Diagnosing trigger finger is a doctor’s job and, you will need to see a doctor if you suspect that you have a trigger finger.

In a person who has trigger finger pain, one of the fingers, or even the thumb, has a tendency to be frequently stuck at an awkward bent position.

Timely intervention can help prevent greater pain and, the chances of the finger getting locked in the bent position are reduced.

 Diagnosing trigger finger at the doctor’s clinic:

 Your doctor is likely to carry out a physical examination of the affected finger and, ask you a few questions. The typical questions that a doctor diagnosing trigger finger may ask include:

* symptoms you have
* duration of the symptoms
* whether symptoms are persistent or come and go
* what makes them worse or better
* any particular time of day when the symptoms are worse or better
* any repetitive tasks performed by you
* any recent injuries to your finger or hand
* whether you are a diabetic or have a family history of diabetes

Physical examination for diagnosing trigger finger:

 Elaborate tests are usually not required for diagnosing trigger finger. During the physical examination, your doctor will check your fingers and determine the areas of pain. He or she will ask you to open and close your hand several times to detect any locking of the fingers.  Special attention will be payed to examining the joints of the fingers while examining the hands. If the trigger finger pain is very severe, the doctor may use an anesthetic first to numb the pain before carrying on with the physical check up.

Trigger finger treatment:

 After diagnosing and establishing that you are suffering from trigger finger, your doctor will specify a treatment procedure to be followed. The treatment varies according to the severity of the symptoms. For mild cases he or she may suggest splinting in which you may need to wear a splint for about six weeks to keep the finger in place and, to prevent bending.

Alternatively, you may be advised exercises for the finger. You will also be advised to avoid any repetitive movement involving your fingers.

If the case is serious, then the doctor may prescribe nonsteroidal anti-inflammatory drugs like Ibuprofen or even a steroid injection. In very severe cases where the finger is permanently locked in a bent position, you may need surgery to correct the problem.

 Apart from the above treatment procedures a few home remedies you may try out include warm water soaking of affected finger to reduce the pain. You may even massage the affected part to dull the pain. Resting the finger would help to alleviate the pain to a great extent. Visit your doctor when you suspect you may have trigger finger for timely diagnosing trigger finger condition and get it treated before the condition becomes severe.

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When is Trigger Finger Release Necessary?

Trigger Finger Release refers to the surgical procedure used to release the tendon from the tendon sheath, allowing the tendon to return to move freely again.

Trigger finger release is usually only necessary if other forms of treatment fail to resolve the problem. Surgery is a more invasive and expensive option for treatment, so it is usually only performed as a last resort when other treatments fail.

Other treatments used as primary options are:

* anti-inflammatory medications
* splinting and resting the joint. This might be necessary for several weeks.
* a single injection of cortisone into the affected tendon sheath resolves the issue permanently in more than 50% of cases.

What does Trigger Finger Release Surgery Entail?

There are two options for Trigger Finger Release surgery:

* percutaneous surgery
* open surgery .

Either option is performed at a day clinic.

The Procedure For the Percutaneous Trigger Finger Release Surgery

* You will be given a local anesthetic injection into the palm of your hand
* Your Doctor will insert a needle into the base of the affected finger, and use the needle to release
the tendon by opening up the sheath.
* A sterile dressing will be used to cover the area. It can usually be removed the next day.
The advantage of this method is that you will have no stitches.

The Procedure for the Open Surgery for Trigger Finger Release

* You will be given an injection of local anesthetic into the palm of your hand.
* Your doctor will make a small incision (less than an inch long), over the area
* He will make a slit in the tight portion of the tendon cover or sheath to release the tendon.
* He will make sure that the tendon is fully released and gliding easily in its sheath by straightening and bending the affected
joint.
* You will receive a couple of stitches to close the wound
* A sterile dressing will be applied, and you can go home.

After Trigger Finger Release Surgery

* Your hand will be numb for up to six hours after the procedure.
* You might need pain relief pills.
* Movement of the finger is encouraged to prevent the tendon getting “stuck” again and to promote
healing.
* You will be told by your Doctor to leave the dressing in place for a few days
* You might be referred for physical therapy to encourage complete recovery of movements.
* You might have difficulty straightening the last joint of the affected finger for some months, but
the problem will resolve itself with time and exercise.

Complications after Trigger Finger surgery are very rare. You might get an infection in the wound.
The area will become tender, swollen and might have a discharge. You should contact your Doctor
immediately in this case.

