The bones that make up the hand and the wrist provide the body with support and flexibility in order to manipulate objects in many different ways. With the support of the ulna and radius of the forearm that support many of the hand’s muscles, the 27 bones in the hand have an incredibly precise range of motion. The hand can be considered in four segments:
- Fingers – digits that extend from the palm of the hand, making it possible to grab the smallest of objects
- Palm – the “high-five” side of the hand
- Dorsum – the back side of the hand where a web of veins is often visible
- Wrist – the point of connection between the hand and the forearm which facilitates proper motion of the hand
These four segments, along with a network of muscles, tendons, and tissues work cohesively to enable the hand to perform the most complicated activities. Unfortunately, like the rest of the body, hands and wrists are susceptible to number of different injuries and conditions.
Tendons are rope-like structures that attach muscle to bone and are covered by a thin slippery layer, called synovium. The synovium lubricates the tendons, enabling them to easily slide through a fibrous tunnel called a sheath. When muscles contract, tendons pull on bones, causing the hand to move. Flexor tendons, which are long tendons located in the forearm extend from the muscles through the wrist to the small bones in the fingers. Trigger finger is a condition that occurs when one of the fingers get stuck in a bent position due to inflammation-induced narrowing of the space within the sheath.
Signs and symptoms of trigger finger include:
- Stiffness in the finger, especially in the morning
- A popping or catching sensation in one or more fingers
- Pain when bending and straightening one or more fingers
- Inability to straighten a finger that is locked in a bent position
- A nodule/lump that is tender in the palm at the base of the affected finger(s)
Diagnosis of trigger finger is generally made entirely upon a physical examination. The physician will instruct the individual to open and close their hands, checking for areas of pain, the ease of motion and signs of locking. They may also examine the palm for any lump formations.
The treatment for trigger finger varies depending on the severity of the condition and the duration of persistent symptoms. There are a few non-operative treatment options and surgery is always the last resort.
Splint – If the symptoms are mild, the physician might recommend the use of a supportive splint to reduce discomfort and keep the affected finger in a neutral, resting position.
Medication – Pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling.
Steroid Injections – Injecting the tendon sheath with cortisone, a powerful anti-inflammatory medicine, might aide in relieving pain. However, if symptoms don’t improve after two injections, surgery might be considered. Injections may not provide permanent pain relief if the individual has had the trigger finger for a long period of time, or if they have diabetes or history of seizures.
Surgery – Surgery may be an option when conservative, non-operative treatments have been exhausted. The goal of surgery is to widen the opening of the tunnel allowing more space for the tendons to slide through the sheath. This short outpatient procedure can be performed using a “twilight sleep” technique.
Recovery after surgery depends on the severity of the trigger finger and the complexity of the procedure. Most individuals are able to move their fingers soon after the surgery despite some soreness in the fingers or the palm. Full recovery from surgery usually occurs within a few weeks, but the swelling and stiffness may take up to six months to subside. In some cases, physical therapy may be help to loosen the stiffness in the fingers.
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