Hand > Trigger Finger

What are the Flexor Tendons?

Flexor Tendons are strong ropes that attach the muscles in the forearm to the bones of the fingers (phalanges). When a muscle contracts it shortens which pulls on these ropes, which causes the finger to bend.

A trigger finger is an isolated flexor tendinitis. Tendinitis simply means that a portion of the tendon has become inflamed and swollen. This occurs in the entrance at the base of the finger. The swelling causes a nodule in the rope and as this rope slides back and fourth within its tunnel it catches giving a popping sensation in the finger. The most commonly affected digits are the thumb, middle and ring fingers, although it can affect any digit.

Anything that inflames and thickens the flexor tendons in your fingers can cause trigger finger. The most common cause is repeated, forceful grabbing of a racket or tool. Sports like tennis, squash, golf, and ice hockey that involve rackets, clubs, or sticks put athletes at risk for trigger finger. Heavy weight lifting and rock climbing can also damage your finger’s straightening mechanism.

Considerations

If left untreated, trigger finger usually interferes with many of the most common daily activities, like typing, cooking, and driving, and you may suffer an increasing loss of function in your finger. The tendon sheath progressively thickens, causing more pain and locking of your finger. You may be at risk of developing carpal tunnel syndrome. Trigger finger can usually be treated without surgery. Several options are available for treatment. The least invasive method is resting the tendon with activity modification and splints. This can be combined with oral anti-inflamatories. A more effective method of treatment is a local injection of a synthetic cortisone. This type of cortisone is formulated so that it does not circulate in your blood stream, in significant concentration so that systemic side effects are avoided. The medicine works locally to reduce swelling of the tendon and remain in the area for up to two months. It shrinks the nodule in the tendon and relieves the pain and catching sensation within one week after the injection. Almost everyone experiences relief after injection and this relief is permanent 80 percent of the time. If you are the 20 percent which has a recurrence after injection, a second or even third injection can be attempted but with each recurrence the likelihood that your doctor will recommend surgery will increase.

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

Your physician may ask you about when your finger pain began and whether the pain is acute or chronic. You may be asked to describe the location of the pain and whether it has been radiating to other parts of your hand. You may be asked to explain your history of other medical conditions, especially congenital finger deformities and any problems you may have had with vascular diseases or rheumatoid arthritis in your hands. The physician may ask you about other hand pain or numbness since trigger finger can frequently be associated with carpal tunnel syndrome. If you have had any prior hand or finger injuries, your physician will ask about the treatments you have tried and which have been successful.

Your physician usually examines your hand by putting direct pressure on the tendons in your knuckles to reproduce the symptoms. You may be asked to move your fingers as he touches your knuckles. Your tendons may have become thick enough for him to feel an abnormal bump.

TESTS

If you have a history of injury or arthritis, you may be given an X-ray so that the physician can evaluate the bones and joints. This diagnosis is generally made by physical exam. More complex studies such as MRI (magnetic resonance imaging) and ultrasound are generally not necessary.