When your Doctor opts for Trigger Finger Release surgery, discuss the procedure and ask any questions
you might have. Make sure you understand what you need to do and what will be necessary for your full
recovery. The chances of full recovery are excellent and there should be no recurrence of the problem
after Trigger Finger Release surgery.

For additional information on trigger finger release, click on the banner below….

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Use a trigger finger splint to prevent pain!

A trigger finger splint is a great solution as it can be worn to prevent the finger from bending all the way but still allow you to use your hand.

Trigger finger splints are easy to wear and, by limiting how far the finger bends, the tendon is less likely to get caught in the pulley or sheath. Therefore, it has the chance to rest and heal.

Trigger finger splints may be worn during the day and at night as well as being used after the finger has been injected to allow the finger to rest and the injection to be fully effective.

An Oval-8 Trigger Finger Splint helps reduce triggering by limiting finger flexion.

By limiting finger motion, the tendon is less likely to get caught in the pulley and it has the chance to rest and heal.

Oval-8 splints can be worn during the day and at night. They are ideal to use after the finger has been injected with an anti-inflammatory medication. The splint allows the finger to rest and the injection to be fully effective.

Because a precise fit is required to assure optimal treatment results, a trigger finger splint is best sized by a healthcare provider or medical equipment specialist.

Trigger finger splints may be purchased from Amazon

How To Size a Trigger Finger Splint or Trigger Finger Brace With A Jewelers Ring Sizer:

While we do recommend being properly sized by a health care provider or medical supply specialist using an Oval-8 sizing set, in a pinch, Oval-8 sizes can be estimated using a jeweler’s ring gauge.
Oval-8 splint sizes are close to, but not a perfect match for, jewelry ring sizes. The difference between the full circle of a jeweler’s gauge compared to the half circle design of the Oval-8 band, can mean the difference of a half or full size.

Instruct the jeweler to fit the ring gauge around the joint where the Oval-8 splint will be worn. Do not fit the gauge where you wear a ring as this is likely to result in an incorrect size.

As each Oval-8 splints fits both a size and a size and a half, if the ring size is an 8 and a half, the Oval-8 size 8 would be theproper one to choose.

Trigger finger exercises

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Is a corticosteroid trigger finger injection an effective treatment for trigger finger ?

An injection of a steroid medication, such as cortisone, near or into the tendon sheath also can be used to reduce inflammation of the sheath. It is important to note that this treatment can be most effective if given soon after trigger finger signs and symptoms begin.

Trigger finger injections can be repeated if necessary, though repeated injections may not be as effective as the initial injection. Steroid trigger finger injections may not be as effective in people with other medical conditions, such as rheumatoid arthritis or diabetes.

Most patients will respond to the cortisone trigger finger injection. When a trigger finger persists after two injections and, is not responsive to the above treatments, surgical procedures to ultimately remove the inflamed or scarred tissue are considered.

At this time, further treatment, such as splinting, repeat corticosteroid injection (but not within a few weeks of a previous injection),  or surgical referral for severe, unresponsive cases will be considered. In addition, any complications from previous injections should be assessed.

About 50% of all trigger fingers will be completely resolved with injections, although it may take more than one.

It is not a good idea, in general, to receive more than three injections in any one location in the body, as it can cause some collagen degeneration.

Following a trigger finger injection

You can have three in each involved finger, but not more than three in any one finger. If a finger has been locked, the injection will often resolve the locking, but it probably will not be completely effective in resolving the problem, and you are more likely to proceed to the next step which is trigger finger surgery.

Following the trigger finger injection or surgery, a home exercise (stretching) program may be one component of treatment for patients.

 Of course, alternatives to trigger finger injection include splinting and modification of activity and you should try these first..

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A common ailment involving the painful triggering or locking of the thumb is that it can significantly interfere with hand function as well as the performance of other routine activities. In many cases, trigger thumb surgery may have to be performed.

How do I prepare for trigger thumb surgery?

 Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:

* You should complete any pre-operative tests that have prescribed by your doctor.

 * Definitely arrange to have a relative or friend drive you home from the hospital.

* One week before surgery you should refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs).

* Refrain from eating or drinking anything after midnight the night before surgery. 

What happens during trigger thumb surgery?

Comfortably on your back,with your hand out to the side, the procedure is then performed in an operating room. The hand is cleaned and usually draped sterilely, which prevents you from being able to see it. Typically, the surgeon will then release the band, or pulley, that is restricting the tendon. You may be asked to move the tendon during the trigger thumb surgery to make sure it has been completely released and, that the clicking and locking has been eliminated.

