolated condition because of repetitive trauma. Activities such as gardening, pruning, and clipping, etc., are risk factors for trigger finger. Sometimes, trigger finger is an associated condition resulting from an underlying illness that causes inflammation of tissues of the hand, such as rheumatoid arthritis. In fact, data presented at the 2005 American College of Rheumatology national meeting suggested that a majority of patients with rheumatoid arthritis have inflammation around the tendons of the palm of the hand that could develop into trigger finger.

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Trigger Finger Treatment

Cortisone Injection

Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis of the hip, knee, elbow, or shoulder), a tendon (tendinitis such as tennis elbow), and a joint (arthritis). Knee osteoarthritis, hip bursitis, painful foot conditions such as plantar fasciitis, rotator cuff tendinitis, frozen shoulder, and many other conditions may be treated with cortisone injections. Certain skin disorders, such as alopecia (a specific type of hair loss), can be treated with cortisone injections.

What are symptoms of trigger finger?

Symptoms of trigger finger may occur when any of the four fingers of the hand attempts to flex closed while gripping. Instead of a smooth, continual closure, the digit hesitates, then snaps closed (causing a "trigger" affect). When attempting to extend the digit, a similar hesitation may occur before it "snaps" into full extension. In severe cases, the digits must be manually brought into full extension or flexion. The closure is frequently associated with pain at the base of the digit on the palm of the hand. Triggering can also affect the thumb.

What specialties of doctors diagnose and treat trigger finger?

Trigger finger is commonly diagnosed and treated by primary-care doctors, including general practitioners, family medicine physicians, and internists. Specialists who treat trigger finger include orthopedic surgeons, sports-medicine doctors, plastic surgeons, hand surgeons, and rheumatologists. Occupational therapists and physical therapists can be involved in the care of patients with trigger finger.

How do health-care professionals diagnose trigger finger?

Health-care professionals diagnose trigger finger based on the history of "snapping" sensation that the patient experiences, as well as noting in the examination that there is tenderness and nodular irregularity of the involved flexor tendon in the palm of the hand.

What is the treatment for trigger finger?

Stretching, ice, and anti-inflammation treatments can be helpful. Oral anti-inflammatory medications that may be helpful include naproxen (Aleve), ibuprofen (Motrin, Advil), diclofenac (Voltaren, Cataflam, Cambia), and others.

The quickest and most effective treatment is a local cortisone injection into the tendon sheath around the affected tendon. Most patients will respond positively to the cortisone injection, but this may only be a temporary response. When a trigger finger persists after two injections and is not responsive to the above treatments, surgical procedures to release the tendon sheath and/or remove the inflamed or scarred tissue are considered. Surgical intervention is usually a permanent cure for this condition.

Are there home remedies for trigger finger?

Trigger finger can initially be treated at home with remedies including cold packs, resting, and over-the-counter medications, such as ibuprofen and naproxen. Massaging the involved area of the palm gently followed by cold pack application can be helpful. Care must be taken to avoid reinjuring the strained tendon in the palm.

What is the prognosis of trigger finger?

The prognosis of trigger finger is excellent. Nearly all patients recover completely when cortisone injections are given. Sometimes repeat injections are necessary. Only rarely is surgery required.

Is it possible to prevent trigger finger?

Trigger finger can be prevented by avoiding activities that strain the finger flexor tendons in the palms of the hands.

REFERENCE:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders, 2013.

Last Editorial Review: 8/10/2016

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Reviewed on 8/10/2016
References
REFERENCE:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders, 2013.

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