Stenosing tenosynovitis is commonly referred to as “trigger finger”, “trigger thumb” or collectively as “trigger digit.” Our fingers bend when the tendons in our hand glide smoothly beneath a series of pulleys that hold the tendon close to the bone. This is similar to how the eyes of a fishing rod guide the line. A trigger finger occurs when either the pulley becomes to thick or the tendon is enlarged. Either condition does not allow the tendon to move easily when we attempt to bend the finger. The pulley that is affected is found in our palm just below our fingers.
There are multiple medical conditions that cause or contribute to trigger digit; these include: gout, diabetes, arthritis and thyroid disease. Benign cysts on the tendon can increase the size of the tendon and limit the ability of the tendon to pass beneath the pulley. Repeated motion of the hand and activities associated with strong gripping may lead to a trigger digit. Often no cause is identified.
A common symptom of a trigger digit is pain in the palm where the fingers meet the palm. (Fig. 1) Pressure in this area may produce pain and often a lump is felt beneath the skin. The finger might stay bent or “catch” when making a fist and a “pop” may be felt when the finger is straightened. The limited motion through the pulley might also limit the motion of the finger.
Treatment focuses on decreasing the swelling at the area where the pulley and tendon interface.
Nonsurgical treatment options include:
- Nighttime only finger splinting to keep the finger from bending and “catching”
- Massage of the pulley area with an anti-inflammatory topical medication (e.g. arnica, topricin, emu oil)
- Activity modifications
- Anti-inflammatory medications (e.g. ibuprofen, naproxen)
- Steroid injections
If nonsurgical treatments do not lessen or alleviate symptoms, surgery is a consideration. The goal of surgery is to open the roof of the pulley at the base of the finger to allow the tendon to move freely. After surgery the finger will no longer “pop” or “catch” but it may remain tender or be stiff. These are normal symptoms after surgery and should resolve after a few weeks. Occasionally hand therapy is needed to help regain motion in the finger.
BZ Phillips, MD