Here is a surgical video to help you understand what happens during trigger thumb surgery.

What happens after trigger thumb surgery?

To close the incision, two to three small sutures are used and, a sterile dressing is applied. Depending on the exact situation, the dressing will be removed by the patient five to seven days later and a  sterile bandage will be applied and changed daily by the patient.

The incision should be kept clean, dry and covered until the sutures are removed 10 to 14 days following the trigger thumb operation. During this period, motion of the thumb is encouraged, from full flexion into full extension. However, heavy gripping, pulling and pushing are discouraged. Everyday activities are allowed during this time period.

How long is the recovery period after surgery?

In general, use of the thumb is restricted from heavier activities for a period of three weeks. The incision will be tender for six to eight weeks but will improve steadily over that time. Length of recovery is dependent upon joint contractures that may have developed prior to surgery. Sometimes fairly prolonged therapy (one to two months) is required to overcome these contractures.

What is the rehab after surgery?

The day of the first post-operative visit, patients are instructed on a specific range-of-motion program. Depending on their condition, they may see a hand therapist. Five to seven days later, they are started on a scar massage program which may incorporate use of a “scar conformer” at night. The scar conformer may be made of silicone and places direct, mild pressure over the incision to help minimize scarring and maximize remodeling and healing of the tissues. If a joint contracture was present prior to surgery the patient may be given a splint to help supplement their exercise program and eliminate these contractures.

How can I manage at home during recovery from the procedure?

Immediately following surgery, daily activities are allowed. Heavier or repetitive activities are discouraged. The wound should be kept clean, dry and covered. You do not have to wear a splint and, you will be able to change your own dressing. Your doctor will advise you regarding showering.

How frequently should I schedule follow up appointments with my doctor following surgery?

The first post-operative visit will take place 10-14 days following trigger thumb surgery, and often the surgeon will see the patient one more time in another two to three weeks.

<<==Trigger Finger and Thumb Guide==<>>

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Trigger thumb is a painful condition that cause the thumb to catch or “lock” most often in a bent position.

The problem often stems from inflammation of the tendons located within a protective covering called the tendon sheath.

A doctor can usually diagnose the problem from a description of the symptoms and by examining the thumb. X-rays or other tests are not usually needed.

Trigger thumb symptoms

One of the first trigger thumb symptoms may be soreness at the base of the thumb.The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected thumb. In some cases, the thumb that is affected locks in a flexed position, or in an extended position as the condition becomes more serious.

In fact, joint contractures may eventually occur if left untreated. Usually the most severe symptoms occur when awake and when  awakening in the morning. There’s the possibility that the symptoms may improve during the day.

Trigger thumb may be caused by repetitive or forceful use of the the thumb. As an example, if you repeatedly wring a washcloth it’s known to cause the problem.

Then there are medical conditions that cause changes in tissues, such as rheumatoid arthritis and diabetes.

Prolonged, forceful grasping of power tools, may also aggravate the condition. Farmers, industrial workers and musicians who rely on their thumbs for multiple repetitive movements are among those most frequently affected.

However, in some cases, no specific cause can be found.

The majority of trigger thumb problems respond to conservative medical treatment. The first step to do is to restrict the activities that were aggravating the condition.Occasionally, your doctor will splint the affected thumb to restrict joint motion and, avoid the painful clicking and locking. Because many patients sleep with their hands tightly flexed, splinting at night to avoid tight bending of the fingers can be especially helpful.

If your trigger thumb symptoms continue, anti-inflammatory medications may be given orally or may be injected into the tendon sheath to reduce inflammation and subsequent pain, clicking and locking.

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If the trigger thumb condition doesn’t respond to conservative measures or recurs, surgery may be recommended to release the pulley and restore full movement.

 Trigger thumb surgery

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Trigger finger in children refers to a difference in which the digit, almost exclusively the thumb, locks or catches when it’s flexed and extended.

Occasionally, parents will complain that their son or daughter cannot straighten out their finger or thumb.

The thumb is the involved finger most of the time with trigger finger in children. The parents may go on to say that they can straighten the finger out but they feel a small pop when they do so.

Trigger finger is a condition which is associated mostly with adults, but occasionally a child may be born with this condition.  Often it is not noticed for some time by the parents.

When seen in infants the trigger is observed for a time.  Occasionally, trigger finger in children will correct spontaneously and no other treatment is needed.  However, if the triggering persists, then treatment is indicated to prevent joint contracture.

If the effected joint is flexed for too long then it will become stiff and not move well even if the triggering is resolved.

The treatment of trigger finger in children involves a small surgical procedure to open the pulley, allowing the tendon to slide freely through it.

Historically, this condition in children has been referred to as congenital trigger thumb. However, recent evidence indicates that it usually presents sometime after infancy; it is thus more appropriately referred to as pediatric trigger thumb.

Although present at birth, diagnosis is often not made until 4-6 months of age

Trigger finger in children prognosis:

If trigger thumb is present at birth, approximately 30 % of children will recover spontaneously in one year.
12 % of the trigger thumbs that develop at the age of six to 30 months recover in six months
However, if trigger thumb develops in a child over three years of age, it almost never improves spontaneously. Therefore, it is wise to operate as soon as acceptable at this age.

Trigger finger in children Treatment:

Surgery should be considered if not resolved by 12 months of age. Most surgical procedures for trigger thumb should be postponed until the age of 2 yrs, but should not be delayed beyond 3 yrs because of possible flexion contractures.

Trigger finger symptoms

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Trigger finger causes are not always readily apparent.

Although trigger finger causes are not always apparent, once the tendon in your finger starts getting stuck, the condition usually gets progressively worse.

This can happen in one of three ways:

The constant irritation or friction from the tendon getting stuck can cause the tendon to swell, making it harder for it to fit into the sheath. The sheath is lined with a slick coating called tenosynovium. The irritation from the tendon can cause the lining to become inflamed (swollen), making the sheath narrower. The irritation from the tendon can cause a nodule (a small growth or lump of tissue) to form in the sheath, partially blocking it.

As the cycle of irritation and inflammation repeats itself, the tendon eventually gets stuck and, the finger becomes locked in a bent position.  Sometimes, the tendon will pop free and, your finger will be able to move again, but it may become stuck in a permanently bent position.

The cause of these problems is not fully understood and, in most cases, is never known. However, there are some factors that may cause trigger finger more likely.

In many cases trigger finger causes may be the result of repeated strain of this area due to work or hobby activities. Many other hand and upper extremity problems and repetitive motion disorders have been associated with trigger finger.

Tasks that require repetitive grasping or the prolonged use of tools (scissors, screwdrivers, etc) which press firmly on the tendon sheath at the base of the finger or thumb may irritate the tendons and result in thickening of the tendons themselves or the tendon sheath. Someone may be more prone to the development of a trigger finger if they routinely grip an item such as a power tool or musical instrument for extended periods of time.

Factors of trigger finger causes include:

Some trigger finger causes are associated with medical conditions such as rheumatoid arthritis, gout and diabetes.

Local trauma to the palm/base of the finger, repeated trauma from pistol- griped power tools, or long hours grasping a steering wheel can cause triggering. Infection to the synovium causes a rounded swelling (nodule) to form in the tendon which may be a factor on occasion, but in most cases there is not a clear cause. Triggering can also be caused by a congenital defect that forms a nodule on the tendon. The condition is not usually noticeable until infants begin the use their hands. Trigger Finger may also be caused by an infection of the synovium, resulting in the scarring and formation of a nodule on the tendon. 

Trigger finger causes:

While trigger finger often has no apparent cause, the factors below may make you more likely to develop it:

It is up to six times more common in women than men.

It is more common in children under six years of age or in adults over 40, and is most common in people in their 50s or 60s.

It is more common if you have injured the base of your finger or palm.

Repetitive movement and gripping, such as using power tools at work, may be linked to trigger finger, though there is no evidence to support this.

You may be more likely to develop trigger finger if you have any of the following medical conditions:

 Diabetes: a long-term condition that is caused by too much glucose in the blood.

 Rheumatoid arthritis: a long-term condition caused by a problem with your immune system (the body’s defence system) resulting in pain and stiffness in your joints.

 Gout: a short-term condition that causes inflammation (swelling) in one or more of your joints.

 Amyloidosis: a condition where a protein called amyloid builds up in organs, such as your liver.

 Hypothyroidism: having an under active thyroid gland, so that your body does not produce enough of certain hormones.

 Congestive heart failure: when your heart is not strong enough to pump blood efficiently around your body.

 Mucopolysaccharide storage disorders: a group of rare disorders that cause progressive physical and sometimes mental disability.

 Carpal tunnel syndrome: a condition that affects the nerves in your wrist, causing pain and tingling.

 Dupuytren’s contracture: a condition that causes one or more fingers to bend into the palm of your hand.

 De Quervain’s disease: a condition affecting the tendons in your thumb, causing pain in your wrist.

Always see your GP if you notice any clicking, stiffening or pain in your fingers or thumbs.Your GP will base a diagnosis on an examination of your hands and the history of your symptoms in an attempt to establish the trigger finger causes.

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Trigger finger symptoms may progress from mild to severe and include:

• Finger stiffness, particularly in the morning
• A popping or clicking sensation as you move your finger
• Tenderness or a bump (nodule) at the base of the affected finger
• Finger catching or locking in a bent position, which suddenly pops straight
• Finger locked in a bent position, which you are unable to straighten

Your trigger finger symptoms more commonly occurs in your dominant hand, and most often affects your thumb or your middle or ring finger. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

Trigger finger symptoms develop when either the ring, middle, or index finger attempts to flex closed while gripping. Instead of a smooth, continual closure, the digit stutters, then snaps closed. The closure is frequently associated with pain at the base of the digit on the palm of the hand. Trigger finger can affect the thumb.

If your trigger finger symptoms include any stiffness or catching in a finger joint – see a doctor:

If you have any stiffness or catching in a finger joint, bring it to the attention of your doctor so that he or she may review your trigger finger symptoms and perform a physical evaluation of your hand. If your finger joint is hot and inflamed, seek immediate medical care because these signs indicate a possible infection.

How are trigger finger symptoms diagnosed ?

No X-rays or lab tests are used to diagnose trigger finger. It is generally diagnosed following a physical exam of the hand and fingers. In some cases, the affected finger may be swollen and there may be a nodule, or bump, over the joint in the palm of the hand. The finger also may be locked in a flexed (bent) position, or it may be stiff and painful.

Trigger finger treatment

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What can happen if you don’t seek  Trigger Finger Treatment ?

Unfortunately, most patients do not seek trigger finger treatment and attention for this problem until the symptoms have already progressed.

The biggest risk factor for the patient who does not seek trigger finger treatment is probably the possibility of the development of a fixed contracture, or bend, of the finger.

Often if there is severe pain and locking, a person may avoid moving the involved finger altogether. After a period of time when there is no movement at a joint, the finger can become locked in a bent or straight posture.

Simple trigger finger treatment exercises may then not be sufficient to restore movement.

Stretching, ice, and anti-inflammation treatments can be helpful. Medications that have been used include naproxen, ibuprofen, diclofenac, and others.

The most rapidly effective trigger finger treatment is a local cortisone injection around the affected tendon. Most patients will respond to the cortisone injection.  The reported success rate of this treatment with 1 injection is approximately 50% and with 2 consecutive injections 75%. When a trigger finger persists after two injections and is not responsive to the above treatments, surgical procedures to ultimately remove the inflamed or scarred tissue are considered.

A Hand Therapist may help:

A hand therapist is an occupational therapist or physical therapist who, through advanced study and experience, specializes in treating individuals with conditions affecting the hands and upper extremity. A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT).

Hand therapists may see a patient with trigger finger for conservative, or non-surgical, management or for post-surgical rehabilitation. Conservative treatment may include fabrication of a splint and instruction in appropriate exercises.Your hand therapist will also educate you regarding precautions and ways to modify everyday activities so as not to aggravate the condition.

Trigger finger treatment may also include:

Techniques to decrease inflammation including heat, cold, ultrasound, phonophoresis (the delivery of medicine into the tissue by ultrasound), or iontophoresis (the delivery of medicine into the tissue by electricity).

Your hand surgeon may also refer you to a hand therapist following surgical release. Therapy is generally initiated within the first week following surgery.Your hand therapist will address care of the wound, show you techniques to decrease swelling, and instruct you in exercises to restore full motion.

Again, your hand therapist may use forms of heat and cold to address problems of pain, stiffness, and swelling. Your therapist will provide you with ongoing education regarding functional use of the affected hand. Exercise programs are individual but several precautions are standard for treatment of trigger finger.You should avoid repetitive fisting, especially with a ball or putty. Maintaining a firm grip and exerting pressure over the palmar (palm-side) base of the finger are also discouraged as part of trigger finger treatment.

For further information on trigger finger treatment please visit: 

The Trigger Finger and Thumb Guide

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